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A Population Health Approach: Addressing Social Determinants of Health through a Community Health Needs Assessment

Aug 30, 2018 08:21AM ● By MED Magazine

Despite increasing health care costs projected to reach $5.5 billion by 2030, “health outcomes in the United States continue to fall behind other developed countries” (Partnership to Fight Chronic Disease, n.d.). A growing body of research strongly suggests that social determinants of health (SDOH), “the structural determinants of and conditions in which people are born, grow, live, work, and age”, are the key predictors of health outcomes (Heiman & Artiga, 2015, p. 2).  While the health care system increasingly recognizes the importance of addressing SDOH to improve health, efforts still concentrate on clinical care and treatment and often neglect to address SDOH, health equity, and prevention to improve community health.

Emerging strategies to address SDOH and improve health outcomes center on a population health approach that can improve health outcomes, including elevating the SDOH and engagement of hospital and community partnerships through a community health needs assessment (CNHA) and community health improvement plan (CHIP) process. The Centers for Disease Control and Prevention (2017) defines a CHNA as “a process that identifies key health needs and issues through systematic, comprehensive data collection and analysis”. The Patient Protection and Affordable Care Act of 2010 emphasizes the need for hospitals and health systems to focus on implementing strategies through this process to address priority needs of the community(ies) they serve. In addition, the Internal Revenue Service enforces the Affordable Care Act and provides CHNA requirements that tax-exempt hospitals must follow, including data collection, identifying and prioritizing community health needs, inventory of resources, collaboration and input from diverse partners, the community, and public health, including underserved, low-income, and minority populations (Association of State and Territorial Health Officials, 2015).

Assessment from a public health perspective is one of the core functions of the evidence-based public health framework (Prevention Research Center in St. Louis, 2018). Using a public health framework approach to the CHNA and CHIP, emphasizes identifying health issues, using broad SDOH to identify influences on health issues, identifying health disparities, partnering with multi-sector partners, engaging the community, developing an action plan to address priority health issues, leveraging resources, improving population health, and opportunities to engage ongoing dialogue with the community (Pennel et al., 2015). However, medical and public health disciplines often have differing viewpoints on how community and health are perceived. Rural hospitals often are understaffed, have limited financial resources, and available staff often lack public health training important to understanding and addressing the SDOH in the CHNA and CHIP process (Health Research & Educational Trust, 2013). Specifically, SLM Consulting has had the opportunity to help hospitals facilitate a CHNA and CHIP process, observing challenges with hospitals to address SDOH, albeit due to hospital priorities, staff capacity, and/or challenges with community engagement.

A CHNA and CHIP is an important process to support a population health approach. Utilization of mixed methods data collection can provide a comprehensive understanding of the issues that affect the communities served by the hospitals, including qualitative and quantitative data collection such as asset mapping of local resources and services, key informant interviews of key stakeholders, focus groups of priority populations, a survey of community residents, and/or collection of secondary data from valid sources, such as Community Commons, County Health Rankings, or the U.S Census Bureau American Community Survey. This approach provides an opportunity to understand the community’s health status, risk factors, socio-economic factors, mortality, health needs, community assets, and data on the delivery of public health system essential services. Moreover, utilization of an external expert to support facilitation of the process as well as quality data collection, will support a strong process.

In general, the community health assessment process offers an opportunity to understand how to integrate components essential in creating a sustainable healthy community. Key aspects of this process important to address SDOH should draw on expertise and perspectives of stakeholders to address health related issues facing communities, including individuals affected by issues, such as those who are underserved and health disparate, not just those who represent them. Engagement of public and private leaders will also better arm them with information and incentives to make health-wise policy decisions and investments to support long-term community health promotion and chronic disease prevention.  The assessment provides valuable insight into the health of a community to understand strategies necessary to improve and promote long-term community health.

Despite evidence-based practices and resources available to guide hospitals through the CHNA and CHIP process, hospitals struggle to engage multi-sector community partners and stakeholders in this process, a vital factor to effectively address health outcomes. To truly make an impact on the community’s served, it is necessary to build hospital capacity to understand and address SDOH, including training of hospital staff in public health concepts and systems change to emphasize prevention.  Over time health systems, nonprofits and community organizations have identified successes, challenges and recommendations to effectively support implementation of the community assessment process. Specifically, data sharing across sectors, addressing SDOH and engaging vulnerable populations, and coordinating community health assessments across sectors in efforts to reduce silos and duplication of efforts are among the keys to success. Resources are available to support hospitals to address SDOH, including the American Hospital Association , ASTHO, and more.

SLM Consulting has key resources available to support addressing SDOH and can help facilitate a quality and comprehensive CHNA and CHIP process, guided by a population health approach.   

Sandra Melstad, MPH-CEO, SLM Consulting, LLC



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