Write a letter to community heathy community health officer requestion him/ her to organize a health awareness program in your locality.
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A Community Health Improvement Process
Many factors influence health and well-being in a community, and many entities and individuals in the community have a role to play in responding to community health needs. The committee sees a requirement for a framework within which a community can take a comprehensive approach to maintaining and improving health: assessing its health needs, determining its resources and assets for promoting health, developing and implementing a strategy for action, and establishing where responsibility should lie for specific results. This chapter describes a community health improvement process that provides such a framework. Critical to this process are performance monitoring activities to ensure that appropriate steps are being taken by responsible parties and that those actions are having the intended impact on health in the community. The chapter also includes a discussion of the capacities needed to support performance monitoring and health improvement activities.
In developing a health improvement program, every community will have to consider its own particular circumstances, including factors such as health concerns, resources and capacities, social and political perspectives, and competing needs. The committee cannot prescribe what actions a community should take to address its health concerns or who should be responsible for what, but it does believe that communities need to address these issues and that a systematic approach to health improve-
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Suggested Citation:"4 A Community Health Improvement Process." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.×
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ment that makes use of performance monitoring tools will help them achieve their goals.
PROPOSING A PROCESS FOR COMMUNITY HEALTH IMPROVEMENT
The committee proposes a community health improvement process (CHIP) 1 as a basis for accountable community collaboration in monitoring overall health matters and in addressing specific health issues. This process can support the development of shared community goals for health improvement and the implementation of a planned and integrated approach for achieving those goals.
A CHIP would operate through two primary interacting cycles, both of which rely on analysis, action, and measurement. The elements of a CHIP are illustrated in Figure 4-1. Briefly, an overarching problem identification and prioritization cycle focuses on bringing community stakeholders together in a coalition, monitoring community-level health indicators, and identifying specific health issues as community priorities. A community addresses its priority health issues in the second kind of CHIP cycle—an analysis and implementation cycle. The basic components of this cycle are analyzing a health issue, assessing resources, determining how to respond and who should respond, and selecting and using stakeholder-level performance measures together with community-level indicators to assess whether desired outcomes are being achieved. More than one analysis and implementation cycle may be operating at once if a community is responding to multiple health issues. The components of both cycles are discussed in greater detail below.
The actions undertaken for a CHIP should reflect a broad view of health and its determinants. The committee believes that the field model (Evans and Stoddart, 1994), discussed in Chapter 2, provides a good conceptual basis from which to trace the multifactorial influences on health in a community. A CHIP must also
1
The CHIP acronym adopted for this report is not unique to the community health improvement process. In a health context, others use it to refer to community health information programs/partnerships/profiles. See, for example, the discussion of MassCHIP—the Massachusetts Community Health Information Profile—in Chapter 5. The committee anticipates that communities will adopt their own designations for their local community health improvement process.
Page 79
Suggested Citation:"4 A Community Health Improvement Process." Institute of Medicine. 1997. Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press. doi: 10.17226/5298.×
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