key elements of a community health assessment

CDC is not responsible for the content of materials not generated by CDC. In contrast, independent evaluation can yield unbiased insights about an HIA from the perspectives of stakeholders and decision-makers, can contribute to a more robust external peer review, and can provide rich information regarding the strengths, weaknesses, and most effective methods and approaches in the field. Simply producing and disseminating a report may not be sufficient to secure adoption and implementation of HIA recommendations. Other groups have developed standard approaches to promote and evaluate practice quality, including the quality of analysis (see, for example, Fredsgaard et al. Available studies suggest that efforts to involve and inform decision- makers throughout the HIA process and a strong relationship between the HIA team and decision-makers are often critical for the HIAs effectiveness (Veerman et al. The programs and policies, however, may not provide any guidance on how health should be considered (see, for example, Pub. The process of describing pre-existing health issues, health disparities, and influences on health may also begin during scoping, although the full characterization of baseline health status generally takes place during assessment. Self-evaluation should be considered a valuable step of the HIA process. Lester C, Hayes S, Griffiths S, Lowe G, Hopkins S. Implementing a strategy to address health inequalities: A health authority approach. The discussion described pathways by which Iupiat health was likely to be affected. Articles in Google Scholar by Kaye Bender, PhD, RN, FAAN In some cases, recommendations are developed by a decision-maker in response to an HIA report (Quigley et al. The key findings are provided in the opening section of the report, and they are categorized according to the strength of the evidence as highly likely, likely but less well-supported by the available evidence, and plausible, but not well-supported. For example, according to the report, a requirement for paid sick days is highly likely to lead to more workers taking leave to recuperate from an illness, to receive preventive care, or to care for ill children and dependents. It is not reasonable to expect decision-makers to adopt HIA widely in the absence of evidence of its effectiveness and value. There are, however, no current examples of HIAs in the United States that include outcome evaluation as described here. It is also useful to assess the political context of the proposal to be assessed and consider, for example, the major political drivers of the proposal, the arguments made by political supporters and those opposed to the proposal, and any economic or technical constraints that limit the alternatives that can be considered. MeSH Physical activity associated with changes in pedestrian infrastructure. To provide this care as a community health nurse, you need to continually acquire knowledge, refine skills, and assess yourself. The committee is not endorsing the HIAs or the recommendations, but simply providing examples. In practice, not all HIAs have conducted systematic literature reviews or documented review methods. The committee emphasizes that the effectiveness of recommendations depends not only on the scientific validity of the interventions identified but on their relevance to the affected communitys concerns and their applicability within the regulatory or legislative framework of the proposal being considered. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Chapter 2 established the rationale for examining the potential effects of decisions on health and health disparities and highlighted health impact assessment (HIA) as a potential tool for assessing the health implications of various decisions. As in the realm of health risk assessment, there remains a need to distinguish between the assessment and management phases to avoid manipulation of analytic components by decision-makers. Before In most cases, influencing decisions to protect or promote health is a central objective but by no means the sole outcome of value. Another categorization is based on the breadth of the HIA and distinguishes HIAs that have a tight focussuch as ones that use a narrow definition of health and emphasize quantification from HIAs that have a broader, holistic focus shaped by the social determinants of health (Kemm 2001). Throughout the document recommendations and thoughts from community members' . Open communication is necessary to build trust and ensure mutual objectives. The assessment also highlighted several potential benefits, such as funding for infrastructure and health care; increased employment and income; and continued funding of existing infrastructure (BLM 2007, p. 500). Although less common to date, HIAs are also sometimes conducted by a decision-making agency, such as a metropolitan planning organization or a federal agency complying with NEPA. 2006). Why Complete an Assessment and Improvement Plan? There are six elements that make up a health assessment. Although completed HIA reports are readily available, peer-reviewed or gray literature that discusses the impacts of specific HIAs is still rare. Given the breadth of decisions that are likely to warrant consideration, the approach taken will vary on the basis of who is initiating the HIA, the capacity and authority of the agency or entity undertaking it, and the objectives for contemplating an HIA. An evaluation report should be produced at the conclusion of the HIA that includes the following: Few HIA evaluation data have been published in the United States and relatively few elsewhere. CHA/CHIP trainings and tools - NACCHO A related issue is incomplete disclosuresuch as disclosure of only summary information without data or analysis, disclosure only by electronic media in communities unlikely to have access, and English-only reports. A Guide to Health Impact Assessments in the Oil and Gas Industry. 