The American Hospital Association (AHA) developed Community Health Assessment Toolkit

The American Hospital Association (AHA) developed Community Health Assessment Toolkit

The American Hospital Association (AHA) developed Community Health Assessment Toolkit as a systematic guideline for the assessment and improvement of the population health. The Community Health Assessment Kit is defined as a systematic process of involving the community in the identification and analysis of community health needs and assets, prioritization needs, and implementation of plans to solve the population healthcare needs. To ensure the promotion of community healthcare outcomes, the Affordable Healthcare Act calls for all non-profit healthcare institutions to conduct Community Health Needs Assessment (CHNA) comprehensively. This assessment should be performed every three years to engage the community stakeholders and the general population in enhancing the quality of life in the community as well as addressing essential healthcare needs. The CHNA provides an opportunity for healthcare professionals to incorporate qualitative and quantitative data in assessing community healthcare needs. It addition to that, the systematic process allows one to not only interpret statistical data but also include the feedback and opinion from members of the community. After successful completion of the community health needs assessment, a community health improvement plan is developed to address the identified healthcare needs and improve population health.

A community health needs assessment was conducted for Burbank City. Burbank City is located in the Los Angeles County of Los Angeles metropolitan area of Southern Carolina.  The land is extensive, with a general humidity of 35%, wind speed at 13km/h, and an average temperature of 22 degrees Celsius (CBC, 2020). It occupies a total area of 17.4 square miles and borders Toluca Lake on the west, Glendale to the east, Verdugo Mountains from the north, and Griffins park to the south.

Burbank City covers 12 zip codes namely; 9501, 91505, 91503, 91507, 9122, 91510, 91502, 91506, 91504, 91521, 91508 and 91523. According to USA Census data (2010), Burbank, CA is home to a population of 105,000 people, of the total population, 88.2% are citizens. The diversity composition of the population of Burbank, CA is 56.7 % White Alone residents, 24.5 % Hispanic residents, and 11.5 % Asian 2.51% Black or African American, 950 Some Other Race Alone residents (0.9%), 300 American Indian & Alaska Native Alone residents (0.286%), and 23 Native Hawaiian and as of 2017, 32.9% of Burbank, CA residents were born outside of the country (DataUSA, 2017).

A community health assessment was conducted in Burbank City, which involved the collection of qualitative and quantitative data. In addition to that, a windshield survey was conducted to get a visual observation of the community. Practical community assessment and implementation of improvement plans is an inclusive process that brings together all the relevant community stakeholders. Some of the stakeholders include healthcare providers, social workers, general social service providers, community decision-makers, and spokespersons of the community. In addition to obtaining statistical data from the online governmental resources, interviews were conducted to gather the input, opinion, and feelings of the community members. The information collected from interviews was from law enforcement agencies, clinical personnel, paramedics, firefighters, teachers, clergy, business owners, and community leaders. General community members who had suggestions or opinions that could positively contribute to the assessment of community needs were also interviewed. The public community members mainly comprised of the low-income population

According to DataUsa (2020), the overall life expectancy for females 84.5% while that of males was 80.3% while the general quality of life is 87.1%. About 79% of the total population of Burbank aged 25 years and above have a minimum of High School Diploma and above. Consequently, 84% of the total population are employed in the entertainment industry. Burbank city is currently known as the “Media Capital of the World” with massive investment in the media and film industry. The unemployment rate is Burbank city is 3.4%, which is impressive compared to other cities. The poverty level of the Burbank community is below 9%, which is impressively lower compared to other cities of equivalent rating. Less than 4% of the Burbank population are homeless, while the majority of the population lives in residential houses.  Burbank is a hub for entertainment and media for the United States and beyond with award-winning film content.

Interpretation of additional quantitative data related to the healthcare behaviors of residents of Burbank City. Tobacco smoking, lack of physical activity, and poor nutrition. Consumption of Tobacco is prevalent, with individuals at a very high risk of lung cancer and associated risks. 14% of the adult population actively smoke cigarettes with 32.2 deaths from lung Cancer per 100,000 population (CCHP, 2019). Consequently, there are 28.6 deaths from chronic Obstructive pulmonary diseases per 100,000 people. The individuals are further exposing non-smokers to the negative healthcare impacts Second-Hand smokers. However, physical activity guidelines are not well adhered to by majority of the population. According to the Physical Activity Guidelines Advisory Committee report, only 38% of adults who are 18 years old and above meet the prescribed guidelines for physical Activity (CCHP, 2019).  This is an alarming trend since it increases the rates of obesity, cardiovascular and other detrimental health conditions.  About 18% of adults above 18 years of age are obese while close to 29% are overweight tending towards obesity. This is a significant healthcare issue resulting from the dietary habits and reduced physical activity of the Burbank residents. These three healthcare-related behaviors resulted in chronic disorders such as heart disease, cancer, type II diabetes, stroke, and lung cancer that significantly contributed to 53.4% of all the deaths in the years 2018.

List of Health Needs

After a comprehensive analysis of both qualitative and quantitative data that was collected, there fundamental community health priorities include Tobacco, physical Activity, and nutrition (poor diet). Physical activity within a community results in positive healthcare benefits such as improved weight maintenance or weight loss, improved cardiovascular health, reduced risk of obesity, or developing diabetes. Physical activity through exercise also enhances positive mental health with reduced symptoms of anxiety, stress, and depression. Consequently, a healthy diet (nutrition) reduces the risks of diseases such as hypertension, Type 2 Diabetes, cancer, heart disease, obesity, and overweight. To ensure improved healthcare outcomes, the Burbank community should invest in positive healthcare outcomes through healthy nutrition. Tobacco smoking is a fundamental healthcare challenge that reduces the general quality of life for smokers. Consequently, tobacco smoking increases the chances of diseases such as lung cancer and other pulmonary disorders. According to (), Tobacco smoking remains a single cause of the highest number of preventable deaths in the United States.

