What’s Public Health Got To Do With… Assessing Community Health?

As an integral framework for public health policies, programs, and services, the 10 Essential Public Health Services (EPHS) guide strategic planning to protect and promote the health “of all people in all communities”, (The Public Health National Center for Innovations, 2023). Fittingly, one key tenet of the EPHS centers on the importance of assessment, instructing public health organizations to first and foremost assess and monitor population health status, factors that influence health, and community needs and assets. Because of the multi-faceted nature of aging and the variability of older adults’ needs and assets, including older adult health and social needs in the assessment process is an essential first step to promote healthy aging in a tailored, holistic, and sustainable way.

Local health departments primarily use the community health assessment, or CHA, to identify key community health needs through data collection and analysis, based on indicators that are pertinent to their community’s health. However, many health departments have little experience including older adults in the CHA process and lack awareness of or access to data and indicators of their health and well-being. As a result, the needs of older adults are often underrepresented in CHA data findings raising questions about whether health disparities are fully addressed. Fortunately, there are resources that include older adult health indicators that can enhance data collection (see What’s Public Health Got To Do With… Older Adult Health Data?), and help health departments build capacity to include older adults more completely in CHA data collection.

Other ways to elevate equity in community health actions include the use of frameworks. The newly revised Mobilizing for Action through Planning and Partnerships (now MAPP 2.0) developed by the National Association of County and City Health Officials (NACCHO) is a great example. The MAPP 2.0 frameworks for Community Status and Context Assessment both provide approaches to CHA data collection that emphasize attention to root causes of inequity and the active inclusion of all community members. These tools can help form a comprehensive picture of population health and reveal hidden systems and multi-level factors that influence older adult well-being. With a greater awareness about health disparities among older adults offered by CHA data, resulting action plans can better address the social determinants that affect their health.

These action plans are often created by local health departments as part of a Community Health Improvement Plan, or CHIP. This action aligns with EPHS #5 – create, champion, and implement policies, plans, and laws that impact health. The Centers for Disease Control and Prevention defines CHIP as a long-term, systematic effort to address public health problems (most CHIPs are updated every three to five years) and they are typically based on the outcomes of the CHA process. Prioritizing older adult health and social needs in the CHIP is a key strategy for health departments nationwide to begin integrating an age-friendly approach to public health. In doing so, we can help to ensure that our nation is better attuned to the needs of all people, including older adults and their caregivers.

Here are some strategies to include healthy aging in CHA and CHIP based on the Age-Friendly Public Health Systems 6Cs Framework.

  • Creating and leading a community commitment to promoting healthy aging by ensuring the CHA/CHIP processes dedicate special attention to older adult health and social needs.
  • Connecting and convening local and community stakeholders to create a partnership that supports collaboration with the aging services sector, emergency services, health systems, and other sectors that engage with the older adult population.
  • Coordinating existing supports and services, such as local volunteer programs and faith-based organizations, to aid in carrying out strategies that meet CHIP priorities.
  • Collecting, analyzing, and translating data on older adult health challenges, such as local rates of Alzheimer’s disease or related dementias, challenges experienced by caregivers, issues with mobility or transportation, or the accessibility of existing resources, like routine health screenings.
  • Communicating data, common themes, and identified community health priorities in the CHIP to the older adult community and partners in a culturally sensitive, informed, and productive manner.
  • Complementing the collection of pertinent data indicators that signal community health needs or disparities with the addition of recommended healthy aging indicators.

The August AFPHS training highlighted community health assessment and improvement activities that support the first C of the AFPHS 6Cs Framework, Creating and Leading. Speakers Anna Clayton, National Association of County and City Health Officials (NACCHO) and Ryan Mims, Florida Department of Health in Walton County shared tools and strategies for using CHA and CHIP actions to support healthy aging, such as:

  • NACCHO’s newly revised Mobilizing for Action through Planning and Partnerships (MAPP) framework for community health improvement,
  • ensuring the promotion of health equity is foundational to CHA and CHIP planning through MAPP’s Health Equity Action Spectrum,
  • using the new Indicators of Healthy Aging Guide to add older adult data to the CHA process,
  • elevating community interests and insights in the findings of CHA and CHIP projects, and
  • integrating age-friendly actions into CHIP priorities.