Community health assessment

Community health assessment calls for regularly and systematically collecting, analyzing, and making available information on the health of a community, including statistics on health status, community health needs, epidemiologic and other studies of health problems.

Often this can take the form of community needs assessments, which are intended to assist the community in adapting and responding to important health problems and risks. Increasingly, moving beyond problems and deficits toward an analysis of community strengths and resources is becoming recognized as a critical part of understanding a community’s health. (National Association of County and City Health Officials. Advancing Community Public Health Systems in the 21st Century. Washington, DC; 2001.)

Glossary

• Access: The potential for or actual entry of a population into the health system. Entry is dependent upon the wants, resources, and needs that individuals bring to the care seeking process. Ability to obtain wanted or needed services may be influenced by many factors, including travel, distance, waiting time, available financial resources, and availability of a regular source of care.

• APEX-PH: Assessment Protocol for Excellence in Public Health. A community assessment and planning tool developed by the National Association of County and City Health Officials (NACCHO) for use by local health departments and other organizations.

• Assessment: the process of regularly and systematically collecting, assembling, analyzing, and making available information on the health needs of the community, including statistics on health status, community health needs, and epidemiologic and other studies of health problems. Assessment is one of the three core functions of public health agencies as identified by the Institute of Medicine.

• Asset Mapping: A tool for mobilizing community resources. It is the process by which the capacities of individuals, civic associations, and local institutions are inventoried.

• Assurance: One of public health's three core functions, Assurance, is the ongoing process of ensuring the public health system is effectively and adequately addressing the health improvement and care needs of the community.

• ASTHO: The Association of State and Territorial Health Officials. www.astho.org.

• Behavioral Risk Factors: Behaviors which are believed to cause, or to be contributing factors to, accidents, injuries, disease, and death during youth and adolescence and significant morbidity and mortality in later life.

• Benchmarks (local peer, state and national): Indicators of progress that tell us whether elements of a long term strategic plan are being achieved. (Oregon Benchmarks)

• Biological Agent Outbreak: Biological agents are infectious microbes or toxins used to produce illness or death in people, animals or plants (FEMA). An outbreak exists when there are more cases of a particular illness or disease than expected in a given area or among a specific group of people over a particular period of time.(CDC)

• Board of Health: A legally designated governing body whose members are appointed or elected to provide advisory functions and/or governing oversight of public health activities, including assessment, assurance, and policy development, for the protection and promotion of health in their community.

• Body Mass Index: This index mathematically relates height and weight for a result that is a good indicator of body fat.It is a better predictor of health risk than weight alone. This formula is most accurate for adults other than body builders, competitive athletes, and pregnant or breast feeding women. BMI is determined by calculating the weight in kilograms divided by the height in meters squared. BMI =(weight in kilograms) / (height in meters).

• BRFSS: Behavioral Risk Factor Surveillance Survey. A national survey of behavioral risk factors conducted by states with CDC support.

• Capacity: is the ability of an individual, organization or system to effectively complete specific tasks over time and across issues.

• Capacity building: Capacity building is the process of developing or acquiring the skills, competencies, and tools, processes and resources that are needed to improve the ability of an individual, organization or system to achieve its identified objectives.

• Capacity measures: Capacity measures look at the ability of a group-such as a program-to carry out a service such as a health screening, education program or surveillance activities. These measures look at the group's infrastructure or available resources to conduct an activity.

• Cause of Death: Any condition that leads to or contributes to death and is classifiable according to the International Classification of Diseases.

• CDC: The Centers for Disease Control and Prevention. www.cdc.gov

• Coalition: A group of individuals and/or organizations that join together for a common purpose.

• Communicable Disease: Measures within this category include diseases that are usually transmitted through person to person contact or shared use of contaminated instruments/materials. Many of these diseases can be prevented through the use of protective measures, such as a high level of vaccine coverage of vulnerable populations. This is a category of data recommended for collection in the Community Health Status Assessment.

• Community: The aggregate of persons with common characteristics such as geographic, professional, cultural, racial, religious, or socio economic similarities; communities can be defined by location, race, ethnicity, age, occupation, interest in particular problems or outcomes, or other common bonds.

• Community Assets: Contributions made by individuals, citizen associations, and local institutions that individually and/or collectively build the community's capacity to assure the health, well being, and quality of life for the community and all its members.  

• Community Collaboration: A relationship of working together cooperatively toward a common goal. Such relationships may include a range of levels of participation by organizations and members of the community. These levels are determined by: the degree of partnership between community residents and organizations, the frequency of regular communication, the equity of decision making, access to information, and the skills and resources of residents. Community collaboration is a dynamic, ongoing process of working together, whereby the community is engaged as a partner in public health action.

• Community Health: A perspective on public health that assumes community to be an essential determinant of health and the indispensable ingredient for effective public health practice. It takes into account the tangible and intangible characteristics of the community, its formal and informal networks and support systems, its norms and cultural nuances, and its institutions, politics, and belief systems.

• Community health assessment: The Community Health Assessment is part of a strategic plan that describes the health of the community by collecting, analyzing and using data to educate and mobilize communities, develop priorities, garner resources, and plan actions to improve public health (Working Definition at New York State Department of Health). Assessment is the ongoing process of identifying what needs to be done for improving the health of its people . Assessment: the process of regularly and systematically collecting, assembling, analyzing, and making available information on the health needs of the community, including statistics on health status, community health needs, and epidemiologic and other studies of health problems. Assessment is one of the three core functions of public health agencies as identified by the Institute of Medicine.

• Community Health Improvement Process: The community health improvement process involves an ongoing collaborative, community wide effort to identify, analyze, and address health problems; assess applicable data; develop measurable health objectives and indicators; inventory community health assets and resources; identify community perceptions; develop and implement coordinated strategies; identify accountable entities; and cultivate community ownership of the entire process.

• Community health needs: Are traditionally defined as the gaps and deficiencies identified through a community health assessment that needs to be addressed. However, there is increasing recognition that gaps and deficiencies must be balanced with a recognition of building on strengths identified in the community.

