Community health assessment. The first step in community health planning

Hospitals face a paradigm shift: from planning service delivery to population-based community health planning. Comprehensive community health planning is a two-step process: assessment and action, in that order. Assessment identifies community problems and resources; action follows planning, which determines which of those problems should be addressed with which resources. This paper provides an overview of the community assessment process. The first challenge in launching a community health initiative is to identify and recruit partners drawn from the ranks of prominent community organizations, such as school boards, public health agencies, and elected officials. The best enlistment strategies are those that empower persons outside the hospital to take visible control. Defining the community is the first step in analyzing the community. It is important that everyone involved in the assessment process agree on the definition, which should take in those characteristics that make the community unique, including its social systems, environmental factors, and demographics. The next step in the process is developing a community health profile, a set of key community indicators or measures that will help you set priorities, document successes and failures, and monitor trends. There are a number of models available to consult in developing indicators, whether traditional, medically oriented determinants of health or broader parameters, such as housing and public safety. Criteria for selecting indicators include validity, stability and reliability, and responsiveness. Most indicators will be developed using secondary, or already existing, sources of data, such as census data, Medicare and Medicaid files, police records, and hospital admission and exit records. Conducting the community assessment involves putting together a list of problems to be solved and a list of available resources, both of which can be compiled using the same four-step process of gathering and analyzing data: obtaining community input, identifying problems already being addressed, consulting with professional experts, and analyzing existing data. Demographics are one way of analyzing data; another is using a "community scoreboard" that groups causal factors into four categories: lifestyle, environment, human biology, and health services. Once the community assessment is complete, planning and implementation of programs can begin. At the same time, it is essential to mobilize the community to support your initiative. Again, you must look beyond the hospital walls to build a constituency for change, to community leaders in education, employment, transportation and recreation, housing, and the physical environment, as well as health education and preventive services.(ABSTRACT TRUNCATED AT 400 WORDS)