Transcript Community Assessment - Virginia Commonwealth University

Introduction to Public Health
November 7, 2004
Community Assessment with
Health Disparities Groups
Judith Bradford, Ph.D.
Community Health Research Initiative
Survey and Evaluation Research Lab
[email protected]
Defining the Population
Communities
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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
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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
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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.
Policy Framework
Healthy People Movement
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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
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…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.
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 - 1
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Access to quality
health services
Arthritis,
osteoporosis, and
chronic back
conditions
Cancer
Chronic kidney
disease
Diabetes
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Disability and
secondary conditions
Educational and
community-based
programs
Environmental health
Family planning
Food safety
Health
communication
Focus Areas - 2
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Heart disease and
stroke
HIV
Immunization and
infectious diseases
Injury and violence
prevention
Maternal, infant, and
child health
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Medical product
safety
Mental health and
mental disorders
Nutrition and
overweight
Occupational safety
and health
Oral health
Focus Areas - 3
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Physical activity and
fitness
Public health
infrastructure
Respiratory diseases
Sexually transmitted
diseases
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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 heath
needs of LGBT communities
What’s the question?
Who is in the community?
On a scale of 1 - 10….
How complete are available data?
How difficult to obtain currently unavailable data?
Which sampling strategies are most effective?
Using existing data sets
How to determine the distribution of
identified cases in a geographic area
defined by Census tracts?
(using same-sex HH data from 1990 & 2000;
difficulty 2)
How to capture reliable data on the local
health priorities of sexual minority African
American women?
No existing federal data system contains
directly relevant data.
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Successful example: Community forum
and priority setting through partnership
with community organizations.
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Difficulty: 8
How to determine the HIV risks and
prevention needs of Transgender persons
in Virginia?
No existing federal data system will do this.
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Web-based and mail-back surveys.
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Strategies: set up field study with regional
managers and gatekeepers from; careful
translation of concepts; even more careful
selection of survey administrators.
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Anticipated difficulty: 10
Conclusions
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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.
The need for social-behavioral
research
…the nature of human relationships – the degree
to which an individual is interconnected and
embedded in a community – is vital to an
individual’s health and well-being as well as to
the health and vitality of entire populations.
Berkman LF, Glass T. Social integration, social networks, social support
and health, in Social Epidemiology, Berkman LF and Kawachi I, Eds.
New York: Oxford University Press, 2000.
What are our major challenges in conducting LGBT
assessments?
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Acknowledging, accepting disparities within LGBT
communities.
Placing higher priority on least understood areas.
Recognizing the power and implications of cultural
context for LGBT health.
Finding common cause and forming strong affiliations
to work across dividing lines.
So many questions…
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Who is the population we wish to study?
What factors influence their lives and lead
to health disparities?
What are the questions we need to ask
and answer?
What methods are best to use?
How do we put it all together?
Social-Ecological Model for Levels of Influence
McElroy KR, Bibeau D, Steckler A, Glanz . An ecological perspective on health
promotion programs. Health Education Quarterly 15:351-377, 1988.
Interpersonal: family, friends, peers that
provide social identity, support and
identity
Individual: awareness, knowledge, attitudes,
beliefs, values, preferences
Public Policy: local,
state and federal
government
policies, regulations,
and laws
Community: social
networks, standards
and practices
among
organizations
Institutional/Organizational: rules,
policies, procedures,
environment, and
informal structures
within an
organization or
system
Community-based participatory research
CBPR…
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recognizes community as a unit of identity
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builds on strengths and resources within the
community
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Facilitates collaborative, equitable partnership in all
phases of the research
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Promotes co-learning and capacity building among
all partners
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Integrates and achieves a balance between research
and action for the mutual benefit of all partners
CBPR…
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emphasizes local relevance of public health problems and
ecological perspectives that recognize and attend to the
multiple determinants of health and disease.
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involves systems development through a cyclical and
iterative process.
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disseminates findings and knowledge gained to all partners
and involves all partners in the dissemination process.
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involves a long-term process and commitment.
Minkler M, Wallerstein N (Eds.). Community Based Participatory Research
for Health. San Francisco: Jossey-Bass & Co., 2003.
Contributions to the field of social and behavioral
health from LGBT health disparities studies
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Communities cannot be usefully studied without
their own participation, through partnership and
with mutual accountability.
As we do this work together, we are learning, and
with each step forward, there is a general increase
in knowledge. We are using what we learn.
LGBT community research provides a model for
use by others – a foundation that can be built
upon to address and to learn from diversity.