• Community Health Profile: A comprehensive compilation of measures representing multiple categories that contribute to a description of health status at a community level and the resources available to address health needs. Measures within each category may be tracked over time to determine trends, evaluate health interventions or policy decisions, compare community data with peer, state, nation, or benchmark measures, and establish priorities through an informed community process. .  

• Community health status: Health status in a community is measured in terms of mortality (rates of death within a population) and morbidity (the incidence and prevalence of disease). Mortality may be represented by crude rates or age-adjusted rates (AAM); by degree of premature death (Years of Productive Life Lost: YPLL); and by cause (disease--cancer and non-cancer or injury--intentional, unintentional). Morbidity may be represented by age-adjusted (AA) incidence of disease.

• Community Partnerships: A continuum of relationships that foster the sharing of resources, responsibility, and accountability in undertaking activities within a community. . A cooperative relationship formed between two or more organizations to achieve a shared goal or pursue a common interest.

• Community Support: Actions undertaken by those who live in the community that demonstrate the need for and value of a healthy community and an effective local public health system. Community support often consists of, but is not limited to, participation in the design and provision of services, active advocacy for expanded services, participation at board meetings, support for services that are threatened to be curtailed or eliminated, and other activities that demonstrate that the community values a healthy community and an effective local public health system.

• Constituency: Organizations and individuals that have an interest in the activities performed by the public health organization. Constituencies are often defined to include clients of public health programs, staff, community residents, policymakers, governing board members, health related organizations and professionals in the community, and area businesses and employers.

• Constituency development: The ongoing identification and involvement of individuals and organizations in the process of applying community resources to identified community health priorities. Constituency building is the process of establishing collaborative relationships among the LPHS and all current and potential constituents.

• Constituents of the LPHS: All persons and organizations who directly contribute to or benefit from improved community health status; including members of the public served by the LPHS, the government bodies it represents, and other health, environmental, and non health related organizations in the community.

• Continuing education and training: Work extension opportunities (i.e., bridging courses or cross-training experiences [distance learning?]), workshops, seminars, conferences, and other formal and informal educational opportunities. These activities are intended to strengthen, update, and add to the professional knowledge and skills of employees in fields of interest to the LPHS. .

• Contributing Factors (Direct and Indirect):Those factors that, directly or indirectly, influence the level of a risk factor (determinant). A risk factor (causative factor) that is associated with the level of a determinant. Direct contributing factors are linked with the level of determinants; indirect contributing factors are linked with the level of direct contributing factors.

• Core Public Health Functions: Activities regarded as essential elements of public health practice at local, state and national levels. The Institute of Medicine identified three core functions - assessment, policy development and assurance - in the 1988 review of the U.S. public health system in "The Future of Public Health".

• Core Indicators-MAPP: Data elements that MAPP recommends all communities collect and track. The core indicators have a higher priority based on the critical nature of the data, potential for comparative value, and relevance to most communities. . An element used to measure health status, risk or outcome. A measure of health status or a health outcome.

• Core public health competencies: Are defined as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively on assessment, policy development and assurance.

• Credentialling: An activity involving the establishment of specific requirements and the evaluation of an individual's qualifications for entry into a particular status. Licensure, certification, registration, and education are examples of credentialling procedures.

• CSTE: The Council of State and Territorial Epidemiologists. www.cste.org

• Cultural competence: A set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups and individuals. This competence requires a willingness to draw on the community-based values traditions, and customs to work with knowledgeable persons of and from the community in developing targeted interventions and communications. The ability to communicate acceptance, understanding, and responsiveness to the needs and concerns of members of diverse cultural populations. A thorough knowledge of the values, traditions, and customs of diverse cultures is often required to communicate effectively with members of these cultures.

• Death, Illness, and Injury: Health status in a community is measured in terms of mortality (rates of death within a population) and morbidity (rates of the incidence and prevalence of disease). Mortality may be represented by crude rates or age-adjusted rates (AAM); by degree of premature death (Years of Productive Life Lost or YPLL); and by cause (disease - cancer and non-cancer or injury - intentional, unintentional). Morbidity may be represented by age-adjusted (AA) incidence of cancer and chronic disease. This is a category of data recommended for collection within the Community Health Status Assessment.

• Demographic Characteristics: Demographic characteristics include measures of total population as well as percent of total population by age group, gender, race and ethnicity, where these populations and sub-populations are located, and the rate of change in population density over time, due to births, deaths and migration patterns. This is a category of data recommended for collection within the Community Health Status Assessment. . Characteristic data such as size, growth, density, distribution, and vital statistics, that are used to study human population. Demographic characteristics of your jurisdiction include measures of total population as well as percent of total population by age group, gender, race and ethnicity, where these populations and sub populations are located, and the rate of change in population density over time, due to births, deaths and migration patterns. .

• Determinants (or Risk Factors): Direct causes and risk factors which, based on scientific evidence or theory, are thought to influence directly the level of a specific health problem. . Broad causal factors involved in influencing health and illness, including social, economic, genetic, perinatal, nutritional, behavioral, and environmental characteristics. A primary risk factor(causative factor)associated with the level of health problem:i.e., the level of the determinant influences the level of the health problem.

• Dialogue: The exchange or interaction between people that develops shared understanding as the basis for building trust, fostering a sense of ownership, facilitating genuine agreement, and enabling creative problem solving.

• Distance learning: A system and a process that connects learners with distributed learning resources characterized by: separation of place or time between instructor and learner, among learners, or between learners and learning resource and interaction between the learner and the instructor, among learners, or between learners and learning resources conducted through one or more media. Use of electronic media is not required. (Healthy People 2010, chapter 23-21).

• Effectiveness: The improvement in health outcome that a strategy can produce in typical community based settings. . The extent to which a program or other intervention produces intended outcomes in actual practice settings rather than under optimal conditions. The improvement in health outcome that a strategy can produce in typical community-based settings. Also, the degree to which objectives are achieved.

• Emergency response plan: A document describing the role of one or more LPHS partners in the event of public health emergencies. .

