Community Health Improvement for the Public Health Professional

Article written by Shelley Argabrite, Chief Health Strategist at the Garrett County Health Department

Do people in your community know what health planning is, why it’s attempted and how it can impact their daily lives?  The results from our 2016 Community Health Needs Assessment ¹ let us know too many people in our community weren’t aware of core safety net programs let alone a community health improvement plan. As public health professionals we need to make sure the public is well informed of the available services in the community and clearly communicate how people can become more involved in the process.  Communities are hurting; many struggle to afford adequate essentials like food, shelter, and medical services.  Yet others in the same community are thriving and have a very different quality of life. To accomplish meaningful health improvement planning we need to meet our communities where they are and give everyone an opportunity to participate.

To address the growing disparities candidly we need to understand and appreciate as many perspectives as possible.

-Shelley Argabrite

In Garrett County, this meant changing the way we approached elements of health planning.  We began by defining health planning within the constructs of our health department and the community we serve.  It’s important to consider state and local governance and accreditation status as both aspects may provide frameworks in how health planning activities are operationalized.

The state of Maryland is considered a largely shared state in governance with the local boards of health in every county in Maryland.²  This allows the local health departments to be more nimble and uniquely positioned to tailor systems and approaches that are reflective of the local community.  In Garrett County’s case, I was hired as a health planner to carry out the essential functions of leading the community health assessment and the community health improvement plan after initial Public Health Accreditation was sought through the Public Health Accreditation Board. ³ Since that time, the team has been expanded and preparations are being made to create a Population Health Unit housed within the local health department to lead the effort.

Equity in community engagement is largely supported by the high standards that accompany accreditation.

-Shelley Argabrite

Equitable approaches are woven through the standards and measures set forth by the Public Health Accreditation Board, and by committing to follow those standards, health departments have no other option, and must accept the challenge of improving equity.  As a new health planner, I inherited an existing community health improvement plan and an action plan issued from PHAB within my first week of employment.  The standards to improve equity from PHAB were instrumental in gaining the support needed to innovate and make equity a priority as we moved toward functioning as a high level health department.

If you don’t know, find out.

So, how many people in your community are aware that your health department is involved in conducting a community health assessment or crafting a community health improvement plan?  That was one of the first questions we had to answer for ourselves and the answer caused us to question everything.  We found that only ½ of 1% of our entire county population was aware we had a community health improvement plan. Out of the approximately 150 people that were aware of our health improvement processes, most of them were agency stakeholders.  A turning point in our process was honestly assessing equity within our community, and inherently, addressing the unmistakable need to drastically change our approach.

In a National Community Engagement Analysis Survey conducted at PHIT (Public Health Improvement Training) in Alberqueque, a sample of 100 communities revealed that less than 5% of community members were aware of either a community health assessment or community health improvement plan.

This supports the notion that community engagement is difficult and our agency is not alone in this journey. Inspiration to innovate and drive change toward improving equity is being recognized on national levels with competitive funding opportunities.⁴  Take the time to honestly assess how you approach improving equity and seek ways to improve it. I invite you to consider once again your governance and how the policies in place empower or hinder your ability to be inclusionary in the processes of health planning.  There are many great tools out there, so find one and use it.  As we refine our approaches toward improving equity, take the time to redefine your own operating standards, and make the case for equity conversations in your community. We are called to a higher standard and our communities are depending on our abilities to ignite change by collaborating with everyone!

Additional Resources:

See the Equity Profile designed by the Colorado Department of Public Health & Environment found here https://www.colorado.gov/cdphe/ohe

References

1. Garrett County Health Department 2016 Community Health Assessment. Garrett County Health Department. Oakland, MD: Population Health Unit; 2016 https://mygarrettcounty.com/cha/.
2. http://www.astho.org/Research/Major-Publications/ASTHO-NORC-Governance-Classification-Report/
3. Public Health Accreditation Standards & Measures Version 1.0. Alexandria, VA: Public Health AccreditationBoard; 2011. http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.01.pdf. Accessed July 6, 2017.
4. Public Health National Center for Innovations. Alexandria, VA: PHNCI; 2018. https://phnci.org/journal/phnci-innovation-grant-program

Author: Shelley Argabrite, M.A., Strategic Health Planner, Garrett County Health Department