2007; ICMM 2010). 2006). Catholic Healthcare West Guidelines for Community Health Assessment This document is meant to help CHW hospitals identify and evaluate community health issues, and capacities for dealing with them. An evaluation plan should have been developed early in the HIA process to guide selection of the appropriate methods for conducting evaluations. Mindell J, Biddulph J, Taylor L, Lock K, Boaz A, Joffe M, Curtis S. Improving the use of evidence in health impact assessment. The degree to which they are systematic varies, and some authors have suggested frameworks and guidance for conducting systematic reviews (Mindell et al. Cole BL, Fielding JE. Bookshelf 2006) as a technical definition of HIA: HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of the effects within the population. HIAs conducted as part of a formal government process are generally subject to disclosure and freedom-of-information requirements. The committee concludes that the following are the most important factors to consider in determining whether to do an HIA: Ultimately, the HIA report should provide a rational and consistent explanation of how proposals are selected for screening. As described by Ross (2007, p. 9), the Atlanta BeltLine is a transit, trails, parks, and redevelopment project that uses a 22-mile loop of largely abandoned freight rail line that lies between two and four miles (more). The committee notes that each approach for gathering and interpreting data may be conducted in ways that are more or less participatory, engaging stakeholders in shaping the research questions, interpreting the findings, and developing recommendations on the basis of the findings. Paper No. 2005; PHAC 2005; Harris et al. Petticrew M, Cummins S, Sparks L, Findlay A. Validating health impact assessment: Prediction is difficult (especially about the future). On the basis of the findings, the HIA recommended a series of public-health mitigation measures that were selected to maximize any favorable impacts and to minimize harms. It also shows how HIA results can be disseminated widely in different formats through a number of channels. In some cases, the HIA process allows a period for formal public comment on a draft of the HIA report. HIA is meant to assist decision-makers, so although the act of reporting is a formal step in the HIA process, it is also in the interest of decision-makers and the HIA team to keep in constant communication throughout the HIA process so that emerging results can be incorporated into the policy, plan, program, or project. 2009; Bhatia et al. National Research Council (US) Committee on Health Impact Assessment. Scholars point to a remarkable consistency in the basic elements that are generally included in descriptions of HIA (Mindell et al. It should define the vision for the health of the community through a collaborative process and should address the gamut of strengths, weaknesses, challenges, and opportunities that exist in the community to improve the health status of that community. Impact evaluation can also help to determine an HIAs effectiveness relative to the objectives set out during screening and scoping. HIAs in the private sector are increasingly common, pursuant to internal corporate guidelines or requirements of lending banks, such as the International Finance Corporation and World Bank (see Appendix A for further discussion) (Birley 2005; IPIECA/OGP 2005; McHugh et al 2006; ICMM 2010; IFC 2007, 2010).3 Few, however, are made public. Assessment and Plans - Community Health Assessment - STLT Gateway - CDC 2 Setting priorities considers pathways that appear most important from a public-health perspective and considers issues that have been raised prominently by stakeholders. In the absence of mandates or formal procedures, topics for screening are often chosen on the basis of the interests of a group wishing to use HIA as opposed to a structured, strategic selection process. The opportunity to bring health information into a decision-making process that may otherwise not include this information. Decision-making is rarely based solely on scientific evidence but instead takes into account an array of political, economic, technical, and practical considerations. