Community Health Assessment and Improvement Planning

The fundamental purpose of public health is defined by three core functions: assessment, policy development and assurance. Community health assessments (CHAs) provide information for problem and asset identification and policy formulation, implementation, and evaluation. CHAs  also help measure how well a public health system is fulfilling its assurance function (1,2).

A CHA should be part of an ongoing broader community health improvement process. A community health improvement process uses CHA data to identify priority issues, develop and implement strategies for action, and establish accountability to ensure measurable health improvement, which are often outlined in the form of a community health improvement plan (CHIP) (3). A community health improvement process looks outside of the performance of an individual organization serving a specific segment of a community to the way in which the activities of many organizations contribute to community health improvement (3). The Public Health Accreditation Board’s (PHAB’s) voluntary, national public health department accreditation program is designed to document the capacity of a public health department to deliver the three core functions of public health and the Ten Essential Public Health Services.

Public Health Infrastructure

Resource Center

The Resource Center for Community Health Assessments and Community Health Improvement Plans.

Public Health Infrastructure

Resource Center

Public Health Infrastructure

Mobilizing for Action through Planning and Partnerships

MAPP is a community-driven strategic planning initiative. Find resources like the MAPP Handbook here

Public Health Infrastructure

Mobilizing for Action through Planning and Partnerships

Community Health Assessment (CHA)

PHAB defines a CHA as "a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. The ultimate goal of a community health assessment is to develop strategies to address the community's health needs and identified issues. A variety of tools and processes may be used to conduct a community health assessment; the essential ingredients are community engagement and collaborative participation.

Community Health Improvement Plan (CHIP)

PHAB defines a CHIP as "a long-term, systematic effort to address public health problems on the basis of the results of community health assessment activities and the community health improvement process. This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate and target resources. A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health. It should define the vision for the health of the community through a collaborative process and should address the gamut of strengths, weaknesses, challenges, and opportunities that exist in the community to improve the health status of that community."

For a description of these definitions and information on application to the accreditation standards, refer to the PHAB Standards and Measures Version 1.0.

The Public Health Accreditation Board (PHAB) launched its voluntary national accreditation program for public health departments in September 2011. When preparing for the Public Health Accreditation Board (PHAB) application process departments will review a statement listing principles by which the health department will abide, including an agreement to follow the guidelines of the PHAB accreditation program and a declaration of the accuracy of all information submitted. This statement includes the health department director’s assurance that the health department has an adopted, current (dated within the previous five years) community health assessment, community health improvement plan, and department strategic plan.

NACCHO is committed to assisting LHDs in successful accreditation applications, and from July 2011 - December 2012 coordinated the "Accreditation Preparation: Community Health Assessment and Community Health Improvement Plan" (CHA/CHIP) project, with the support of the Robert Wood Johnson Foundation

  1. Increase the readiness of LHDs to apply for national accreditation;
  2. Build the capacity of LHDs to engage in a community health improvement process that yields a CHA and CHIP;
  3. Model meaningful LHD collaboration with local public health system (LPHS) partners in the community health improvement process; and
  4. Generate exemplary CHAs and CHIPs that model engaging the community in a meaningful way, addressing the social determinants of health, and using quality improvement (QI) and quality planning techniques.

The cornerstone of the CHA/CHIP project was to support a community of LHD demonstration sites (representative of LHDs across the country and with varying levels of experience) that developed CHAs and CHIPs. The 12 demonstration sites can be found here. Moreover, NACCHO is working with national public health partners to facilitate CHA and CHIP work in collaboration with LHDs among their respective constituencies. 

NACCHO is committed to supporting all LHDs in their CHA/CHIP efforts by making the tools, resources, CHAs and CHIPs, and case studies of the CHA/CHIP demonstration sites available in a public, online resource center. Visit the CHA/CHIP Resource Center here.

Please contact CHACHIP@naccho.org if you have any questions.

Provisions of the Patient Protection and Affordable Care Act (ACA) require each non-profit hospital facility in the United States to conduct a community health needs assessment (CHNA) and adopt an implementation strategy to meet identified community health needs. In conducting the CHNA, non-profit hospitals are required to take into account input from persons who represent the broad interests of the community served, including those with special knowledge of or expertise in public health.

NACCHO is committed to helping local health departments (LHDs) strategically align their community health assessment efforts with other assessment initiatives such as those of non-profit hospitals. The resources below provide information to help LHDs and non-profit hospitals conduct collaborative community health assessment and improvement processes.

