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4. Strategic Issues - Overview


During this phase of the MAPP process, participants develop an ordered list of the most important issues facing the community. When addressing "strategic" issues, a community is being proactive in positioning itself for the future, rather than simply reacting to problems.

Strategic issues should reflect the results of all of the previous MAPP phases. Up to this point, the process has largely focused on developing a shared vision and identifying challenges and opportunities for improving community health. Strategic issues reveal what is truly important from the vast amount of information that was gathered in the four MAPP Assessments. Identifying strategic issues can be compared to pouring the assessment findings into a funnelwhat emerges is a distilled mix of issues that demand attention.

 
Definition

Strategic issues are those fundamental policy choices or critical challenges that must be addressed for a community to achieve its vision.

 

How to Identify Strategic Issues

Step 1. Brainstorm potential strategic issues
Participants should begin by reviewing the shared vision, common values, and results of the four MAPP Assessments. They should ask, "What factors identified in the assessments must be addressed in order to achieve the vision?" As participants discuss this question, they should try to identify where results converge. The adjacent example shows how results from each of the four assessments can point to a major issue. Each potential strategic issue should be phrased as a question.

Step 2. Develop an understanding about why an issue is strategic
After strategic issues are identified, participants should discuss each issue until they understand why it is strategic. The definition and criteria for strategic issues provided on the MAPP Web site is a useful resource. This discussion will help to separate strategic issues from other problems. Participants must understand the issues to be able to make wise decisions about how to address them.                     

Step 3. Determine the consequences of not addressing an issue
Next, participants should consider each strategic issue and ask, "What are the consequences of not addressing this?" This will help participants determine whether or not action is required. Strategic issues may have significant consequences for the community or the local public health system, and failure to address them could lead to serious repercussions.

Step 4. Consolidate overlapping or related issues
At this point, a large number of strategic issues may have been identified. Participants should examine all of these issues and consolidate them into a limited number of non-overlapping issues. Ideally, a community should have no more than 12 strategic issues; the fewer the better.

Step 5. Arrange issues into an ordered list
Finally, the strategic issues should be ordered into a list. When developing this list, participants determine if certain issues should be addressed first, if there are issues with immediate consequences, or if there are timelines or upcoming events that may help or hinder addressing an issue. In some cases, communities may decide to address simpler issues first in an effort to build the momentum and teamwork for addressing more complex, controversial issues.

Identifying Strategic Issues - Example

Strategic Issue: How can the public health community ensure access to population-based and personal healthcare services?                                     

Vision: Accessible services.         

  • Community Themes and Strengths Assessment: Lack of insurance; language/cultural barriers; need for more services for seniors; lack of day care; inconvenient hours.          
  • Local Public Health System Assessment: Somewhat high use of referral mechanisms; outreach is targeted, but possibly not at correct populations.            
  • Community Health Status Assessment: High need for affordable healthcare; high use of emergency rooms; lack of insurance.                                    
  • Forces of Change: Inadequate insurance coverage; disparities exacerbated by access challenges and racism. 


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NACCHO Annual Conference July 7-9, 2015