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The MAPP Approach: Using Community Health Status Assessment for Performance Improvement

Jacobs, Lisa M.; Elligers, Julia Joh MPH

Journal of Public Health Management and Practice: January-February 2009 - Volume 15 - Issue 1 - p 79–81
doi: 10.1097/01.PHH.0000342949.35242.79
News From Naccho

The National Association of County and City Health Officials (NACCHO) is the national organization representing local health departments. NACCHO supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

This column describes the use of the MAPP approach for improving public health in the communities. It helps communities create dynamic and updatable health status data systems.

Lisa M. Jacobs,, is Program Associate, National Association of County and City Health Officials, Washington, DC.

Julia Joh Elligers, MPH, is Senior Analyst, National Association of County and City Health Officials, Washington, DC.

Corresponding Author: Lisa M. Jacobs, NACCHO, 1100 17th St, NW, 2nd Floor, Washington, DC 20036 (

Performance improvement processes use assessment data to advance public health practice and improve health in communities. The collection of assessment data alone does not automatically result in health improvements; rather, data must be analyzed, applied, and monitored to track improvements over time. Mobilizing for Action through Planning and Partnerships (MAPP) is a performance improvement process that incorporates health status data along with data from three other types of assessments. MAPP applies assessment data toward developing and implementing community-based strategic plans that result in improved public health system performance and better health outcomes.

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The MAPP Process

Between 1997 and 2000, a workgroup composed of local health officials, Centers for Disease Control and Prevention (CDC) representatives, community representatives, and academicians developed the MAPP process. The process was launched in 2001 by the National Association of County and City Health Officials (NACCHO) in cooperation with the Public Health Practice Program Office at CDC. Since 2001, over 600 local jurisdictions have used the process.

MAPP is a community-wide strategic planning process for improving public health. The process combines a series of six distinct phases designed to facilitate the development of a community-derived and community-owned strategic plan. Communities begin by organizing, planning, and developing partnerships. Following this initial planning phase, community members develop a collective vision of their ideal community and, with their vision as a guide, complete four assessments.

Many would describe the assessment phase as the core of the MAPP process. During this phase, users complete four different assessments, including a community health status assessment. These four complementary assessments reveal information about community strengths and challenges, local public health system (LPHS) capacity, local trends and forces, and community health status. The assessment phase provides a comprehensive picture of public health in a given locality. In subsequent phases, assessment data are used to identify strategic issues and formulate action steps that will help the community reach its vision.

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Community Health Status Assessment

Many local jurisdictions across the country regularly conduct community health assessments. According to NACCHO's 2005 National Profile of Local Health Departments (LHDs), 51 percent of LHDs have completed a community health assessment in the last 3 years.1 Additionally, many other organizations also collect community health assessment data (eg, United Way, local hospitals, and schools). Overall, community health assessments provide an overarching view of a community's health status and help public health professionals understand and prioritize health status issues.

The Community Health Status Assessment (CHSA) in a MAPP process is similar to a traditional community health assessment; however, the MAPP process deliberately emphasizes community and public health system participation in all aspects of assessment completion.2 By engaging system partners and community members at every stage of the process, from indicator selection to data collection and dissemination of findings, the MAPP CHSA builds trust between the community and local public health entities. Additionally, by mobilizing community partnerships to complete this assessment, the MAPP CHSA strengthens the partnerships that are so critical to ensuring the delivery of the 10 Essential Public Health Services.

Establishing a system to monitor indicators over time is also a defining characteristic of the MAPP CHSA. Traditional community health assessment is sometimes perceived as a static activity. In contrast, the MAPP process encourages communities to create dynamic and updatable health status data systems. Establishing a monitoring system helps ensure that future CHSA efforts are efficient and effective, and use CHSA benchmark data to document public health improvements. Finally, as in all aspects of the MAPP process, collaboration among community partners is essential to the creation and maintenance of a CHSA monitoring system.

