Introduction to Public Health September 18, 2000

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Introduction to Public HealthSeptember 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)
• jbbradfo_at_vcu.edu

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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

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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.

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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.

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Healthy People Movement

• 1979 The Surgeon Generals Report on Health
  Promotion and Disease Prevention
• 1980 Promoting Health/Preventing Disease
• HP2000 National Health Promotion and Disease
  Prevention Objectives

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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

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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.

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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.

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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

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Subgroups of Concern for Eliminating Disparities

• Differences that occur by.
• gender
• race or ethnicity
• education or income
• disability
• living in rural localities
• sexual orientation

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Major HP2010 Data Sources

• 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)

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10 Leading Health Indicators

• 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

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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

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Essential Public Health Services

• 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

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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

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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

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Focus Areas

• Physical activity and fitness
• Public health infrastructure
• Respiratory diseases
• Sexually transmitted diseases

• Substance abuse
• Tobacco use
• Vision and hearing

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Limitations of Current System forHP2010
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

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For example, sampling for HIV assessment..

• Whats the question?
• Whats 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?

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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

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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 mens study
• Difficulty of additional data collection 5
• Strategies cooperation from worksite and
  community gatekeeper

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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.

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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)
  multi-stage targeted recruitment (difficulty7)

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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.