The history and evolution of assessing community health for the purpose of planning programs and services goes to the very root of public health. At least 4,000 years ago there is evidence of communities designed to facilitate the disposal of sewage and waste.1 Although we lack actual documentation, it can be safely assumed that there was an assessment or identification of the problem of accumulating sewage that led to plans to remedy that situation.
Prior to the 1960's community assessments were largely based studying morbidity, mortality and demographic characteristics to identify patterns of distribution of disease. In the 1970's and 1980's the recognition of risk factors and the development of risk factor assessments, added an important dimension to community assessments. The adoption in 1986 of the Ottawa Charter recognized the importance of identifying social and ecological determinants of health and a movement towards the new public health, focusing on health promotion and prevention.2 In the late 1980's and early 1990's functional health status assessment measures and later health-related quality of life measures were developed and incorporated into more sophisticated community health status assessment efforts. Social capital and factors related to health disparities were included in assessments from the mid-1990's on.3 (The article in this issue by Felix and Burdine on developing community health status assessments during this period sheds some additional light on this evolutionary process.)
The formalization of the three core functions in 1988 and further development of the ten essential public health services in 1994 cemented assessment as a foundational component of public health.4 In the 1990's and 2000's, the role of community grew exponentially with the acceptance of the social ecological model.5 Foundation and government collaborative programs like the Turning Point Initiative and the Community Health Status Indicators (CHSI) project developed infrastructure to support community health improvement programs based on assessment.6 Technological developments and the Internet have continued to improve access to data through other initiatives like the County Health Rankings and Policy Map, among others.7,8 While most health professionals recognize the importance of community health assessment, they also acknowledge a need to simplify the process and better prepare the public health workforce to use assessment to catalyze community initiatives.9
The challenges in conducting community health assessments range from who and what is being assessed to the scope and purpose of the assessment. In this supplement, we include articles that represent a cross-section of the thinking, methods and strategies around community health status assessment as being implemented in various environments for various purposes.
We start with commentaries to illustrate the significance and evolution of the field. Kaye Bender, President and CEO of the Public Health Accreditation Board, addresses the importance and status of community health assessment and improvement planning in the public health accreditation process. In her article, Julie Trocchio, Senior Director, Community Benefit and Continuing Care, Catholic Health Association, discusses the history, evolution and application of community benefits thinking and models based on her experience over the past 30 years with emphasis on the prevailing attitudes about for- profit versus non-profit hospitals. “A Personal History of the Evolution of Health Status Assessment” by Michael R. J. Felix and James N. Burdine describes the experiences of two leaders in the field over a twenty-plus year period chronicling key players, events, and leaps in the development of strategies, methods and models for community health status assessment.
The next section focuses on the models and frameworks used in the field. In their article titled “A Comparison of Community Health Assessment and Community Health Improvement Planning Models: Approaches for Population Health Improvement,” Pennel et al examine 18 different models and approaches. Smith follows with a discussion of combining models to achieve community engagement and agile processes. Bias et al present how community stakeholders reconciled differences between their perceptions of key community issues the findings of community health assessments in establishing community health improvement priorities. Gutilla, Hewitt and Cooper, provide insights into how a community organization which has been conducting community health status assessments for more than twenty years learn from an examination of the fundamental assumptions and processes of those assessments.
To understand the relationship of the assessment with implementation, Hill et al. study factors that influenced CHIP completion among 57 agencies in the Rocky Mountain Region and Western Plains. Castle et al. then describes a preliminary effort to quantify measurement of community leadership within a community health status assessment framework. Then Gutilla et al. provide an insightful comparison of the value and effectiveness of electronic health records (EHRs) with public health surveys. Finally, Smith and Burdine conclude with a review of the competencies needed to capitalize on the foundation of community health assessment.
The past three decades have yielded new ideals and insights in how communities are engaged in health assessments and the unique and shared health concerns communities have. Given the complexity of developing interventions to address such concerns, new methods of examination, data collection and engagement will need to be developed for community health assessment to face new challenges in the prominent future. The articles selected for this issue will help to highlight cross-sectional thinking, methods and strategies which might offer utility in your community health efforts.
1. Rosen G. A History of Public Health. MD Publications, New York. 1958.
2. World Health Organization. Ottawa charter. Geneva: World Health Organization. 1986.
3. Felix M, Burdine J. A Personal History of Health Status Assessment. J Public Health Manag Practice. 2017;23(4 Supp):S9–S13.
4. Institute of Medicine (US). Committee for the Study of the Future of Public Health. Future Public Health. 1988;88(2). National Academy Press.
5. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education Behavior. 1988;15(4):351–377.
10. Burdine J, Wendel M. Framing the question: needs assessment vs. health status assessment. Texas Public Health Association J. 2007;59(1):12–14.