Assessing Community Health

As we have discussed, an enormous public health effort is underway in much of the world. If we consider direct health care costs, and then the costs of other health and safety promotion measures, this effort encompasses more than ten percent of the economies of the developed world today.

But after more than a century of success in addressing large and urgent health threats – notably sanitation risks and infectious diseases– our international public health effort has more recently begun to show signs of entrenchment, incapacity, and diminishing returns. Our public health system may even be losing ground in the fight against new health threats, and the pursuit of new health opportunities, emerging in the affluence and diversity of post-modern life. For these reasons, our public health system appears increasingly unprepared for progressive health promotion in our new century.

In our view, the diminishing impact of more recent public health efforts and the only partial transferability of earlier public health models are a predictable consequence of the non-scientific factors we have discussed. These factors include excessive orthodoxy and institutional conservatism, the slow uptake of new and more diverse fields of health science, inadequate facility in political and social leadership, and insufficient progressivity in purpose and methods within our public health system.

Underlying these important factors is a too-limited overall health paradigm – one that is historically-derived and focused primarily on threat mitigation – and an insufficient conception of the potential scope and mission of public health efforts. The full result is the slow-moving, mandate-limited, and participant-blinding functionalism we have discussed and can see when examining public health organizations today. This condition naturally encourages unresponsive and risk-averse bureaucracy, overweighing at top and middle organizational levels, promotion of upward rather than outward career paths, and restriction instead of promotion of change and innovation.

Our view is that, as with other bureaucratic systems of our time and recent history, a central aspect of the breakdown in public health progress is our health system’s long-overdue need to delayer and decentralize – shifting its resources to the essential and complementary organizational tasks of 1) short-term situational responsiveness and 2) long-term strategic relevance. In the case of our public health system, this common failure takes the notable form of limited community involvement in and ownership of health and quality of life advancement.

Without strong community ownership of its health promotion activities, we today have roughly two dozen large-scale, nationally or regionally-led, and task-oriented public health programs in most countries, often run by distant technocrats in capital cities. Instead, we might have two hundred thousand or more locally-based and outcome-oriented health programs, run from and by communities themselves and supported by an enabling international network of health science councils and measurement agencies. We will submit that this profound new vision for our public health system promises to remake not just the structure of today’s public health system, but its responsive and the realized levels of health throughout the world.

A key result of the failure of our public health system to build on past successes and achieve true progress in its health promotion goals, models, and methods – and the waiting source of funding for new health efforts – is the widespread social trend we discussed toward reliance on more costly and less effective medical services to treat preventable conditions of disease and reduced health and well-being. This alternative to effective and progressive public health promotion has steadily and paradoxically gained public acceptance and funding since the mid-twentieth century, and now enjoys the overwhelming majority (and a far from optimal share) of health-related expenditures in the developed world.

As outlined already, HumanaNatura believes that public health organizations and practitioners must become far more socially-integrated and community-oriented, greater and more diverse consumers of health science, more progressive and holistic in employed models of health, and far more ambitious and flexible in health interventions and utilized advocacy techniques. Importantly, we would once again underscore that these needed changes are almost entirely political, organizational, conceptual, and methodological in nature, rather than scientific or technical.

For current and potential community health advocates, HumanaNatura’s proposals highlight the vast new positive health promotion and public health leadership opportunities that exist in the world in our time. These opportunities for new political and community leadership, and new social progress, immediately come into view once our health promotion paradigm shifts and becomes more encompassing in the ways we have outlined in this program and our Personal Health Program.

This new HumanaNatura shift in our basic conception of health – seeing it as an evolved phenomenon subject both to natural requirements and open-ended opportunities for progression – raises our health awareness and uncovers many areas for new personal and public health promotion. It points the way to better uses of our extraordinary and rapidly-expanding levels of health science, and opportunities to reallocate health-related resources far more precisely and more optimally – toward the investment end of the expenditure spectrum.