• Environment: The totality of circumstances where individuals live, work, learn, and play. .

• Environmental Equity: The distribution and effects of environmental problems and the policies and processes to reduce differences in those who bear environmental risks. In contrast to environmental racism, equity includes consideration of the disproportionate risk burden placed on any population group, as defined by gender, age, income, and race. .)

• Environmental health: The quality of our physical environment, including air, water, and food, directly impacts health and quality of life. Exposure to environmental substances such as lead or hazardous waste increase risk for preventable disease. The application of multiple scientific disciplines to investigate the relationship between environmental factors and human health, and to prevent adverse health events that result from environmental exposures. The interrelationships between people and their environment that promote human health and well being and foster a safe and healthful environment.

• Environmental Health Indicators: The physical environment directly impacts health and quality of life. Clean air and water, as well as safely prepared food, are essential to physical health. Exposure to environmental substances, such as lead or hazardous waste, increases risk for preventable disease. Unintentional home, workplace, or recreational injuries affect all age groups and may result in premature disability or mortality. This is a category of data recommended for collection within the Community Health Status Assessment. .

• Environmental Justice: The fair treatment and meaningful involvement of all people, regardless of race, ethnicity, culture, income or education level with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. Environmental justice seeks to ensure that no population is forced to shoulder a disproportionate burden of the negative human health and environmental impacts of pollution or other environmental hazards. .

• Environmental Risk: The likelihood of eating, drinking, breathing, or contacting some unhealthy factor in the environment and the severity of the illness that may result; the probability of loss or injury; a hazard or peril.

• Epidemiology: "The study of the distribution and determinants of health related states or events in specified populations, and the application of this study to control of health problems." (Last 1988 ) .The study of the distribution of determinants and antecedents of health and disease in human populations; the ultimate goal is to identify the underlying causes of a disease and then apply findings to disease prevention and health promotion. The study of disease mechanisms and health processes in populations, including disease etiology, disease transmission, disease prevention, and disease control. The discipline of epidemiology focuses on the interaction of host factors, disease agents, and environmental conditions in determining disease transmission and progression.

• Essential public health services: The services identified in Public Health in America: monitoring health status; diagnosing and investigating health problems; informing, educating, and empowering people; mobilizing community partnerships; developing policies and plans; enforcing laws and regulations; linking people to needed services; assuring a competent workforce; conducting evaluations; and conducting research. (Healthy People 2010, chapter 23-21) .A descriptive categorization of core activities used by public health organizations and professionals in carrying out population-based health promotion and disease prevention efforts. The categorization, identified by a work group convened by the U.S.Department of Health and Human Services, includes 10 essential services. A formulation of the processes used in public health to prevent epidemics and injuries, protect against environmental hazards, promote healthy behaviors, respond to disasters, and ensure quality and accessibility of health services;10 essential services have been identified:-monitoring health status to identify community health problems,-diagnosing and investigating health problems and health hazards in the community,-informing, educating, and empowering people about health issues,-mobilize community partnerships to identify and solve health problems,-developing policies and plans that support individual and community health efforts,-enforcing laws and regulations that protect health and ensure safety,-linking people to needed personal health services and ensuring the provision of health care when otherwise unavailable,-ensuring a competent public health and personal health care work force,-evaluating effectiveness accessibility, and quality of personal and population-based health services,-research for new insights and innovative solutions to health problems.A list of ten activities that identify and describe the core processes used in public health to promote health and prevent disease. The framework was developed in 1994. All public health responsiblities (whether conducted by the local public health agency or another organization within the community) can be categorized into one of the services. .

• Ethnicity: The classification of a population that shares common characteristics, such as religion, traditions, culture, language, and tribal or national origin. .

• Evaluation: A systematic approach to determine whether program objectives are being met. (Brownson, RC, Baker EA, and Novick, LF. Community-based prevention: programs that work. Gaithersburg, MD: Aspen Publishers, Inc.: 1999) . The process of critically examining the inputs, processes, outputs, and outcomes of a program or other intervention-usually in relation to established goals, objectives, and standards-to determine its operational strengths and weaknesses. Evaluations produce information about which programs work and also which program componenets work most effectively. Information obtained from evaluations is most often used for program appraisal, management, and improvement.  

• Evaluation of the local public health system: An assessment of the linkages between population based health services and personal health care, as well as the identification of lapses in coordinated performance as defined by measurable performance indicators. .

• Evaluation of personal health care services: An assessment of the accessibility, quality, and effectiveness of personal health services offered within the LPHS jurisdiction against predetermined performance objectives. The evaluation includes objective measurements of services and inputs from community residents regarding satisfaction with personal health care. .

• Evaluation of population based health services: An assessment of the accessibility, quality, and effectiveness of services offered by LPHS agencies or their contracted agents against pre determined performance objectives. Evaluation of population based services, including those provided by contract, must be as rigorously evaluated as other types of health services. The evaluation uses objective measures of services that are based on established criteria for performance and input from community residents regarding satisfaction with population based services.

• Events: Forces of change that are one time occurrences. Examples of events include the closing of a hospital, a natural disaster, or the passage of a piece of legislation. .  

• Exposure: The amount of a stressor that an organism contacts over a certain period of time. .

• Extended Indicators: Additional indicators from which communities may select to explore issues of importance. .

• External cause of death: Death caused by accidents and adverse effects. These were called AE@ codes in ICD-9. The causes of death are spelled out in greater detail in ICD-10.

• Forces: A broad all encompassing category that includes trends,events, and factors.

• Geocode: Addresses matched and assigned to a corresponding latitude and longitude (Healthy People 2010, chapter 23-22) . The process of assigning geographic location information to attribute data that are to be used for analytic purposes.