Summary of the Internal Revenue Service’s April 5, 2013, Notice of Proposed Rulemaking on Community Health Needs Assessments for Charitable Hospital

This page summarizes proposed regulations that provided guidance to charitable hospital organizations on the 501(r) community health needs assessment requirements and related excise tax and reporting requirements

Resources

The National Public Health Performance Standards (NPHPS) provide a framework to assess capacity and performance of the local public health system, which can help identify areas for system improvement, strengthen partnerships, and ensure that a strong system is in place for addressing public health issues. Please contact performancestandards@naccho.org with questions or comments.

Completion of the Assessment answers:

  • What are the components, activities, competencies, and capacities of our public health system?
  • How well are the 10 Essential Public Health Services being provided in our system?

Benefits of Conducting the Assessment:

  • Identification of partners and community members in the local public health system
  • Increased partner and community member engagement in health assessment and improvement planning efforts
  • Improved communication and collaboration between community members and partners
  • Improved understanding about public health and the interconnectedness of community activities
  • Identification of local public health system strengths and weaknesses
  • Identification of benchmarks for public health practice improvements
  • Strengthened local public health system

* For best utilization of the NPHPS tools, please use Internet Explorer as your browser.

Local Assessment and Governance Tools 

The Community Health Improvement Model was developed to gain a better understanding of the current state of Local Health Department's Community Health Improvement Plans and Non-profit Hospital's Implementation Plans in relation to Social Determinants of Health. The Model can enable local health departments and non-profit hospitals to work together on planning improvement/implementation activities, designating appropriate leads and addressing the social determinants of health.

Local Public Health Finding Ways to Advance Healthy People Across the Country

NACCHO's partnership with Healthy People 2020 (HP 2020) is designed to support and increase the use of HP 2020 among local health departments (LHDs), non-profit hospitals, and other organizations related to community health assessment and improvement planning. All programmatic activities will be designed to support the HP 2020 ten-year agenda for improving the Nation's health.

With fewer resources and staff, many LHDs face significant challenges in providing essential services that ensure the health and safety of their communities. The HP 2020 approach offers an evidence-based, easy-to-use tool designed to aid LHDs and other organizations in community health assessment work.

The HP 2020-NACCHO Partnership is sponsored by the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion.

Healthy People 2020 Stories from the Field

NACCHO is continually developing stories from the field about health departments conducting a community health assessment and developing a community health improvement plan using Healthy People 2020. Check back often as new stories will be posted periodically.

NACCHO Annual 2013Audio-visual clips from five local health department on the use of Healthy People in community health assessment and improvement planning. Recorded during NACCHO's 2013 Annual Conference in Dallas, voices from Georgia, Florida, Kansas, Kentucky and Montana are included.

Plumas County Public Health Agency Collaborative CHA and CHIP: A look at how three hospitals, one local health department, and a tribal health clinic in this small, rural county are navigating past organizational mistrust, competing priorities, and strong intra-community identities to examine their community's health status and take action to improve health and well-being.

San Francisco Department of Public Health Collaborative CHA and CHIP: With collective impact as their primary goal, take a look at how eight hospitals, one local health department, and many other partners are working to identify the salient issues in their CHNA and taking action to improve the health of San Franciscans in implementing their CHIP.

Norwalk Health Department Collaborative CHA and CHIPA look at a strengths-based partnership between the local health department and the hospital in Norwalk, Connecticut, that embodies nearly seamless co-leadership of a community health improvement process yielding a community health (needs) assessment and CHIP. For this group, their ability to recognize their strengths and limitations is the foundation of their work.

NACCHO Annual 2013 Preconference SessionThe Florida Department of Health in Miami-Dade County used Healthy People in various Performance Improvement efforts, including strategic planning, quality improvement, accreditation, community health assessment and community health improvement planning. Recorded during NACCHO's 2013 Annual Conference in Dallas.

Using Healthy People 2020 to collaborate on assessment and planning: A look at the dynamic processes of community engagement and partnership efforts using the Mobilizing for Action through Planning and Partnerships (MAPP) framework. The Cobb & Douglas Public Health presentation  focuses on building strong relationships with schools, organizations, businesses and key decision-makers in the community to support “Healthier Lives. Healthier Communities."

Healthy! Capital Counties Collaborative CHA and CHIPIn the Greater Capital Area of Michigan, three local health departments and four hospital systems collaborated to complete a regional CHA and CHIP that emphasized addressing the root causes of poor health outcomes. Here is a look at how they worked together and how they're moving forward to take action to improve health.