If we have proposed important and far-reaching opportunities for new public health thinking and action, we must next explain where and how specifically. Since we are suggesting a fundamental re-grounding of our public health system, in favor of community focus and a progressive ethos, and the greater use of political leadership and advocacy techniques, the truth is that new health leadership and advocacy can begin right way and wherever we are. They can begin today, in the community you live in, and with you and the people around you.

In the remainder of the HumanaNatura Community Health Program, we will explain exactly how and where you and others can immediately begin the important and practical work of promoting support and enlisting resources for new community health and quality of life measures, wherever you are and amidst life in any community – large or small, developed or developing, conservative or liberal.

As we summarized earlier in the program, HumanaNatura’s process for community health promotion seeks to progressively and systematically increase and transform the state of health and quality of life within entire communities. This systematic process uses HumanaNatura’s five-step community health promotion model, which forms the essential method and practical focus of the remainder of this program:

HumanaNatura's Five Steps of Community Health Promotion

Assess and verify community health conditions
Identify and prioritize potential health actions
Validate potential actions and build community consensus
Design, implement, and monitor community health actions
Assess actions for learning and to increase community support

In practice, these integrated techniques form a powerful, self-progressing, and open-ended process for community health promotion.

First steps of community health promotion
As soon as practically possible, and as long as it is safe for you to do so, we would encourage you to take several exploratory walks through the main streets and other key gathering areas in your community. For perspective, you may also want to take similar walks in the principal streets and places of one or more of your neighboring communities, and even other more distant communities. Since HumanaNatura advocates daily walking in our Personal Health Program, it is perhaps no small coincidence that our program for community health begins with this practice too.

These informal but deliberate explorations of your community and other communities are intended to serve as a gateway to the practical work of community health promotion, and to provide you with a firsthand and quite personal grounding in the health and health potential of your local community environment. With these goals in mind, we would like you to take note in your walks of both the facts and feelings you encounter as you move through and observe your community. Talk to people you meet if you can, and ask or observe what activities and goals they are occupied with, and equally what complaints, issues, and missed opportunities they report.

Observations and interactions of this kind may be awkward or tentative at first, but can become much easier and surprisingly information-rich with just a bit of practice – practice that begins development of essential skills you will use regularly in the work of exploring and promoting community health. During or immediately after each of your observation sessions, we would encourage you to take detailed notes about the things you encounter and ideas you have, however health-specific or not they might initially seem.

After one or more sessions observing the main streets and gathering areas of your community and neighboring ones, you will naturally begin to draw early inferences regarding elements in your community environment that might positively or negatively affect community health levels. As this occurs, we would encourage you to expand your range of observations and specifically to consider what other health-related factors might be present and overlooked in your early judgments or generalizations.

To help in this broadening of your information base, you might spend time in other places in your community, such as markets, commercial areas, community centers, and educational and recreational settings. If you can, attend the public meetings of your community’s governing body, your public health agency, other governmental departments, and whatever public events are available to you. Again, we would encourage you to take reasonably detailed notes about what you observe, including items and attitudes that form the content of your community’s social setting, political agenda, and health and quality of life concerns.

In a similar way, you can and should also use the mass and micro media that emanate from or reach into your community – posters, billboards, news channels, radio, television, popular internet sites, etc. – observing them and taking note of the health-impacting or health-revealing facts and attitudes you find in these community artifacts and sources of health-related information.

Likely, you soon will be startled at how much information you can gather about your community from direct experience and various public sources, once you begin to look at them attentively and with the aim of seeking unseen or unappreciated health limiters and enablers. You soon may become quite practiced at these observations and intrigued with this way of interacting in the world and with others, which we might call fieldwork in health anthropology.