• Geographic information system (GIS): Combines modern computer and supercomputing digital technology with data management systems to provide tools for the capture, storage, manipulation, analysis, and visualization of spatial data. Spatial data contains information, usually in the form of a geographic coordinate system, that gives data location relative to the earth=s surface. These spatial attributes enable previously disparate data sets to be integrated into a digital mapping environment. (Healthy People 2010, chapter 23-22) . Geographic information systems that are computer based processes for capturing, lining, summarizing, and analyzing data containing geographical location information. These systems are particularly useful in supporting visual analysis and communication of data using maps that display the geographic distribution of data. .

• Goals: Broad, long term aims that define a desired result associated with identified strategic issues. . For public health programs, goals are general statements expressing a program's aspirations or intended effect on one or more health problems, often stated without time limits.

• Governmental presence in health at the local level: A concept that calls for the assurance that necessary services and minimum standards are provided to address priority community health problems; this responsibility ultimately falls to local government, which may utilize local public health agencies or other means for its execution.

• Guide to Community Preventive Services: A compilation of evidence based recommendations for community prevention services developed by a 15 member, non Federal panel of experts. The initial recommendations from the Guide were published in a January, 2000 supplement to the American Journal of Preventive Medicine.

• Health: A dynamic state of complete physical, mental, spiritual and social wellbeing and not merely the absence of disease or infirmity.(WHO=S New Proposed Definition. 101st Session of the WHO Executive Board, Geneva, January 1998. Resolution EB101.R2) . The state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. It is recognized, however, that health has many dimensions(anatomical, physiological, and mental) and is largely culturally defined. The relative importance of various disabilities will differ depending on the cultural milieu and on the role of the affected individual in that culture. Most attempts at measurement have been assessed in terms of morbidity and mortality.

• Health Assessment: The process of collecting, analyzing, and disseminating information on health status, personal health problems, population groups at greatest risk, availability and quality of services, resource availability, and concerns of individuals. Assessment may lead to decision making about the relative importance of various public health problems. .

• Health belief model: A theory stating that the likelihood of taking a preventive health action will be determined by one's perceived susceptibility (the individual's perception about his or her own likelihood of contracting a condition); perceived severity (the seriousness the individual would assign to such a condition were it to happen);perceived benefits of the proposed action (the individual=s perception about the likelihood that a given action would succeed in reducing or eliminating harm); and perceived barriers (factors that would interfere with the individuals taking the desired action). (Last, JM, Wallace, R. Maxcy-Rosenau-Last, Public Health and Preventive Medicine, 14th Ed., Norwalk, CT: Appleton & Lange: 1998.)

• Health Care Provider: A person, agency, department, unit, subcontractor, or other entity that delivers a health related service, whether for payment or as an employee of a governmental or other entity. Examples include hospitals, clinics, free clinics, community health centers, private practitioners, the local health department, etc. .

• Health communication: The art and technique of informing, influencing, and motivating individual, institutional, and public audiences about important health issues. The scope of health communication includes disease prevention, health promotion, health care policy, and the business of health care, as well as enhancement of the quality of life and health of individuals within the community. (Ratzan, SC, ed. Health communication, challenges for the 21st century. American Behavioral Scientist 38, 1994.) .

• HCFA: The U.S. Health Care Financing Administration. www.hcfa.gov . The government agency within the U.S.Department of Health and Human Services that directs the Medicare and Medicaid programs(Titles XVIII and XIX of the Social Security Act) and conducts the research to support those programs.

• Health education: Any planned combination of learning experiences designed to predispose, enable, and reinforce voluntary behavior conducive to health in individuals, groups or communities. (Green, LW and Kreuter, MW. Health Promotion Planning: An Educational and Ecological Approach, 3rd ed. Mountain View, CA: Mayfield Publishing Company, 1999. Healthy People 2010, chapter 7-28.) . Any combination of learning opportunities designed to facilitate voluntary adaptations of behavior (in individuals, groups, or communities) conducive to good health. Health education encourages positive health behaviorv

• Health Hazard: The probability of an occurrence of a disaster caused by a natural phenomenon(e.g., earthquake, tropical cyclone), by failure of manmade technology(e.g., nuclear reactor meltdown, industrial explosion), or by uncontrolled human activity(e.g., warfare, overgrazing). .

• Health Problem: A situation or condition for people and their environment measured in death, disease, disability, or risk that is believed to persist in the future and is considered undesirable. . A situation or condition of people (expressed in health outcome measures such as mortality, morbidity, or disability) that is considered undesirable and is likely to exist in the future.

• Health promotion: Any planned combination of educational, political, regulatory, and organizational supports for actions and conditions of living conducive to the health of individuals, groups, or communities. (Green, LW and Kreuter, MW. Health Promotion Planning: An Educational and Ecological Approach, 3rd ed. Mountain View, CA: Mayfield Publishing Company, 1999. Healthy People 2010, chapter 7-28.) . An intervention strategy that seeks to eliminate or reduce exposures to harmful factors by modifying human behaviors. Any combination of health education and related organizational, political, and economic interventions designed to facilitate behavioral and environmental adaptations that will improve or protect health. This process enables individuals and communities to control and improve their own health. Health promotion approaches provide opportunities for people to identify problems, develop solutions, and work in partnerships that build on existing skills and strengths. Any combination of educational, organizational, environmental, and economic interventions designed to encourage behavior and conditions of living that are conducive to health.    

• Health Promotion Activities: Any combination of education and organizational, economic, and environmental supports aimed at the stimulation of healthy behavior in individuals, groups, or communities. .

• Health Plan Employer Data and Information Set (HEDIS): A set of standardized performance measures designed to assure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. It is sponsored, supported, and maintained by the National Committee for Quality Assurance (NCQA). .

• Health resources: Factors associated with health system capacity, which may include the number of licensed and credential health personnel and the physical capacity of health facilities. In addition, this domain includes measures of access, utilization, cost and quality of health care and prevention services. Service delivery patterns and roles of public and private sectors as purchasers and/or providers may also be relevant. .

• Health Resource Availability: Factors associated with health system capacity, which may include both the number of licensed and credentialed health personnel and the physical capacity of health facilities. In addition, the health resources category includes measures of access, utilization, and cost and quality of health care and prevention services. Service delivery patterns and roles of public and private sectors as payers and/or providers may also be relevant. This is a category of data recommended for collection within the Community Health Status Assessment.