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. The health effects that are included, the data sources and methods that are used, and the recommendations that are made are therefore determined by the HIA practitioners rather than according to a legal or regulatory standard (Wernham 2011). Turnock B. Impact evaluation attempts to judge whether the HIA influenced the decision- making process, that is, whether and to what degree the recommendations were adopted and implemented and how the HIA influenced the decision-making process. Ensuring that the public has accurate and complete information on adverse and beneficial effects. The HIA team needed an authoritative description on which to base its assessment. The process may include identifying communities and geographic regions; demographic, economic, racial, and ethnic groups; and vulnerable populations, such as children, elderly people, disabled people, low-income people, racial and ethnic minorities, and people who have pre-existing health conditions. Identification of the population and vulnerable groupssuch as children, the elderly, racial or ethnic minorities, low-income people, and communities that are likely to be affected. Final Supplemental Environmental Impact Statement. A community health assessment (sometimes called a CHA), also known as community health needs assessment (sometimes called a CHNA), refers to a state, tribal, local, or territorial health assessment that identifies key health needs and issues through systematic, comprehensive data collection and analysis. Moreover, disease rates in small populations can vary substantially, and it may not be possible to calculate them reliably. The Importance of Common Metrics for Community, Social - Health Leads Those pathways and others were evaluated by using public-health data, literature on analogous populations, knowledge about accepted mechanisms of health and disease, witness testimony, and the effects analysis of other resources. That description is consistent with the earlier characterizations of HIA as a combination of procedures, methods, and tools (WHO 1999; Quigley et al. Adopting a position for or against a proposal (for example, support for or opposition to a legislative proposal). Outcome evaluation should be undertaken when available resources and data will allow reasonable judgments regarding the association between the implementation of decisions and observed changes in health outcomes or health determinants. Health-supportive measures that would generally support health but are not tied directly to a specific impact (for example, building a clinic in an underserved neighborhood that would be adversely affected by emissions from a new freeway). World Bank. It solicits and responds to input from stakeholders throughout all stages of the process and includes publicly available and accessible documentation of processes, products, and sponsors. It is important for nonprofit hospitals to be knowledgeable about the Internal Revenue Services regulations for CHNAs. Characteristics unique to the affected community may not be obvious to HIA practitioners who are outside the community. Improving relationships and collaboration between stakeholders. In some cases, collaboration between a health department and other agencies has resulted in the identification of appropriate proposals for screening. Monitoring and evaluation are often, although variably, described as the final stage of HIA (see Appendix E). If it is not possible to undertake complete, systematic literature reviews for an effect analyzed in an HIA, HIA practitioners must be vigilant to avoid selective searching and consideration of only studies that confirm particular conclusions (Mindell et al. Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. Catholic Health Association, Guide to Assessing and Addressing Community Health Needs [PDF-1.5MB], June 2013. Furthermore, some policies may focus on determinants of healthfor example, economic development, transportation, or housingrather than explicitly mentioning health. The final draft responds to public comments and incorporates necessary changes or new information. This list can then be used to set priorities. EPA (U.S. Environmental Protection Agency). The committee notes that a variety of qualitative and quantitative approaches are often used to generate predictions, but regardless of the methods used, most available guidance emphasizes the importance of considering diverse forms of evidence, a consistent and unbiased approach to selecting and interpreting evidence, and a clear and transparent description of the analytic approach (WHO 1999; Mindell et al. The baseline profile characterizes the health status of affected populations and includes trends and factors (social, economic, and environmental) known to affect health. 3, Elements of a Health Impact Assessment. For private corporations undertaking an HIA, the decision of whether to make an HIA public and what to disclose may be governed by internal corporate policies, by the standards of lenders supporting the project, or by a government that has jurisdiction over the project (McHugh et al. In this report, HIA practitioner refers to the person (or people) involved in conducting an HIA. Across the field, there is little uniformity in the content of written HIA reports. It can also include information from social-science and epidemiologic studies regarding the strength of associations between the social and physical environment (such as air and water quality and economic impacts) and health outcomesinformation essential in the quantitative prediction of health effects. Vol. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. An official website of the United States government. The reader will notice that some of the committees descriptions and characterizations overlap with those of other guides; the similarities highlight the consistencies in the field. The assessment phase includes two tasks. 