Although these initial observations of your community are quite informal and generalized, they are nevertheless an essential part of the process of 1) assessing your community’s health and quality of life conditions, 2) meeting people and developing useful contacts, and 3) integrating yourself more deeply and powerfully into the community you wish to serve. HumanaNatura will provide you with a much more formal way to assess and benchmark your community’s health and quality of life levels, including use of our Community Assessment Form, but this tool and our overall health promotion process are not substitutes for careful and health landscape-probing observation of your community, and intimate and cordial interaction with its members.

Through special care understanding and networking in your community, an important foundation is created for using the leadership process and tools of applied health science we will introduce. This care and networking is essential to ensure the clear identification of a community’s underlying and most actionable health enablers and health limiters, and to build personal trust and respect in your community – attributes that will prove essential to the ongoing work of progressive health promotion within it. In fact, once we move from community observation and formal assessment to the work of prioritizing and consensus-building potential health promotion actions, your firsthand knowledge and personal connections within your community will become indispensible.

After all, it is here, in the lives and relationships and the everyday attitudes and assumptions of your community, that traditional top-down methods of public health assurance most reliably break down, fail to understand and advance quality of life issues specific to each community, and miss the opportunity to enable true health promotion. This is especially true now, in our age of advanced science and information technology, where actionable health science is widespread and access to it is remarkably easy. Now, as we have discussed, it is our ability to act, rather than our ability to know, that most greatly limits our individual and general state health. In the more diverse and complex communities that is our human reality today, health-based action also now requires new and more tailored approaches, again encouraging thorough knowledge of local conditions and active community networking.

In fact, in our time and in all times, work and progress on health issues becomes nearly impossible using traditional public health approaches, especially when taking on the more subtle fabric-of-life issues and opportunities that are increasingly the next frontier of progressive health and achieving what HumanaNatura calls Natural Communities.

Questions for your early health fieldwork
What is it that you see and hear when you look at and listen to your community, and probe its underlying and perhaps sometimes enigmatic health landscape? What notes and observations recur as you begin to examine your community as a burgeoning health anthropologist?

Here are some questions to help guide, and perhaps enlarge, your analysis of your community and review of your fact-finding notes:

Are people receptive when meeting you, or guarded in their interactions? Does this vary by location or the type of people you meet? Why do you think this is? What are the “types” in your community? Is the community subject to certain preoccupations, and perhaps different ones during the course of the day or year?

How does the community feel? Are people cool or warm, and in what proportions? Are people generally fearful and hostile, or open and relaxed? What portions of people strike you as withdrawn, impulsive, anxious, and engaged? What shares seem negative and positive, religious and non-religious, and past, present, and future oriented?

Based on your observations, can you objectively describe the culture and of sub-cultures of your community? Do you sense that people are closed or open to the external world? Are people curious and free-thinking, or more traditionally-minded? In what proportions and along what lines?

How do people look? Do they generally appear fit and healthy? Are people typically underweight, overweight, or somewhere in between? Are people similar in these respects, or is there a wide variation? Are there recurrences of certain illnesses or of health and well-being complaints in the community? Are there apparent patterns or clusters of health levels?

Do you see people exercising around you, or is life more sedentary? Does this vary by time and place? Why do you think it is the way it is?

Are the air and water around you clean? Are the various areas of the community generally noisy or quiet? Are various areas populated or more deserted? Are people hurried or more leisurely in them? Are community areas welcoming or more stern? Are some community areas dominated by certain types of people, by activities and uses? What is the relative density of vehicles and amount of traffic, and how does this influence the character of different areas?

What are people eating or buying in the market? Is smoking common, and is it practiced in public places or only in designated areas? How about the prevalence of alcohol use or other drugs? Can you observe drug use firsthand or infer it from what people talk about? Are there graffiti and signs of gangs?

What are the key issues facing your community’s school system and what are the dominating ideas about education, desirable life paths, and personal development?

How are economic conditions? Are people worried about paying bills and maintaining adequate housing, or is your community more affluent? Is wealth conspicuously displayed or more modestly revealed? Is there significant unemployment or is there work for everyone? Is the local economy dominated by a large employer or a single industry, or is it more economically diversified? Are there industrial areas in the community and the potential for industrial health risks?