• HRSA: The Health Resources and Services Administration. www.hrsa.gov .

• Health Status Indicator: A single measure that purports to reflect the health status of an individual or defined group. (

• Health Status objectives: Established goals and specific targets for health improvement at the population level. Usually objectives are linked to specific health status measures that are used to track progress toward the goal.

• Healthy People 2010: Healthy People is a national health promotion and disease prevention initiative that brings together national, state, and local government agencies; nonprofit, voluntary, and professional organizations; businesses;communities; and individuals to improve the health of all Americans, eliminate disparities in health, and improve years and quality of healthy life. In Healthy People 2010, 467 health promotion and disease prevention objectives are identified for achievement by the year 2010. . An update of the Healthy People 2000 document, establishing national health promotion and disease prevention goals and objectives to be accomplished by the year 2010. . The national disease prevention and health promotion agenda that includes some 300 national health objectives to be achieved by the year 2000, addressing improved health status, risk reduction, and utilization of preventive health services.

• Incidence: Rate of occurrence of new cases of a specified condition in a specified population within some time interval, usually a year. . A measure of the disease or injury in the population, generally the number of new cases occurring during a specified time period. . The number of new cases of disease occurring in a defined population during a specified time period.

• Indicator: A measurement that reflects the status of a system. Indicators reveal the direction of a system (a community, the economy, the environment), whether it is going forward or backward, increasing or decreasing, improving or deteriorating, or staying the same. . A measure of health status or a health outcome. An element used to measure health status, risk, or outcome.

• Infant Mortality Rate: A death rate calculated by dividing the number of infant deaths during a calendar year by the number of live births reported in the same year. It is expressed as the number of infant deaths per 1,000 live births. . The annual number of live-born infants who die during their first year of life, expressed per 1,000 live births. The number of live-born infants who die before their first birthday per 1,000 live births; often broken into two components, neonatal mortality (deaths before 28 days per 1,000 live births) and postneonatal mortality (deaths from 28 days through the rest of the first year of life per 1,000 live births).

• Infectious disease measures: The incidence of diseases that are usually transmitted through person to person contact or shared use of contaminated materials. Many of these diseases can be prevented through a high level of vaccine coverage of vulnerable populations, or though the use of protective measures, such as condoms for the prevention of sexually-transmitted diseases. .

• Injury: Injuries can be classified by the intent or purposefulness of occurrence in two categories, intentional and unintentional injuries. Intentional injuries are ones that are purposely inflicted and often associated with violence. These include child abuse, domestic violence, sexual assault, aggravated assault, homicide, and suicide. Unintentional injuries include only those injuries that occur without intent of harm and are not purposely inflicted.

• International Classification of Disease 10th Revision Clinical Modification (ICD-10-CM): The ICD-10-CM is based on and is completely comparable with the International Classification of Diseases, Tenth Revision. The ICD-10 is used to code mortality data. Its purpose is to provide a common language, specifically number and letter codes, for identifying illnesses, injuries and causes of death. This enables communities, health care organizations, insurance companies, regulatory agencies, etc. to compare rates of disease and injury, as well as allowing comparison of cost and pricing practices.  

• Laboratory support: The ability to produce timely and accurate laboratory results for diagnostic and investigative public health concerns. The actual testing may be performed outside the local public health system;however, the public health system retains the responsibility for ensuring that proper testing and timely results are available to the community. .

• Local Control: The ability of a jurisdiction to adopt and enforce its own rules, policies, and procedures related to carrying out its functions. .

• Local Health Department: An administrative or service unit of local or state government concerned with health and carrying some responsibility for the health of a jurisdiction smaller than the state. . Functionally, a local(county, multicounty, municipal, town, other) health agency, operated by local government, often with oversight and direction from a local board of health, that carries out public health's core functions throughout a defined geographic area. A more traditional definition is an agency serving less than an entire state that carries some responsibility for health and has at least one full time employee and a specific budget.

• Local Public Health System: The human, informational, financial, and organizational resources, including public, private, andvoluntary organizations and individuals, that contribute to the public=s health. . A system that includes all public, private, and voluntary entities, as well as individuals and informal associations that contribute to the delivery of public health services within a jurisdiction.

• MAPP: Mobilizing for Action through Planning and Partnerships. A community wide strategic planning tool developed by NACCHO and CDC. .

• Maternal and Child Health: A category focusing on birth data and outcomes as well as mortality data for infants and children. Because maternal care is correlated with birth outcomes, measures of maternal access to, and/or utilization of, care is included. One of the most significant areas for monitoring and comparison relates to the health of a vulnerable population: infants and children. Births to teen mothers is a critical indicator of increased risk for both mother and child. This is a category of data recommended for collection within the Community Health Status Assessment. .

• Maternal and child health measures: Birth data and outcomes as well as mortality data for infants and children. Because maternal care is correlated with birth outcomes, measures of maternal access to, and/or utilization of, care is included. Births to teen mothers is a critical indicator of increased risk for both mother and child.

• Mentoring: The pairing of more experienced with less experienced staff to provide the latter with needed advice, skills development, and other career resources. .

• Morbidity: Illness or lack of health caused by infection, dysfunction, or injury. Most illnesses are not reportable to the board of health. Available morbidity data is often not population based and is partially available from either public or private sources. . A measure of disease incidence or prevalence in a given population, location, or other grouping of interest. Characteristics of disease severity, progression, and burden, including the disease's biomedical, functional, and psychological effects on health status. .

• Mortality: A measure of the incidence of deaths in a population. . Expresses the number of deaths in a population within a prescribed time. Mortality rates may be expressed as crude death rates(total deaths in relation to total population during a year) or as death rates specific for diseases and sometimes for age, sex, or other attributes (e.g., the number of deaths from cancer in white males in relation to the white male population during a given year).   

• NACCHO: National Associationof County and City Health Officials.www.naccho.org . National Association of County and City Health Officials, a membership organization composed of the administrators of local public health agencies throughout the nation. .

