Pros And Cons Of Community Health Assessment

A Community Health Needs Assessment (CHNA) was conducted in the city of Atlanta, Georgia, with the focus on mainly Dekalb and Fulton Counties. The CHNA was conducted to identify the needs and resources in the community with the input from the community members, key stakeholders, and the public health. The CHNA would be used as a guide for the community in its future community health projects.
The two logic models utilized were Precede-Proceed model and MAPP (Mobilizing for Action through Planning and Partnerships). The qualitative data methods used for the data collection were- researching the national, state, and local databases; reviewing the previously conducted county health assessments and reports; interviewing key stakeholders in the

community; performing a windshield survey; and creating Photovoice data. Based on the CHNA, it is evident that Atlanta’s needs are dependent on several of its social and economic determinants of health. The priority health issue the city faces is obesity. However, the underlying risk factors for obesity is largely race/ethnicity, and social and environmental factors. The other health issues widespread in the community are violence/crime, poverty, access to health services and substance abuse. Thus, the most vulnerable population for poor health in Atlanta are the low-income or low socioeconomic status (SES), uninsured, and the undereducated. The paper also explores several of the limitations of the assessment that must be considered. The CHNA summarizes the current resources or actions addressing the several health issues in the city and evaluates its adequacy.
Brief Community Description:
Atlanta, the capital and the largest city in Georgia, with a population of 472,522, is among the fastest growing cities in the nation.1 It is one of the most diverse cities in the nation, racially, ethnically, and linguistically.2 Atlanta consist of about 52.40% (majority) Black/African-American, 37.2 % White, 4.8% Hispanic or Latino, 4.0% Asians, 0.30% Native Americans and Alaska Native, and 0.00% Pacific Islanders (180).1 The two counties, Dekalb and Fulton, are of interest due to their high obesity rates as well as its ranking as one of the highest crime and violence rates in U.S.
The three major socioeconomic factors that impact the health status of the target community are poverty, lack of healthcare insurance, and education. Based on the HP2020 indicators, research, interviews, and observation tools such as windshield survey and photovoice, the most important public health concerns facing Atlanta today are- Obesity/Nutrition/ Physical Activity, Violence/ Crime; Poverty; Access to Health Services, and Substance Abuse.3 Out of the these, obesity is considered the priority public health issue of Atlanta, primarily in the Dekalb and Fulton County. In fact, about 75% of Fulton County adult residents and 18% of youth were obese or overweight.4 The low-income or low socioeconomic status (SES), the uninsured or underinsured, and the uneducated populations are most susceptible to the effects of poor health status in Atlanta.5
Methodology:
The two logic models that will be utilized in the community health needs assessment of the city of Atlanta are Precede-Proceed model and MAPP.6,7 The major pros of PRECEDE-PROCEED model are that it integrates several strategies to transform an individual’s ecosystem for their well-being.8 This model analyzes the different elements of the individual’s ecosystem such as environment, health, lifestyle, and quality of life when developing the strategies. Studies show the best way to design programs to achieve positive changes is to understand the reasons for an individual’s behavior and what motivated them to change.9 This is classified under the predisposing, enabling, and reinforcing factors of the logic model.9 However, a negative aspect of this logic model is that it forms precise instructions or strategies that may not be applicable to the current issue. This forces one to modify the model to fit the problem. The success of the strategies also depends on the availability of funds.
MAPP is an interactive process wherein public health leaders and the community can collaboratively apply strategic thinking, using the data collected, in addressing the public health issues involved and identify the necessary resources to tackle the problem.7 One of the major pros of MAPP is that the four assessments focus on the community, its system, and their needs.7 For example, the Community Health Status Assessment examines the health of community members and of the community.10 Quality of life issues, such as employment, housing, the environment, neighborhood, etc., are also considered here as part of the community perspective on health.10 The MAPP process is formed based on information gathered the previous planning efforts and helps the community to anticipate and manage change effectively.7 It also focuses on strengthening the local public health system by utilizing the Ten Essential Public Health Services which are key to a well-functioning public health system.7 A possible disadvantage of the MAPP logic model is that it is not applicable to all issues.

It is more feasible if the public health issue affects a community, rather than an individual. For the strategic plan to work, funding is

essential.
To address the public health issue of obesity in the city of Atlanta, I would use a combination of Precede-Proceed model and MAPP (Mobilizing for Action through Planning and Partnerships). I would use the first four phases of the Precede-Proceed model to analyze the underlying factors, such as environmental or behavioral factors, that lead to the rise in obesity in Atlanta city.6 MAPP’s initial four assessments also identifies these factors.10 Then, using, the MAPP, I will focus on developing a community-driven strategic plan to improve the target community health.7
The data for the CHNA were collected through - utilizing the national, state, and local databases; reviewing the previously conducted county health assessments and reports; interviewing community member; conducting a windshield survey; and creating a Photovoice data.11,12 Researching and creating comparison tables and graphs help to assess the current public health issues of the county based on statistical data.

Reviewing previously conducted county health assessments and reports is also important in evaluating the trend of the issue over the past few years. Conducting semi-structured individual interviews with key stakeholders from the community, senior Police Officer from Atlanta Police Department, Officer B. Mathew, and the Nurse Manager of Emory Rehabilitation Hospital, Mrs. Elizabeth Thomas, helped to gather data in an informal environment to obtain the most productive responses regarding their professional perspective of the priority community health issues.13 Finally, using creative tools such as windshield survey of the streets of Fulton county and photovoice of the houses and living environment of the certain areas in the county helps to identify and explore the community, its needs, its strengths, and its priority concerns through visual observations and

images.12
In order to address the public health issues in the city, it is important to involve the community to research and perform community health analysis and the data gathered can be utilized to develop a strategic plan or interventions and take action.14 It is also vital to develop partnerships with local and global organizations to strengthen the community and its efforts.14 Neighborhood institutions and organizations are a core component in creating social capital, i.e., forming social trust and engaging in community-oriented activities.15 For example, the Cure Violence (CeaseFire Chicago) program used a community-wide intervention strategy, with the help of community, local and federal government, law enforcement agents, outreach workers, etc., to reduce shooting in the target areas.15 Such community-oriented organizations and their networks of public and private agencies within and across city limits, will help strengthen the ties between residents, other agencies, and the government or political authority, and help mobilize community resources.15 Strong internal and external ties will thereby aid in regulating activities in public spaces and control the threat of crime or violence.15