What dominates the agenda of your local governing council and media? Is it concerned with quality of life issues? Which ones? Are there specific problems the community is in the midst of facing? Is the community divided or united on the needed course of action? Why is this? Are there one or more fault lines of unresolved conflict within the community? Who are the community’s leaders and key constituencies, and what are their stated and unstated agendas?

Beyond economics and politics, what do people talk about? Are they oriented to the natural environment and science, or more biased toward society and popular culture? How receptive are people to change and new ideas? What do people in your community hope for, and think about? How do they think about their health and quality of life?

What else do you see in or can reliably surmise about your community and its state of health and level of health promotion?

As you will learn firsthand in your community interactions, even informal observations of your community can produce a great deal of information about health-related conditions, This can lead to strong personal intuitions about its health landscape and potential areas for health interventions. All of us can make such informal observations, and most or all of us do make them to some extent amidst life in any community (but sometimes with insufficient exploration, information, and reflection).

Although personal observations and investigations can be quite insightful and useful, we also need a degree of caution before investing in or acting on our intuitions, especially if we are to have a sustained and optimal impact on the health of a community over time. Each health-related inference or idea must be treated as a health hypothesis – a proposal requiring testing, clear evidence, and confirmation or correction. This is true whether ideas are arrived at through informal observation or discussion and perspective-sharing with others, or through formal measurement and analysis procedures.

And even when a particular health hypothesis is confirmed or validated, each resulting health insight must then be introduced adeptly into the community – at a right time and in a right way – if it is to be used to build momentum for community participation and consensus, lead to lasting and integral change, and foster eventual self-advancing health promotion dynamics. Here, as suggested before, investments in relationships and network-building in the community prove not just important, but essential.

As we will discuss next, a robust community health assessment requires a relatively systemic approach to gauging and benchmarking local or regional conditions against scientifically-valid health factors. In practice, however, resulting health insights often prove counterintuitive to the people of a community, and often require considerable health awareness-raising efforts before they are understood and can be accepted and acted on. For this reason, all ideas for health interventions require not just an evidence-based approach, but also careful prioritization, patient consensus-building, and thoughtful advocacy and campaigning, if they are to create impactful, lasting, and catalyzing change in a community.

If our mission as community health advocates is to permanently and progressively improve the health and quality of life of a community, we must work to develop and continually advance three foundational items in the community:

The foundation of progressive change

A shared sense of what the community is today and why
An inspiring vision what might be possible in the near and longer-term
A practical plan to move from the current state to an improved one

Introducing the specific content of any particular health insight or health promotion objective, and marshalling resources toward its fulfillment, must always be subordinated to the need to build and cultivate this essential foundation for sustained and progressive social change.

HumanaNatura’s Community Assessment Form
When you are ready to make a more formal assessment of the health status and opportunities of your community, you will need to assemble a working group of people interested in evaluating and then advancing health and quality of life issues in the community. Assembling a sufficiently diverse and committed group of community health advocates can take time, and it is usually never too early to begin this work.

Your working Health Action Group can and of course ideally should represent the full community. It should have members of different ages, backgrounds, and skills, and even be accepting of people with different levels and durations of commitment to health promotion efforts. After all, even short-term positive involvement in your group can promote its goals, while creating generally supportive life-long alumni of the group and a source of future support in the community.

As your Health Action Group forms, one or more coordinators will need to be named, a meeting schedule and venue determined, and a mission statement and operating rules established. These items – the tasks of creating its basic organization, structure, and process – can be the first work of the Health Action Group, helping it to form and learn about itself and its basic dynamics. In larger communities, an executive committee of five people (always a odd number so tied votes are not possible) is usually recommended to aid decision-making and provide essential oversight of the more diverse activities of a larger Health Action Group.