• NAHDO: The NationalAssociation of Health DataOrganizations. www.nahdo.org .

• NALBOH: National Associationof Local Boards of Health. www.nalboh.org . National Association of Local Boards of Health, a membership organization representing individuals appointed to serve on governing and advisory boards for local public health agencies. .

• NAPHSIS: The NationalAssociation for Public HealthStatistics and Information Systems.www.naphsis.org .

• NCHS: The NationalCenter for Health Statistics. www.nchs.gov .

• NDI: The NationalDeath Index is a central computerized index of death record information (beginning with 1979 deaths) compiled by NCHS from records submitted by state vital statistics offices.The index is used by medicalresearchers in determining whether persons in their studies have died and, if so, providesthe names of the states in which those deaths occurred, the datesof death, and the corresponding death certificate numbers. .

• National Public Health LeadershipInstitute: A program supportedby the Public Health PracticeProgram Office of the CDC and administered through the University of California State and Regional Leadership Development Programs are supported in academic institutions in several areas, targeting health departmentprofessionals, community leaders,leaders from managed care and preventive medicine, academics,and other health officials. State/regional leadership programs are currently available or being developed in 21 states. .

• NHTSA: The National Highway Traffic Safety Administration is a division of the U.S.Department of Transportation. www.nhtsa.gov .

• NIOSH: The National Institute for Occupational Safety and Health is an agency within CDC. www.cdc.gov/niosh . Supports scientific investigations of workplace health threats and designs prevention and control programs to improve safety and wellness and reduce health risks within occupational settings.  

• Objectives: There are three types of objectives cited in MAPP. . Targets for achievement through interventions. Objectives are time limited and measurable in all cases. Various levels of objectives for an intervention include outcome, impact, and process objectives. .

• Outcome Measures:The results of the services. Outcome means a change, or lack of change, in the health of a defined population that is related to a public health intervention - such as the tests, investigations, or educational services you offered as part of your process.

• Outcome Objective: An outcomeobjective is long term (greater than 3 years)and measurable. The objects of interestare mortality, morbidity, and disability. . The level to which a health problem is to be reduced as a result of an intervention. Outcome objectives are often long term(two to five years), measurable, and realistic.

• Impact Objective: An impact objective is short term (less than three years) and measurable. The object of interest is on knowledge, attitudes, or behavior.

• Performance Measures:The specific quantitative and/or qualitative representation of a capacity, process, or outcome deemed relevant to the assessment of performance.

• Performance Indicators:Summarize the focus (e.g., workforce capacity, customer service) of performance goals and measures, often used for communication purposes and preceding the development of specific measures.

• Performance Management:A systematic process used to continually address the quality of services through data-driven decision making. Its primary goal is to create agreement and understanding about what is to be achieved in your programs, and then developing quality improvement strategies to increase the chance that it will indeed be achieved. Performance management includes the following components: Performance standards, performance measures, reporting of progress, and quality improvement.(5,6 )

• Performance Management System:The continuous use of performance standards, performance measures, performance reporting and quality improvement so that they are integrated into an agency's core operations. Performance management can be carried out at multiple levels, including the program, organization, community, and state levels.

• Performance Standards: A generally accepted, objective standard of measurement such as a rule or guideline against which an organization's level of performance can be compared. A performance standard establishes the level of performance expected. It can be descriptive or numerical and may be developed based on national, state, or scientific guidelines; by benchmarking against similar organizations; and/or reflect the public's or organization's expectations.

• Primary data: Information that is collected first-hand by those conducting the assessment. This type of data would include original information gathered through surveillance activities, focus groups, interview and observations.

• Process Objective: A process objective is shortterm and measurable. The object of interest is thelevel of professional practice in the completion of the methods establishedin a Community Health Plan. Process objectives may be evaluated by audit, peerreview, accreditation,certification, oradministrative surveillance.Objects of evaluation may include adherence to projected timetables, production, distribution, and utilization of products, and financial audits. .

• PACE-EH: Protocol for Assessing Community Excellence in Environmental Health. A community environmental assessment and planning tool developed by NACCHO to assist local health departments and their communities in prioritizing environmental health risks. .

• Partnership: A cooperative relationship formed between two or more organizations to achieve a shared goal or pursue a common interest.

• Personal Health Services: Services provided to individuals, such as those provided by local health department maternal and child health programs. . Health services delivered to individuals, including primary care, specialty care, hospital care, emergency care, and rehabilitative care. Personal health services may include health promotionand health education services that are delivered on an individual basis. .

• Policy development: The means by which problem identification, technical knowledge of possible solutions, and societal values converge to set a course of action(IOM, 1988). As such, policy development is an outgrowth of the assessment and monitoring activities described with respect to all other Essential Services. Policy development is not synonymous with the development of laws, rules,and regulations (which are the focus of Essential Service #6).Laws, rules, and regulations maybe adopted as tools among others to implement policy. Policy development is a process that enables informed decisions to be made concerning issues related to the public's health. One of public health's three core functions. Policy development involves serving the public interest in the development of comprehensive public health policies by promoting the use of the scientific knowledge base in decision making and by leading in developing public health policy. . Processes by which public health organizations formulate policies and plans to address priority health issues for the populations they serve, and advocate for the adoption and implementation of these policies by legislative and regulatory bodies and by private sector institutions. Policy development processes typically involve planning and priority-setting efforts that include broad participation by community members as well as health-related professionals and institutions.

• Population health registries: Information systems which maintaincurrent, unduplicated counts ofindividual health related events for a defined population. .

• Process measures: Process measures look at the activities being performed by individuals or groups as part of the provision of public health services which will likely influence overall health outcomes. In public health, things like meeting with community groups or performing health screenings are processes that can be measured.

• Public Health: The mission of public health is to fulfill society's desire tocreate conditions so that people can be healthy (Institute of Medicine, 1988). . Activities that society undertakes to assure the conditions in which people can be healthy. This includes organized community efforts to prevent, identify, and counter threats to the health of the public.  

