USING CHSI INDICATORS TO DEVELOP POLICIES
FOR COMMUNITY HEALTH IMPROVEMENT

County Profile : “Next Steps?”

Now that you have your report, you want to get started making changes to improve the health of your community. The following suggestions come from interviews with local policy makers, and an environmental scan of health policy resources.

Data can support your position

As one county representative said, “I was devastated when I got the true (indicator) numbers.” This reaction is more common than most people expect, and is a powerful motivator to change the status quo. Receiving, reviewing, and accepting accurate health status data is an important stage in moving toward action. Policy makers told us that they were able to take health status information to the wider community and other policy makers and initiate a call to action. As one policy maker said, “In the absence of data, it’s difficult to initiate policy change.”

What got us here in the first place?

Social factors may need to be addressed to improve community health. Exploring root causes may improve the likelihood that action leads to valid policy development and performance improvement. Are there grocery stores in every neighborhood? Is it safe to walk around during the day or night? How is the community addressing access to health care? What kinds of inequities exist in the community?

You may want to look at the Relative Health Importance figure in your CHSI profile. Indicators where you are doing worse compared to your peers, and the nation as a whole, may be areas to address first. The Measures of Birth and Death table may also help you identify poor health, which will respond to public health and community-oriented interventions.

You may also want to broaden the ownership of the problem, the solutions, and get to the root causes of issues identified by the CHSI report. One health department investigated the reason for its high stroke death rate. They found casual completion of the death certificate, lack of blood pressure control and a very high smoking rate to be contributing factors in the county. The health department partnered with local physicians, reoriented all their clinics toward high blood pressure detection and smoking cessation, and instituted a local clean indoor air ordinance.

Some changes within the community can happen quickly and with little controversy. Other changes will take months, and maybe even years to implement. Plan to celebrate small, as well as big successes, to bolster momentum. Continue to track your community’s health improvement using CHSI!

Other data sources to consider

Other data sources within your community may have more current data, or data for sub-county areas. Check with governmental agencies such as the public health department, and the department of transportation. Other sources of data may be obtained from non-governmental organizations such as the United-Way, hospitals, clinics, and schools—check with them for additional data. You may also want to invite them to be a partner.

Types of Policies

Governmental policies

Many health indicators can be affected by changes in local, state, or national laws. Bans on smoking indoors, mandating access to health care, speed limits on roads, laws requiring vaccination, creation of parks, and food safety laws are examples of policies that impact community health. Such policies are usually the result of community-wide relationships, planning, and negotiation over a period of years. The resources necessary to create these types of policies can be great: staff time, additional studies and data collection may be required, as well as campaigns to educate the community about the policies’ long-term benefits. Though investment in these policies is great, they have the potential of broad and lasting impact on community health.

Workplace and community policies

Not all policies need to be written into law. An association of counties in one state developed a plan to self-insure its employees—part of its plan included a “path to wellness” program that set health goals, educated employees on how to achieve health goals, and tracked their progress at the worksite.

Some communities have established farmers markets so that local fresh fruits and vegetables are available in areas where grocery stores are scarce or where a commitment to locally grown produce has been made. Schools create policy by increasing physical education activities.

Relationships are Key

Relationships are the most important factor when developing health policy. Policy development starts when people recognize a problem, often identified by data, and begin discussing how to solve the problem. Community members, local, state, and national representatives can be invaluable partners. Even if your representatives do not share your perspective on an issue, you may want to build a relationship with them in the areas where you agree.

Your local business community and non-governmental organizations may also be good partners for developing policy. You can make the case how improving community health will benefit everyone. You may also want to partner with an organization that can increase your data portfolio, such as universities, businesses, and non-governmental organizations.

Mobilizing your community will depend on its readiness to take on an issue. Ask yourself: 1) Do people believe what the data are telling us? 2) Is this issue too controversial at this time? 3) Do people believe that by establishing a community policy, the health indicator will get better? 4) Do people care about this issue? 5) Do people fear any kind of reprisals?

Peer counties

Look up your CHSI peer counties and consider contacting them to learn how they have fixed or avoided the same problem or for ideas on how to develop an effective policy or best practice.

Priorities

In most cases, setting policy priorities should be done in conjunction with all stakeholders. Consideration of your partners’ priorities helps maintain and strengthen your working relationship. The CHSI Relative Health Importance figure provides a starting place for your priority setting.

Assess your partners’ readiness, and the community’s readiness when setting priorities. They may not be ready to face difficult issues, such as teen pregnancy, but they may be willing to take on the sedentary lifestyle that pervades a community. Sometimes starting with a lower priority issue that is less controversial develops trust within the partnership so that the partnership can tackle controversial issues later, building upon the solid foundation of an earlier success.

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