Introduction to Public Health September 17, 2001

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Introduction to Public HealthSeptember 17, 2001

• Community Assessment
• Elizabeth Eustis Turf, Ph.D.
• Survey and Evaluation Research Lab
• Ph.D. in Public Policy and Administration
• (Health Policy Concentration)
• eturf_at_mail1.vcu.edu

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Communities

• Of geography, such as a group of Census tracts,
  or a county or city
• Of individuals with shared characteristics, such
  as demographic and/or other personal
  characteristics
• Of affiliation, such as faith communities

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Critical Concepts

• Community health is profoundly affected by the
  collective behaviors, attitudes, and beliefs of
  everyone who lives in/belongs to the community.
• Partnerships are effective tools for improving
  health in communities.

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Core Issues and Challenges

• Definition of community members -- who is in the
  community?
• Feasible methods of gathering needed information
  about them.
• Effective methods for involving community members
  in assessment and interpretation.
• Goal Trustworthy understanding of
  characteristics and needs.

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Characteristics

• Routinely gathered data can sometimes give
  characteristics of community
• Census data - demographics, housing, income
• Vital statistics - births and deaths
• Notifiable disease surveillance data
• Health care access - offices, hospitals, clinics
• Labor statistics

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Needs

• Compile characteristics to identify gaps
• Lots of pertussis cases -- more immunization
• Few primary care docs -- better access needed
• High infant mortality -- more pre-natal care
• Determine knowledge level of community
• Identify communities perceived needs
• Violence
• Infrastructure

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Needs

• Often necessary to obtain information from people
  in community
• Determine knowledge about disease and prevention
• Determine habits regarding prevention
• Determine community attitudes

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Results

• Results of assessment define future goals
• Results define policy
• Policies should be data driven to target deficits
• Goals
• to improve health of community
• to improve knowledge and self-responsibility
  about disease

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Healthy People Movement

• 1979 The Surgeon Generals Report on Health
  Promotion and Disease Prevention
• 1980 Promoting Health/Preventing Disease
• HP2000 National Health Promotion and Disease
  Prevention Objectives

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Healthy People 2010

• Overarching purpose promoting health and
  preventing illness, disability, and premature
  death
• ... grounded in science, built through public
  consensus, and designed to measure progress

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Healthy People 2010

• Healthy People 2010 challenges individuals,
  communities, and professionals indeed, all of
  us to take specific steps to ensure that good
  health, as well as long life, are enjoyed by all.

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Healthy People 2010

• http//www.health.gov/healthypeople/
• Public health personnel worked together
• DHHS / CDC / Medical students, residents, etc
• Identified 10 Health Indicators to measure
  publics health
• 467 objectives in
• 28 focus areas to monitor improvements

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HP2010 Introduction, Dr. Shalala

• The 20th century brought remarkable and
  unprecedented improvements in the lives of the
  people of the United States. We saw the infant
  mortality rate plummet and life expectancy
  increase by 30 years. While we recognize that
  most of the advances came from prevention
  efforts, we also saw almost unimaginable
  improvements in medical technologies and health
  care.

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HP2010 Introduction, cont.

• The challenge for the 21st century is twofold.
  First, we must ensure that this rate of
  advancement continues unabated. Second, we must
  make certain that all Americans benefit from
  advancements in quality of life, regardless of
  their age, race, ethnicity, gender, sexual
  orientation, disability status, income,
  educational level, or geographic location. These
  challenges are substantial, but with the
  objectives defined by Healthy People 2010, they
  are achievable.

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Goals

• Goal 1 Increase Quality and Years of Healthy
  Life
• help individuals of all ages increase life
  expectancy and improve their quality of life.
• Goal 2 Eliminate Health Disparities
• eliminate health disparities among segments of
  the population, including differences that occur
  by age, gender, race or ethnicity, education or
  income, disability, geographic location, or
  sexual orientation.

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HP2010 Perspective

• increase life expectancy and quality of life
  over the next 10 years by helping individuals
  gain the knowledge, motivation, and opportunities
  they need to make informed decisions about their
  health

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HP2010 Perspective

• encourage local and state health leaders to
  develop community-wide and statewide efforts that
  promote healthy behaviors, create healthy
  environments, and increase access to high-quality
  health care.