As your Health Action Group forms and begins its work, an essential early step is to align on foundational ideas and its needed scope of work. This should include individual review and group discussion of HumanaNatura’s Community Health Program, and a detailed review of our key community health analysis tool – HumanaNatura’s Community Assessment Form.

We mentioned before that our Community Assessment Form is a comprehensive but fairly easy-to-use spreadsheet tool designed to help you and others rigorously investigate and reliably assess the status of important health promotion factors in a community, regardless of whether the community is large or small or where it is located. The goal of the assessment form is to build upon informal observations and knowledge of a community’s health and quality of life status toward a comprehensive and objectively-valid community health assessment.

Our Community Assessment Form is also intended to help both community health advocates and its public leaders and health officials make the critical shift in orientation we have discussed – from the risk prevention focus that so often dominates traditional public health agendas, toward holistic, pragmatic, and progressive community health and quality of life promotion. The objective criteria of the Community Assessment Form also can serve to broaden and enrich public discussion generally, and is useful in countering local political views that can be overly focused on immediate issues and thereby pay inadequate attention to the need for investments in its future.

Because HumanaNatura’s Community Assessment Form is an active document, it is important to check our website periodically for updates to the form. The assessment form is now evolving through its review by and use, as well as through the inclusion of professional feedback and new scientific findings.

Any significant updates to the worksheet will be announced in our free community newsletter, HumanaNatura NaturaLiving, which you can subscribe to via Join Us. For your convenience and future reference, the inclusion and most recent modification date of each health factor is included on the assessment form.

HumanaNatura’s Community Assessment Form is divided into twelve sections or groupings of community health factors, with each section containing related sets of health factors found or strongly suspected by health scientists to promote advancing community health conditions:

Community Assessment Form – Major Sections

Security – freedom from oppression, aggression, and injustice
Infrastructure – environmental quality and sustainable systems
Medical care – access to primary and secondary treatment for injury and illness
Safety – well-planned and protective public and private living areas
Nutrition –dietary conditions promoting optimal personal health
Exercise – adequate movement to ensure lifelong natural conditioning
Governance – transparent, effective, and health-promoting public leadership
Cohesion – social conditions fostering strong community bonds
Development – health and growth-encouraging community support
Economics –diversified and sustainable work and career opportunities
Families – conditions assuring healthy children and parents
Intimacy – environments fostering attentiveness and discovery

The organization and content of our Community Assessment Form reflects many sources of information related to individual and community health. This includes the science underlying HumanaNatura’s Personal Health Program, recent and ongoing research into community health contributors, traditional public health practices and findings, and input from HumanaNatura members and community advocates using our Community Health Program.

To the extent possible, we have organized the assessment form by increasing degree of health promotion – from foundational health enablers to more advanced community health promotion measures. This approach has been used in both the order of the overall assessment form sections and in the order of health factors within each section.

This approach to ordering the assessment forms is not perfect of course, since the progression of community health is not a linear process. Many community health factors are of comparable importance, or are complementary, interdependent, and synergistic. Because of this, special care is essential when using the assessment form – to consider both the importance of health opportunities in a community and those health opportunities with the highest probability of success in the community at any point in time. We will come back to this critical idea and discuss the overall process of issue prioritization in the next section of the program.

In practice, use of HumanaNatura’s Community Assessment Form is fairly simple but can engender quite dynamic discussions. While the form itself is straightforward to use, it promotes a deep review of major community health areas and includes health factors that people may have never considered before. Different people frequently will have varying views regarding the importance of different health factors. And different people may have varying ideas regarding a community’s status for each health factor, either because of varying information levels or different interpretations of identical information.

To address these natural tendencies in working groups and promote clarity and consistency, we have phrased each health factor in objectively measurable terms and included space for noting evidence supporting the scoring of each factor. We have also included a rationale for each health factor in the assessment form, so assessors can understand the importance and intention of the factor and more accurately assess the community’s health status against it.