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Benefits of a MAPP Process

Completing a CHSA through a MAPP process has several benefits. First, CHSA data are validated by data collected in the other MAPP assessments. While the CHSA supplies important information about health status, the other assessments provide information about why certain health issues exist. Second, the data collected through a MAPP process are used to create, implement, and evaluate a community health improvement plan. MAPP is not an assessment process; rather, the process collects and analyzes data to identify and implement appropriate performance improvement strategies. Third, because MAPP is a community-based process that involves the entire public health system, all aspects of the process are informed by collective wisdom and use resources compiled by the multitude of public, private, and voluntary entities responsible for improving public health. MAPP results in a strategic community health improvement plan for the entire public health system as opposed to one public health agency. As a result, implementation of performance improvement plans necessitates collective action and involvement of the entire public health system.

MAPP communities are also better positioned to meet agency performance standards, and they have data and experience that can inform agencies' quality improvement processes. Although MAPP focuses on the public health system, agencies derive important benefits from engaging in the process. As noted in NACCHO's Operational Definition of a Functional Local Health Department,*,3 LHDs should understand community health issues, investigate health problems and threats, engage community and public health system partners, coordinate public health system efforts to reduce inefficiencies, and create strategic plans that result in health improvements that meet community expectations. While the details of the voluntary accreditation of LHDs are still under development, the responsibilities noted in the Operational Definition will be reflected in accreditation standards. In addressing these agency responsibilities, the MAPP process helps LHDs collaborate with system and community partners to collect information; identify health problems, issues, and threats; and reduce duplication and gaps in both agency and system efforts to improve public health. Because LHDs are the backbone of public health systems, the MAPP process benefits both the LHD and the entire LPHS.4 Moreover, to meet the public health needs of communities, agencies and systems must work together to deliver Essential Public Health Services.4 Overall, MAPP improves agency and LPHS interaction and coordination, which are necessary for improving the quality of public health in local communities.

To learn more about the MAPP process, visit or contact NACCHO MAPP Program Manager, Heidi Deutsch, at (202) 507-4214.

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Transition in NACCHO Leadership

Patrick Libbey, Executive Director of the National Association of County and City Health Officials (NACCHO), since September 2002 will be leaving this position to return to the state of Washington. Under Patrick Libbey's leadership, a close relationship was forged between the NACCHO and the Journal of Public Health Management and Practice. Multiple focus issues were developed with the NACCHO: influenza; public health ethics; ethics and the built environment; and MAPP are examples. Libbey was responsible for a significant expansion in the role of the NACCHO. His many accomplishments include the development of the operational definition of the local health department; increasing the emphasis on healthy equity and social justice, and increasing accountability of public health organizations through accreditation and quality improvement. Libbey will continue as a valued member of our editorial board. The new executive director, Robert Pestronk, is immediate past president of the NACCHO. He has broad experience in local public health serving as director of the Genesee County Health Department in Michigan since 1986. Pestronk contributed to many innovative national public health activities, including the development of the Healthiest Nation Alliance, during his volunteer service with the NACCHO. He has also worked closely and been a frequent contributor to the Journal of Public Health and Management.

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1. National Association of County and City Health Officials. 2005 National Profile of Local Health Departments. Washington, DC: NACCHO; Accessed 22 August, 2008.
2. National Association of County and City Health Officials. Community Health Status Assessment At-A-Glance. Washington, DC: Accessed August 22, 2008.
3. National Association of County and City Health Officials. Operational Definition of a Functional Local Health Department and Self-Assessment Tool. Washington, DC: Accessed 22 August, 2008.
4. Institute of Medicine of the National Academies. The Future of the Public's Health in the 21st Century. Washington, DC: The National Academies Press; 2003.

*The Operational Definition of a Functional Local Health Department defines what people in any community can reasonably expect from their LHDs, and it serves as the framework for LHD standards in the voluntary national accreditation program that is under development.
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