3, Elements of a Health Impact Assessment, Improving Health in the United States: The Role of Health Impact Assessment. That definition reflects the committees finding that the involvement of stakeholdersalthough the approaches used vary from little or no involvement to robust engagement and participation at every stephas consistently been described as a core element of HIA practice and should be considered essential to it. This step suggests a modified version of CDC's evaluation guidelines, and may be used as a starting point to tailor an evaluation for a particular community health improvement effort, at . Davenport C, Mathers J, Parry J. Because it will often not be practical or possible to address all direct and indirect health effects that appear theoretically possible, it is important to select issues carefully. A lack of access to needed goods and services. Framework for Environmental Health Risk Management Final Report. While CHNAs are a recent requirement, community health assessments (CHAs) have long been used as a tool by hospitals, public health departments and other social service agencies to identify key community health concerns. Minimum Elements and Practice Standards for Health Impact Assessment (HIA), Version 2. Under NEPA, a federal agency must determine whether a federal environmental decision is likely to have significant effects, and if so, the level of analysis required (40 C.F.R. For example, desktop HIAs may consider indirect stakeholder input through review of public comments submitted outside the HIA process, comprehensive HIAs may have relatively little stakeholder engagement, and rapid-appraisal HIAs of smaller-scale proposals may involve collection of some new data to inform the analysis. 2005; Frank et al. A description of the research questions, data sources, methods to be used, and any alternatives to be assessed. Instead, the committee focused its review on the characterization of effects and the use of evidence, although several recommendations to improve the quality of analysis are discussed in Chapter 4. Experimental evidence of welfare reform impact on clinical anxiety and depression levels among poor women. government site. Red Dog Mine Extension Aqqaluk Project. Using Community Health Assessments to Understand the Social Even when there is substantial uncertainty, an assessment can illuminate potential causal pathways thateven when there appear to be conflicting influences on a specific outcomecan point the way toward a flexible framework for monitoring and managing any impacts that might occur as the proposal is implemented. For those reasons, the committee concludes that HIAs including, to the extent practical, the data used for the analysis, analytic methods, assumptions, findings, uncertainties, data gaps, and recommendations should be made public. It was not possible to derive mortality rates for demographic subgroups. 8600 Rockville Pike Understanding Risk: Informing Decisions in a Democratic Society. Calculations were conducted to develop a vulnerability score. The early and central role of stakeholder identification and participation is analogous to the guidance provided in the report published by the Presidential/Congressional Commission on Risk Assessment and Risk Management (1997). Catholic Health Association of the United States. Northeast National Petroleum Reserve-Alaska, Supplemental Integrated Activity Plan, Record of Decision. FOIA A well-designed dissemination strategy is critical for the success of an HIA. That issue will probably continue to challenge the credibility of HIA practice in the eyes of some audiences and highlights the need for continued research and refinement of methods to improve its value to decision- makers (Petticrew et al. Box 3-6 shows how the results of an HIA of proposals to provide paid sick days to employees were presented clearly in a report with appropriate acknowledgement of the strengths and weaknesses of the evidence. Association for Community Health Improvement. A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health. Having transparency throughout the process and clearly delineating the roles and responsibilities among various parties will help to limit real and perceived bias. 98224-MS. SPE International Health, Safety & Environment Conference; 24 April 2006; Abu Dhabi, UAE. The committee notes three considerations that may be particularly important for producing effective, actionable recommendations. I and III, Breaking the Cycle, East London and the City Health Action Zone and Queen Mary. All information these cookies collect is aggregated and therefore anonymous. Finally, effects that are plausible but are not supported by available evidence include fewer hospitalizations because workers are able to receive the preventive primary care needed to maintain good health. Issues surrounding uncertainty, literature review, and reliability and validity of predictions are discussed in greater depth in Chapter 4. Indicators may be health outcomes in some cases, whereas health determinants may be more appropriate in others. Recommendations are often developed throughout the HIA process. Acknowledgments A community health assessment gives organizations comprehensive information about the community's current health status, needs, and issues. 