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Subgroups of Concern for Eliminating Disparities

• Differences that occur by.
• age, gender
• race, ethnicity
• sexual orientation
• disability
• education, income
• living in rural localities

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10 Leading Health Indicators

• Physical activity
• Overweight and obesity
• Tobacco use
• Substance abuse
• Responsible sexual behavior

• Mental health
• Injury and violence
• Environmental quality (social)
• Immunization
• Access to health care

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10 Leading Health Indicators

• major public health concerns
• motivate action
• data available to measure their progress
• relevant as broad public health issues
• specific objectives track progress

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Major HP2010 Data Sources

• National Health Interview Survey (NHIS)
• National Health and Nutrition Examination Survey
  (NHANES)
• National Vital Statistics System - Mortality
  (NVSS-M)
• School Health Policies and Programs Study (SHPPS)
• National Survey of Family Growth
• National Vital Statistics System - Natality
  (NVSS-N)
• National Hospital Discharge Survey
• National Household Survey on Drug Abuse (NHDA)
• National Profile of Local Health Departments
  (NPLHD)
• Behavioral Risk Factor Surveillance System
  (BRFSS)
• HIV/AIDS Case Surveillance System
• Youth Risk Behavior Surveillance System (YRBSS)
• Medical Expenditure Panel Survey (MEPS)

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Physical Activity

• Objectives
• 22-7. - Increase adolescents involvement ...
• 22-2 - Increase adults.
• Health Impact of Physical Activity
• Populations With Low Rates of Physical Activity
• Other Issues, such as major barriers

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Focus Areas

• Access to quality health services
• Arthritis, osteoporosis, and chronic back
  conditions
• Cancer
• Chronic kidney disease
• Diabetes

• Disability and secondary conditions
• Educational and community-based programs
• Environmental health
• Family planning
• Food safety
• Health communication

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Focus Areas

• Heart disease and stroke
• HIV
• Immunization and infectious diseases
• Injury and violence prevention
• Maternal, infant, and child health

• Medical product safety
• Mental health and mental disorders
• Nutrition and overweight
• Occupational safety and health
• Oral health

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Focus Areas

• Physical activity and fitness
• Public health infrastructure
• Respiratory diseases
• Sexually transmitted diseases

• Substance abuse
• Tobacco use
• Vision and hearing

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Public Health Infrastructure

• Imperative that health agencies have the
  infrastructure to provide essential public health
  services effectively, including
• Data and information systems
• Workforce
• Public health organizations
• Resources
• Prevention research

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Essential Public Health Services

• Monitor heath status
• Diagnose and investigate
• Inform, educate, and empower
• Mobilize community partnerships
• Develop policies and plans
• Enforce laws and regulations
• Link people to personal health services
• Assure a competent health care workforce
• Evaluate effectiveness, accessibility, and
  quality
• Research for new insights and solutions

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Limitations of Current System forHP2010
Community Assessment

• Disparities populations .
• are not always easy to find
• are sometimes difficult to define (and therefore
  to count)
• may be poorly understood by the system
• may have low political/social priority
• may even be considered less valuable or otherwise
  inconvenient

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Indicator --- Responsible Sexual Behavior

• Associated objectives relate to HIV
• HIV-specific focus area has a goal of
• Prevent human immunodeficiency virus (HIV)
  infection and its related illness and death.
• What is needed to achieve that?

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HIV Needs Assessment

• Whats the question?
• Whats the community of concern?
• On a scale of 1 - 10.
• How complete are available data?
• How difficult to obtain currently unavailable
  data?
• Which sampling strategies are most effective?

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HIV Needs Assessment

• How to determine the distribution of identified
  cases in a geographic area defined by Census
  tracts?
• HARS - Surveillance data
• Difficulty 1-2, depending on time of year and
  subject to limitations of case finding
• Additional data not needed

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How to capture reliable data on HIV risks from
Latino male workers?

• No existing federal data system contains directly
  relevant data.
• Many actually non-residents
• Successful example Latino rural mens study
• Difficulty of additional data collection 5
• Strategies cooperation from worksite and
  community gatekeepers

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How to determine the HIV risks and prevention
needs of Caucasian, African American, and Latino
men who have sex with men?

• No existing federal data system will do this.
• Successful example Virginia MSM Survey
• Difficulty of additional data collection 8
• Strategies set up field study, with regional
  managers and gatekeepers from all three
  race/ethnic groups careful translation of
  concepts.

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How to assess the feasibility of engaging faith
communities in HIV prevention and care?

• No existing federal data system contains relevant
  data.
• Successful Example Clergy Survey of
  Predominantly White Congregations and African
  American Faith Initiative Eastern Virginia Pilot
  Study
• Strategies listed samples (difficulty 2)
  multi-stage targeted recruitment (difficulty7)

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Conclusions

• Current public health data systems are inadequate
  for comprehensive community assessment.
• There is a disconnect between HP2010 goals and
  readiness of public health infrastructure to
  fully respond.
• Additional assessment methods must be carefully
  chosen to fit the community of interest and
  challenges it presents.
• Effective participation by community of interest
  is critical.