Transcript Lesbian Health 2000 - EPID 600

Introduction to Public Health
September 18, 2000
Community Assessment:
The Healthy People 2010 Connection
Judith Bradford, Ph.D.
Survey and Evaluation Research Lab
Ph.D. in Public Policy and Administration
(Health Policy Concentration)
[email protected]
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
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.
Core Issues and Challenges
• Definition of community members -- who is
in the community?
• Trustworthy understanding of their
characteristics and needs.
• Feasible methods of gathering needed
information about them.
• Effective methods for involving community
members in assessment and interpretation.
Healthy People Movement
• 1979: The Surgeon General’s Report
on Health Promotion and Disease
Prevention
• 1980: Promoting Health/Preventing
Disease
• HP2000: National Health Promotion
and Disease Prevention Objectives
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
Healthy People 2010
Two overarching goals:
• Increase quality and years of life
• Eliminate health disparities
Format: 467 objectives to improve
health, organized into 28 focus areas.
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
• …encourages 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.
Goal 1: Increase Quality and
Years of Life
• life expectancy (average # of years
people born in a given year are
expected to live based on a set of
age-specific death rates.
• quality of life -- reflects a general
sense of happiness and satisfaction
with our lives and environment
Subgroups of Concern for
Eliminating Disparities
Differences that occur by….
• gender
• race or ethnicity
• education or income
• disability
• living in rural localities
• sexual orientation
Major HP2010 Data Sources
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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)
10 Leading Health Indicators
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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
Public Health Infrastructure
HP2010 Goal: Ensure that ... health agencies
have the infrastructure to provide essential
public health services effectively
• Data and information systems
• Workforce
• Public health organizations
• Resources
• Prevention research
Essential Public Health Services
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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
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
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
Focus Areas
• Physical activity and
fitness
• Public health
infrastructure
• Respiratory diseases
• Sexually transmitted
diseases
• Substance abuse
• Tobacco use
• Vision and hearing
Limitations of Current System for
HP2010 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
For example, sampling for HIV
assessment……..
What’s the question?
What’s 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?
For example, sampling for HIV
assessment……..
How to determine the distribution of identified
cases in a geographic area defined by Census
tracts?
• HARS
• Difficulty: 1-2, depending on time of year and
subject to limitations of case finding
• Additional data: not needed
How to capture reliable data on HIV
risks from Latino non-resident workers?
No existing federal data system contains directly
relevant data.
• Successful example: Latino rural men’s study
• Difficulty of additional data collection: 5
• Strategies: cooperation from worksite and
community gatekeeper
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.
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); multistage targeted recruitment (difficulty:7)
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.