3Elements of a Health Impact Assessment Chapter 2established the rationale for examining the potential effects of decisions on health and health disparities and highlighted health impact assessment (HIA) as a potential tool for assessing the health implications of various decisions. Rethinking human health impact assessment. SFCC (Federation of Swedish County Councils). The second task is to analyze and characterize effects on health and its determinants for the proposal and for any alternatives under consideration relative to the baseline and to each other. By examining the various components of the different assessment and planning models, we are able to identify areas for coordination, ways to maximize collaboration, and strategies to further improve community health. Community Health Assessment and Improvement Planning - NACCHO With clear language in mind, partners should come to agreement on the In general, the baseline profile focuses on health issues and health determinants that may be affected by the proposal rather than on attempting to provide a complete assessment of community health. It was concluded during the screening phase that an HIA would add value to project outcomes. Washington (DC): National Academies Press (US); 2011. An explicit statement of data sources, methods, assumptions, and uncertainty is essential, but uncertainty does not negate the value of the information. Potential health effects have been estimated by using established approaches for quantitative analysis, such as the calculation of the fraction of disease rates in a population that can be attributed to the risk being analyzed and the application of available exposure-response functions to quantify cancer risk associated with incremental changes in exposure to carcinogens. A screening recommendationfor example, no further action required; no HIA, but health advice and input to be offered in an alternative way; or proceed with HIA. Atlanta BeltLine Redevelopment Plan. Public concern or controversy regarding health effects of the proposed decision. The bulleted list below provides examples in which some health impacts or behavioral outcomes have been quantified. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. They expressed interest in developing The Crossings in a way that will address local community needs for affordable housing and for other community assets that are safe, healthy, and supportive (p. Intro-1). 2005; Bhatia and Seto 2011). The Public Health Accreditation board defines community health assessment as a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. Scoping identifies those likely to be affected by the proposed policy, project, program, or plan. Assessment: Northeast National Petroleum Reserve-Alaska. The bulleted list below provides examples in which some health impacts or behavioral outcomes have been quantified. In other cases, all proposals in selected agencies or sectors have been screened by local governments (SFCC 1998; Lester et al. However, where practical, the HIA team should aim to evaluate a variety of alternatives or, minimally, to identify the characteristics of proposed actions that would be health-protective or detrimental to health. Guidance Note 4. It should also identify the points at which there is an opportunity for information from the HIA to influence decisions. Cookies used to make website functionality more relevant to you. Findings of each stage of the HIA and a summary of outputs at the end of each stage. Furthermore, impact assessments, including HIAs, may rely on proprietary business information whose disclosure is legally barred or could damage a proponents business edge or competitiveness. This is the key link between a health profile and a health plan. A description of the proposed policy, program, plan, or project that will be the focus of the HIA, including the timeline for the decision and intervention points at which HIA information will be used. It is important to note that a matrix does not explain how evidence was used to reach conclusions. The choice of what to evaluate will reflect the specific social, political, and policy context of the decision; the needs, interests, and questions of stakeholders and decision-makers; and the health status of the affected population. Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. The fact, however, that the team conducting the HIA is aware of the decision context allows the assessment to be decision-relevant. The process mirrors the one set out by NEPA for an environmental impact statement, but the practice is far more variable for HIA. The committees may be convened for several purposes, including providing technical guidance or peer review, ensuring adequate and fair representation of diverse interests and priorities among stakeholders, communicating the results of the HIA to decision-makers, and developing recommendations that address community needs and are compatible with the specific legal requirements of the decision- making process. Key elements of the model include: Disseminating surveys Conducting key informant interviews and focus groups Incorporating county-level data on health Small rural hospitals may lack the required resources to successfully address issues that may be identified as a result of a CHNA. The process of implementing recommendations should be transparent and should include opportunities for public participation in the decision process and clear mechanisms of accountability. As discussed in this chapter, HIAs have been used for a wide variety of applications and at all levels of government (local, state, tribal, and federal) and have been conducted with varied resources over different schedules. Management of the health effects of a proposal as it moves from planning into implementation should be a dynamic process in which monitoring results may drive continued adaptation of the health-management plan. Lifetime Effects: The High/Scope Perry Preschool Study through Age 40. Cancer risk and changes in life expectancy associated with tobacco taxes.

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