Gallatin City-County Health Department Collaborative CHA and CHIP: A look at how a local health department and local hospital in Bozeman, Montana are working together to apply community health assessment results to improve health in a rural and large area in the heart of the Rocky Mountains.

NACCHO Annual 2013 Preconference Session: The Yellowstone County, MT local health department doing business as Riverstone Health, together with St. Vincent's Healthcare and Billings Clinic, used Healthy People in community health assessment and community health improvement planning activities for a community with both rural and urban challenges. Recorded during NACCHO's 2013 Annual Conference in Dallas.

Community Indicators Consortium: 2014 IMPACT Summit: A look at Cuyahoga County’s (Ohio) social justice approach to their collaborative community health improvement process, and how, as a result, they are addressing health inequities in the community. – Presentation recorded during the Community Indicators Consortium: 2014 IMPACT Summit, Washington, DC.

A look at how one community in Portland, Oregon is collaborating with four local health departments and 14 non-profit hospitals to conduct a regional community health needs assessment.

Hospitals, Public Health Creating Community Value: Practical Tools for Moving Into Implementation: Background on  Wisconsin (WI) communities are conducting the community health improvement process under the WI statutory requirement for health departments to develop a community health improvement plan and process (CHIPP) and an in depth look at two rural counties where hospitals and public health are collaborating in their CHIPP efforts.

Healthy People 2020 and Community Benefit

Recently, NACCHO convened partners and leaders from the local, state and national level for a working meeting on moving forward community health (needs) assessment and improvement planning as a field to assure the conditions in which people can be healthy. Materials and resources from the meeting can be found below. 

Resources

Presentations

Provisions of the Patient Protection and Affordable Care Act (ACA) require each non-profit hospital facility in the United States to conduct a community health needs assessment (CHNA) and adopt an implementation strategy to meet identified community health needs. In conducting the CHNA, non-profit hospitals are required to take into account input from persons who represent the broad interests of the community served, including those with special knowledge of or expertise in public health.

NACCHO is committed to helping local health departments (LHDs) strategically align their community health assessment efforts with other assessment initiatives such as those of non-profit hospitals. The resources below provide information to help LHDs and non-profit hospitals utilize Healthy People 2020 (HP 2020) to conduct collaborative community health assessment and improvement processes.

Resources

The reports, webinars, and other tools listed below provide information to help local health departments (LHDs), non-profit hospitals, and other organizations conduct collaborative community health assessment and improvement processes using Healthy People 2020 (HP 2020).
 
Presentations

The Community Health Improvement Matrix: an effective tool for implementation planning: These PowerPoint slides are taken from a presentation given at the Association for Community Health Improvement's 2015 Annual meeting. Presenters Barbara Laymon, Lead Program Analyst at NACCHO, Reena Chudgar, Program Analyst at NACCHO and Ed Gerado from Bon Secours Health System. The Healthy People 2020 Social Determinants of Health framework using the Community Health Improvement Matrix is highlighted.

Healthy People 2020: Local Action Leading to Better Health and Well-Being: These PowerPoint slides are from a presentation given by Barbara Laymon, Lead Program Analyst at NACCHO, at the American Public Health Association 2013 Annual meeting. The presentation was part of a session on Healthy People 2020: Addressing social determinants to achieve health equity.

Performance Improvement through Healthy People: These Powerpoint slides outline the application of the Healthy People framework to various aspects of performance improvement, including accreditation, quality improvement, performance management, community health assessment, community health improvement planning and agency strategic planning.

Social Determinants of Health in Community Health Assessment and Improvement Planning: These PowerPoint slides are taken from a presentation given at the Association for Community Health Improvement's 2014 Annual meeting. Presenters Barbara Laymon, Lead Program Analyst at NACCHO and Reena Chudgar, Program Analyst at NACCHO. The Healthy People 2020 Social Determinants of Health framework is highlighted.

Reports

Healthy People and MAPP: Survey Findings on Connections, Collaborations, and Challenges: NACCHO surveyed the 434 participants of the Mobilizing for Action through Planning and Partnerships (MAPP) social network site regarding their use of MAPP and HP 2020. This 18-page report describes the current MAPP activity of participants, their views of the impact of MAPP on community health assessment processes and health outcomes, and information regarding the use of HP 2020 within community health assessment activities.

Tools

Community Health Improvement Matrix: The Community Health Improvement Matrix was developed to gain a better understanding of the current state of Local Health Department's Community Health Improvement Plans and Non-profit Hospital's Implementation Plans in relation to Social Determinants of Health. For more information on the Matrix and related resources.