Even with these controls, it is important to remember that our Community Assessment Form is not variation-proof, and disagreements about a community’s health status are likely to occur during the assessment process. Ideally, these disagreements will be seen by all as opportunities for dialogue and learning, with each opposing view respected and used to improve information quality. It is sometimes the case that resistance to a particular assessment of a health factor is not grounded in objective facts, but this form of resistance is usually readily identifiable and surmountable through supportive discussion and the probing of available evidence.

The final result of all divergent views regarding community health factors should of course be learning and more objectively-accurate conclusions, rather than compromise, and everyone involved in the assessment process must be committed to this outcome. In seeking accuracy, the assessment team will reach a more informed understanding of each health factor, foster improved team awareness of its health enablers and limiters, and become better able to prioritize actions and lead community action toward its health potential.

Beginning the assessment process
As we said before, to begin the community health assessment process, you will need to recruit and train a number of people. This first includes the assessment work itself, which may take several weeks on a part-time basis, and later to provide initial staffing for the initial health promotion efforts or campaigns within the community. The process of community recruitment for the assessment process creates your Health Action Group.

In your recruitment effort, you will likely soon find a core group of people very interested in the Health Action Group and assessment process, and then a larger, secondary group who are interested but perhaps less willing to commit time at the outset. This is very common and your overall assessment process can be built around this natural human dynamic – by forming a core working assessment team and a larger assessment review group around it.

At this stage, if the assessment effort is not being led by your community’s public health officials, a decision to either involve or at least inform your local public health agency of work underway is strongly advised.

Operationally, it is best to form a working assessment team with your core group of highly-interested people. Working assessment teams of 5-10 people often strike a good balance between the need for diversity of views, robust and frank discussions of the initial assessment results, and speed of execution. Assessment teams larger than this may be needed, however, especially in larger and more complex communities.

In addition to careful assessment team selection and size considerations, it is also normally best to have each individual in the assessment team separately conduct an independent initial assessment, using the Community Assessment Form, without input or influence from other team members (skipping over health factors where they do not have enough information to assess the factor). Although this approach is initially more time-intensive, it generally saves time overall and allows the assessment team members to become more familiar with the assessment form in advance of group discussions.

As important, having a process that begins with separate initial assessments by each individual in your working assessment team promotes a greater diversity of views and more robust fact-finding. This approach thereby works to prevent premature convergence of thinking across the assessment team – a natural information-limiting phenomenon that is sometimes called “groupthink.” Normally, you should plan on each independent individual assessment taking between 5 and 10 hours, depending on the knowledge of the assessor and complexity of the community. The independent individual assessments of course can and should occur simultaneously.

Once each individual assessor in the assessment team has completed an independent assessment of the community using the Community Assessment Form, the next step is to bring your assessment team together for a number of working sessions, aimed at creating a single, consensus (but fact-based) assessment of your community’s health status against all of the HumanaNatura community assessment factors.

By bringing together multiple, separately-completed initial assessments, and ensuring an environment of respect and open discussion across the assessment team, much richer discussions and more objectively-accurate conclusions are naturally fostered, as the assessment team works together to create a combined community assessment.

We should add that, for identical reasons, it is also helpful to bring new assessment participants into your working group whenever you can, and to have them first complete a new community assessment on their own (without seeing the current combined assessment results) – again to promote fresh perspective and ongoing discussions about improvements to the team-level assessment document.

In all cases, we encourage ongoing improvements to the community assessment as conditions change or as new information become available. We also encourage a complete and thorough review of the assessment results at least once a year.

Scoring each community health factor
For each health factor in the HumanaNatura Community Assessment Form, an individual assessor and the assessment team in total can select one of three affirmative assessment responses, or indicate a “not sure” response by leaving the assessment factor un-scored.

As the full assessment teams works to complete its combined assessment, additional fact-finding should occur as needed to address any blank “not sure” responses and convert them to specific response.

You will note that there is no “not applicable” response in the assessment form, as we believe that each health factor included applies to every local and regional community worldwide, regardless of size or circumstances.