• Public Health Director: The person responsible for the total management ofthe health department. This person is appointed by the governing authority,often the board of health. Thepublic health director is responsible for the day to day operations of the health department and its component institutions,often sets policy or implements policies adopted by the board of health, and is responsible for fiscal and programmatic matters. .

• PHF: The Public Health Foundation. www.phf.org .

• Public health leadership: This isdemonstrated by both individuals andorganizations that are committed to the health of the community.Leadership defines key valuesand guides action; participates in scanning the environment both internal and external for information critical to implementing the public health mission; keeps the public health mission in focus and articulates it clearly; and facilitates the creation ofa vision of excellence and a compelling scenario of a preferred future. Through shared information and decision making, publichealth leadership facilitatesthe empowerment of others to create and implement plans to enact the shared vision and to participate actively in the process of community health improvement. .(WGTOOL_9.6 6/99)

• Public health leadership institutes: National,regional, state, and local level human resource development programs providing leadership education and experiential learning to public health personnel and their partnersin order to strengthen public health leadership. .

• Public Participation: The involvement of citizens in governmental decision making processes. Participation ranges from being given notice of public hearings to being actively included in decisions that affect communities. See community collaboration. .

• Public Health Services: The provision of services to fulfillthe mission of public health incommunities. See EssentialPublic Health Services. . U.S. Public Health Service as reorganized in 1996; now includes the Office of Public Health and Science(whic is headed by the Assistant Secretary for Health and includes the Office of the Surgeon General), eight operating agencies(Health Resources and Service Administration, Indian Health Service, Centers for Disease Control and Prevention, National Institutes of Health, Food and Drug Administration, Substance Abuse and Mental Health Services Administration, Agency for Toxic Substances and Disease Registry, and Agency for Health Care Policy and Research), and the Regional Health Administrators for the 10 federal regions of the country.

• Public Health System: The network of organizations and professionals that participate in producing public health serves for a defined population or community. This network includes governmental public health agencies as well as relevant health care and social service providers, community based organizations, and private institutions with an interest in population health.

• Quality Improvement:Quality Improvement is a continuous and ongoing effort and culture to best achieve measurable improvements in the efficiency, effectiveness, quality, performance, and outcomes of services and systems with the goal of improving the health of their communities. The activities in a QI effort include using data for decisions to improve policies, programs, processes and outcomes; managing changes using QI teams and cycles (i.e. Plan Do Study Act (PDSA)); and creating a collaborative learning environment.

• Qualitative Data: Qualitative data is non-numerical, and is often presented in narrative form. Examples are descriptions of services or programs based on participant observation, barriers to care described by participants or providers.

• Quantitative Data: Is based on numbers and often are called "statistics". Examples include cancer deaths, infant mortality rates, participants responses sorted in 'yes' or 'no' categories in surveys.

• Quality of Life: A construct that connotes an overall sense of well-being when applied to an individual and a supportive environment when applied to acommunity (Moriarty, 1996). While some dimensions of quality of life can be quantified using indicators that research has shown to be relatedto determinants of health and community well being, other valid dimensions of QOL include the perceptions of community residents about aspects of their neighborhoods and communities that either enhance or diminish their quality oflife. This is a category of data recommended for collection within the Community Health Status Assessment.

• Research: A systematic investigation, including research development, testing, and evaluation, designed to develop or contribute togeneralizable knowledge.(Healthy People 2010, chapter 23-20).

• Registration area: The United States has registration areas for recording vital events. In general,registration areas correspond to states and territories with two separate registration areas for the District of Columbia and New York City.

• Reporting of Progress:Analyzing the data gathered, developing a reporting cycle, and providing the information to managers, staff, policy makers, and constituents.

• Risk Assessment: The scientific process of evaluating adverse effects caused by a substance, activity,lifestyle, or natural phenomenon.Risk assessment is the means by which currently available information about public health problems arising in the environment is organized and understood. A systematic approach to quantifying the risks posed to individuals and populations by environmental pollutants and other potentially harmful exposures.

• Risk Communication: An interactive process of sharing knowledge and understanding so as to arrive at well informed risk managementdecisions. The goal is a better understandingby experts and nonexperts alike of the actual and perceived risks, the possible solutions, and the related issues and concerns.

• Risk Factors: See Determinants. A factor associated with the occurrence of disease. This is an association and not necessarily causal. A behavior or condition that, on the basis of scientific evidence or theory, is thought to influence susceptibility to a specific health problem.

• Risk Management: The goal of risk management is to direct limited available resources to those areas and strategies where the greatest amount of risk can be reduced for the least amount of resources. Greatest risk@ can be defined in a number of different ways, it is a value-laden process.

• Secondary Data: Information that has already been collected by someone else. Often secondary data already have been analyzed and disseminated and can be used without any additional calculations. An example of this available in County Profile or other sources. Sometimes secondary data with some analysis completed e.g. death certificate data has to be combined with population estimates to get rates, or may be available in unanalyzed or raw form.

• Sentinel events: Cases of unnecessary disease, disability, or untimely death that could be avoided if appropriate and timely preventive services ormedical care were provided.These include vaccine preventableillness, avoidable hospitalizations(those patients admitted to thehospital in advanced stages of disease which potentially could have been detected or treated earlier)and late stage cancer diagnosis. Sentinel events may alert the community to health system problems such as inadequate vaccine coverageor lack of primary care and/or screening.

• Sentinel Health Event: Sentinel events are those cases of unnecessary disease, disability, or untimely death that could be avoided if appropriate and timely medicalcare or preventive services wereprovided. These include vaccine-preventableillness, late stage cancer diagnosis, andunexpected syndromes or infections.Sentinel events may alert the community to health system problems such asinadequate vaccine coverage, lack of primary care and/or screening,a bioterrorist event, or the introduction of globally transmitted infections. This is a category of data recommended for collection within the Community Health Status Assessment.

• Self-Help: The idea of providing for oneself even in the face of other viable alternatives (political, economic, social).