  • Community Health Improvement Matrix: Research Brief: The Community Health Improvement Matrix was developed to gain a better understanding of the current state of Local Health Department's Community Health Improvement Plans and Non-profit Hospital's Implementation Plans in relation to Social Determinants of Health. The Matrix can enable local health departments and non-profit hospitals to work together on planning improvement/implementation activities, designating appropriate leads and addressing the social determinants of health. To read more about the Community Health Improvement Matrix.

Community Health Improvement Matrix: A tool for addressing the social determinants of health through community health improvement planning.

Tips for Transitioning from Healthy People 2010 to 2020: HP 2020 builds upon four previous Healthy People publications. However, there are major differences between HP 2010 and HP 2020, resulting in some confusion over many of the HP 2020 targets and delayed uptake of HP 2020 as a resource for community health assessment and improvement planning at the state and local level. This document lists strategies on how best to use the HP2020 framework, and transitioning from HP 2010 to HP 2020. View the document here.

Videos

How To Use Healthy People in Your Assessment and Planning Efforts: Community health assessment and improvement planning can be overwhelming, but HP 2020 can make it easier. NACCHO created a series of short videos, each under three minutes, to showcase how elements of HP 2020 can assist assessment and planning activities. There are five videos total, including topics such as:

The Community Health Status Indicators Project (CHSI) Web site makes detailed health and demographic information about each of the nation's 3,141 counties  widely available and easily accessible. County-level reports measure each county against national averages, other counties with similar demographics, and Healthy People 2010 targets. Taken as a whole, the site provides to the public the most detailed picture of health at the county level and is an invaluable resource for public health departments, policymakers, and community advocates.

The CHSI reports, available on the Web at www.communityhealth.hhs.gov, provide an update to reports released in 2000. The original program was developed because health officials, local boards of health, and many others identified a need to help local health departments (LHDs) assess health, plan programs, and develop data-based policies at the community level. CHSI project partners include NACCHO, the Public Health Foundation, the Association of State and Territorial Health Officials, the National Association of Local Boards of Health, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the National Library of Medicine. NACCHO's involvement in this project is supported by a grant to the Public Health Foundation from the Robert Wood Johnson Foundation.

Objective

NACCHO's performance improvement (PI) curriculum is designed to help local health department (LHD) staff implement PI practices and standards within their health departments. This curriculum will allow staff to increase internal alignment and improve effectiveness in helping LHDs to optimize their understanding of PI and recognize its value, leading to improved LHD performance and overall public health practice.

Competencies

  • Characterize the local public health system and community context
  • Demonstrate methods for communicating the value of PI to stakeholders
  • Demonstrate methods for community member and partner engagement
  • Demonstrate skills to manage PI in the community and agency
  • Describe overarching PI concepts and connections
  • Engage in accreditation preparation
  • Implement comment health improvement planning process
  • Use a performance management system to create a culture of quality improvement

Unit 1: Understanding Performance Improvement in Local Health Departments

The first unit of the curriculum is intended to provide a conceptual framework for performance improvement at the local level. After completing the courses, participants should be able to describe overarching performance improvement concepts.

Introduction to Performance Improvement for Local Health Departments

Module 1: The History of Performance Improvement in Public Health
Module 2: Jargon-Free Performance Improvement
Module 3: Stories from the Field

Cultivating a Culture of Quality

Module 1: Quality Management Principles
Module 2: Building a Culture of Quality

Accreditation for Local Health Departments

Module 1: Background on Accreditation in Public Health
Module 2: Local Health Departments and the Public Health Accreditation Process
Module 3: Stories from the Field: Local Health Departments Seeking Accreditation

UNIT 2: Implementing Performance Improvement in Local Health Departments

The second unit of the curriculum is intended to provide practical guidance on how to implement various processes essential to performance improvement in local health departments. After completing the courses, the participant should be able to design and implement processes to characterize the local public health system and community context for a community health assessment, develop a community health improvement plan, use a performance management system, engage in accreditation preparation, and conduct quality improvement.

Strategic Planning

What is Strategic Planning and How Do I Prepare? [through NACCHO University]
Implementing a Strategic Planning Process [through NACCHO University]

Community Health Assessment & Improvement Planning

Mobilizing for Action through Planning and Partnerships (MAPP):Organize for Success/Partnership Development and Four Assessments Phases [through NACCHO University]
Opportunities for Hospital and Local Health Department Collaboration for Community Health Assessment and Improvement Planning [through NACCHO University]

The following publications and fact sheets can help your Local Health Department assess your community's health.