> Scoring options – an affirmative response for each health factor is required, by judging the community’s status in one of the following three ways:

Factor Status	Scoring Value
Strongly describes community, or >75% achievement of metric	2
Somewhat describes community, or 25-75% achievement of metric	1
Does not describe community, or <25% achievement of metric	0
Note sure	Leave Blank

As you can see, percentages are used where the health factor involves a specific metric (for example, percentage of eligible voters who vote). Otherwise, a judgment is made whether the factor strongly describes, somewhat describes, or does not describe the community. In all cases, the assessment goal for each factor is the same: an objectively-valid conclusion about the community’s status against the factor.

> Evidence – in assessing each health factor, the selected status must always be based on substantive evidence. This evidence should be noted or referenced by each assessor in the Evidence section of the assessment form, and then used in discussing and evaluating individual assessments across the work of multiple assessors.

For example, there could be an existing organization in place responsible for a factor, but also evidence of substantial failure or inconsistency in achieving its intended results. Such a situation is common and can lead to different interpretations of available evidence. In the final, compiled assessment, this fact pattern would suggest an assessment of “partially describes community” and the noting of relevant facts in the evidence section for the factor.

As evidence is discussed across the assessment team, the most compelling and relevant evidence should be included for each health factor in the combined community assessment document.

> Potential Actions – in addition to capturing the assessment response and supporting evidence, space is also provided in the Community Assessment Form for each assessor to include ideas for Potential Actions to improve the community’s status for the health factor. Inclusion of such ideas is especially important for those health factors that are scored 1 or 0 by an assessor.

We recommend that each assessor include 2-3 ideas for potential actions for each factor assessed in this range and that the assessment team, when working together to consolidate the individual assessments into a combined community assessment, discuss individual ideas for each health factor to and then include the 3-5 highest priority potential actions for each factor.

Compiling and vetting the assessment

In practice, although some health factors on the Community Assessment Form can engender considerable discussion, many will be assessed and consolidated quickly. In practice, the consolidation of the individual assessment forms usually can be completed in 3-5 working sessions of 3-5 hours each.

Once each factor is consolidated into a combined or master assessment, including relevant points of evidence and top potential actions, the response score total (the overall community score) can be reviewed and discussed. As mentioned earlier, this scoring can be helpful for measuring a community’s progress against HumanaNatura’s health factors over time and for comparing results across different communities.

As your combined community assessment is compiled by your working assessment team, it essential that the emerging assessment remain treated as a draft document, and that the assessment team’s combined findings be reviewed or vetted with your larger assessment review group before taking the assessment beyond the working teams to the full community.

Your secondary assessment review group should be comprised of perhaps 5-20 people, depending on the size and complexity of your community, taken from your larger group of interested people and also potentially from others in the community. In general, the assessment review group should include people with excellent knowledge of the community, who are open to the assessment process and respectful of its participants, and who may be influential in creating or implementing your eventual initial agenda for health promotion in the community.

While the review process will vary in the length of time it requires to reach consensus, because of the potentially higher number of people involved, we would again recommend that you plan for 3-5 working sessions of 3-5 hours each to complete this final and critical part of the assessment process. Participants should of course review the draft combined assessment in advance of the review sessions.

At this stage, the assessment review group’s principal responsibility is for the accuracy, objectivity, and completeness of the assessment team’s combined assessment form, rather than prioritization of actions (which comes after the assessment is finalized). This review should include 1) catching assessment mistakes, 2) challenging assumptions, 3) providing input on evidence either mistakenly used or omitted, and 4) helping to suggest additional potential actions.

This initial round of assessment form discussions of course also begins the essential work of reviewing and prioritizing potential health actions, and will naturally provide insights into the eventual work of building consensus for specific health actions within the community.

Let’s turn this to critical step in our Community Health Program next.

Key Community Links

Most-Used Resources

Assessing Community Health