• Social Capital: A Composite measure which reflects both the breadth and depth of civic community (staying informed about community life and participating in its associations) as wellas the public's participationin political life. It is characterized by a sense of social trust and mutualinterconnectedness, which is enhanced over time through positive interaction and collaboration in shared interests.

• Socioeconomic Characteristics: Socioeconomic characteristics include measures that have been shown to affect health status, such as income, education, and employment,and the proportion of the population represented by various levels of these variables. This is a category of data recommendedfor collection within the Community Health Status Assessment. Socioeconomic characteristics that have been shown to affect health status include income, education, and employment,and the proportion of the populationrepresented by various levels ofthese variables.

• Social and Mental Health: This category represents social and mental factors and conditions which directly or indirectly influence overall health status and individual and community quality of life. This is a category of data recommended for collection within the Community Health Status Assessment.

• Social marketing: A discipline that addresses an issue with particular regard to those affected by it(the target audience), considering their perspectives and perceivedwants and needs to develop strategies toward change.(National Cancer Institute.Making health communicationprograms work. Pub. No. NIH 89-1493. Washington, DC: U.S.Department of Health andHuman Services, 1989.). The development and implementation of information dissemination activities designed to influence changes in individual health behavior.

• Social and mental health measures:Social and mental health conditionswhich directly or indirectly influenceoverall health status andindividual and community quality of life.

• Sponsors: Key organizations and individuals that offer strong initialsupport to an initiative.

• SSA: The Social Security Administration. www.ssa.gov.

• Stakeholders: All persons, agencies andorganizations with an investment or stake in the health of the community and the local public health system. This broad definition includes persons and organizations that benefitfrom and/or participate in the delivery of servicesthat promote the public's health and overall well-being. Organizations and individuals that are involved in a specific activity because they participate in producing, consuming, managing, regulating, or evaluating the activity.

• Strategic alignment: A continuousprocess of determining the mission, goals,resources, and objectives of individual entities comprising the LPHS and aligning them with the community healthimprovement process and resulting action plan.

• Strategic Planning: A disciplined effort to produce fundamental decisionsand actions that shape and guide what an organization (or other entity) is,what it does, and why it does it.Strategic planning requires broad scale information gathering, an exploration of alternatives, and an emphasis on the future implications of present decisions.It can facilitate communication and participation, accommodate divergent interests and values, and foster orderly decision making and successful implementation.

• Strategies: Patterns ofaction, decisions, and policies that guide a group toward a vision or goals. Strategies are broadstatements that set a direction.They are pursued through specificactions, i.e., those carried out in the programs and services ofindividual components of the local public health system.

• Surveillance: The systematic collection, analysis,interpretation, and dissemination of health data to assist in the planning, implementation, andevaluation of public health interventions and programs. Systematic monitoring of the health status of a population. The process of collecting health related data that are representative of a population of interest, for use in assessing trends in disease and other health conditions, measuring the prevalence of health risk factors and health behaviors, and monitoring the use of health services.

• Sustainability: The long-term health and vitality of cultural,economic, environmental, and social aspects of a community. Sustainable thinking considersthe connections between various elements of a healthy society, and implies a longertime span (i.e., in decades, instead of years).

• Underlying cause of death: The disease or injury that initiated the train of events leading directly to death, or the circumstances of the accident or violence that produced the fatal injury.

• U.S. Standard Certificates: U.S. Standard Live Birth certificates,Death Certificates, and Fetal Death Reports are revised periodically allowing careful evaluation of each item and addition, modification,and deletion of items. Standard certificates recommended by NCHS are modified in each registration area to serve the needs.Most certificates conform closely in content and arrangement to the standard certificate and most of the certificates contain a minimum basic data set specified by NCHS.

• U.S. Preventive Services TaskForce: A 20 member nonFederalpanel commissioned by the Public Health Service in 1984 to develop recommendations for clinicians on the appropriateuse of preventive interventions,based on a systematic review of evidence of clinical effectiveness. To datethe U.S. Preventive Services Task Force has published two reports.The first was published in 1989 as the Guide to ClinicalPreventive Services. The Guide to Clinical Preventive Services, Second Edition was published in 1996. 

• Values: The fundamentalprinciples and beliefs thatguide a community driven process.These are the central concepts that define how community members aspire to interact. The values provide a basis for action and communicate expectations for community participation.

• Vision: A compelling and inspiring image of a desired and possible future that a community seeks to achieve. A vision states the ideal, establishes a stretch,links explicitly to strategies,inspires commitment, and draws out community values. A vision expresses goals that are worth striving forand appeals to ideals and values that are shared throughout the local public health system.

• Vital events: Live births, deaths, fetal deaths,marriages, divorces, and induced terminations of pregnancy, together with any change in civil status that may occur during an individual's lifetime.

• Vital Statistics: Data derived from certificates andreports of birth, death, fetal death, induced termination ofpregnancy, marriage, (divorce,dissolution of marriage, orannulment) and related reports. Information compiled by state health agencies concerning births, deaths, marriages, divorces, fetal deaths, and abortions.

• Workforce assessment: The process of determining the personnel, training, skills,and competencies needed to achieve communitywide publicand personal health goals.This community processincludes the identification of those available to contributeto providing the essential public health services and their particular strengths and assets.The assessment included the useof performance measures foridentified competencies, the identification of needed professional personnel, and the formulation of plans to address identified work force shortfalls or gaps.

• Workforce standards: The professional and technical requirementsor position qualifications (certifications, licenses,and education) required by law or established by local,state, or federal policy guidelines. These standards are linked to actual job performance through clearly written job descriptions and regular performance evaluations. 

• Years of Potential Life Lost(YPLL): This measure of premature mortality is the numberof years between the age at deathand age 65, that is, the number of years which are "lost" by persons who die before age 65. A measure of the years of life lost from premature death before a specific age (usually 75), which provides a measure of the impact of specific diseases and injuries on the population of interest. A measure of the impact of disease or injury in a population that calculates years of life lost before a specific age (often age 65 or age 75). This approach places additional value on deaths that occur at earlier ages

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