Potential Resources.

Burbank City has several established resources that are vital to addressing the identified healthcare needs. The Burbank City Council plays a fundamental role in developing programs and campaigns aimed at reducing the prevalence of tobacco smoking among community members. Consequently, the city may also be an essential resource in the creation of more space for physical activity and associated campaigns. There are several health centers such as Wisdom Treatment Center, Absolute Control Transitional Counselling Center and the Miracles in Addiction Treatment Center. These healthcare centers specialized in drug abuse and addiction control can be involved in both anti-tobacco campaign as well as rehabilitation initiatives.  These are essential stakeholders to consult in solving the problem of smoking within the country. These resources can play a crucial role in addressing the issues of poor nutrition and physical activity. Additional resources include inter-professional members of the prioritization committee, which includes doctors, nutritionists, nurses, physiotherapists, teachers, parents, local grocers, community activists, and health administrators.

Since the last assessment, several strategies had been implemented to address the issue of tobacco smoking effectively. This included the creation of policies that required application for a designated smoking area in the Outdoor dining areas. In addition to that, “no smoking” Handout Cards were printed as a strategy of discouraging smoking among the population. However, these strategies only had contributed to the reduction in tobacco by 0.6% from 15.4%. This shows that additional steps are necessary to solve the healthcare issue comprehensively.

Plan Implementation Strategies

Priority Need #1 Tobacco

The overall goal of the implementation strategy is to reduce the access use and exposure of Tobacco and its products among the members of the entire population.

Primary Strategy

1. Foster education among community members on the adverse effects of tobacco consumption.
2. Adherence to the ‘No smoking’ sign in all entrances of the main buildings is another and outdoor shopping center is. This strategy will reduce smoking instances and the danger’s posed to second-hand smokers.

Secondary Strategy

1. Providing education to high-risk populations such as School going children to reduce the chances of self-indulgence into the smoking behaviors.

Tertiary strategy

1. Providing cessation assistance to addicts who willing to quit the addiction through comprehensive support.

Priority 2. Increasing physical activity.

The general goal of implementing the strategies is to promote physical activity among community members for reduced obesity and enhanced healthcare outcomes.

The primary level of prevention

1. Improving collaborations to enhance access to physical activity.
2. Encouraging stakeholders within the neighborhood to pursue environmental and policy changes to foster walkability and healthier means of transport to work.

Secondary level of prevention

1. Collaborating with different community stakeholders and partners to implement the 5-2-1-0 campaign to promote physical activity among high risk population segments-students.

Priority #3- Nutrition (promoting a healthy diet for a healthy life)

1. The overall goal of implementing the strategies would be to enhance knowledge and access of the general community to healthy foods.

The primary level of prevention.

1. Advocate for the adoption of practices and policies that limit the exposure of children to beverage and unhealthy food marketing within School, childcare and general community settings
2. Identify and incorporate opportunities for sustainable intergeneration interventions that foster healthy eating and diet within the community.
3. Implement suitable dietary lessons in strategic places such as soup kitchens and Burbank City Council halls to promote a healthy diet among families.

Implementation Strategies.

For effective implementation of the strategies to address the healthcare needs, an implementation committee and teams will be necessary to oversee the entire project for the achievement of the objectives. However, it is essential to consider the already existing committee, team members, and strategies aimed at addressing the healthcare needs of the general population. The existing committees can be brought on board to form specialized committees to handle each of the priorities effectively. However, it is fundamental that the team members have specialists such as nurses, doctors, nutritionists, parents, teachers, community activists, local grocers, and fire department representatives. This will promote the integration of different skill sets from the multidisciplinary team to improve positive healthcare outcomes in the community. In cases where additional professionals would be needed, recruitment will be conducted to ensure there is an adequate number of highly qualified professionals to implement the strategies. After the formation of a highly skilled and competent team with sufficient personnel, a periodical assessment of the progress can be conducted to assess the progress and challenges of implementing the strategies. In case of need, modifications can be done on the action plan to address the problems better.

According to () since the last assessment, several strategies had been implemented to address the issue of tobacco smoking effectively. The Second-hand Smoking ordinance included several policies aimed at reducing the rate of tobacco smoking as well as the risks for second-hand smokers.  This included the creation of systems that required application for a designated smoking area in the Outdoor dining areas within the community. In addition to that, No smoking Handout Cards were printed as a strategy of discouraging smoking among the population. However, these strategies only had contributed to the reduction of tobacco by 1.6% from 15.4%. The limited success of this project was attributed to the lack of strict follow-up measures by the committee in charge to ensure adherence in all places.

Action plans to achieve the objectives.

Priority #1 Tobacco

The members of the implementation committee will engage different stakeholders to implement the action strategies of smoking cessation and prevention. They will meet with community leaders, school officials, and healthcare professionals from Miracles in Addiction Treatment center, Wisdom Treatment Center, and Absolute Control Transitional Counselling Center. Since the fundamental objective to prevent smoking among the people, community education will start with schools. The members of the community would first discuss the education plans with teachers and school officials. This will ensure that students receive valuable information about the negative effects of tobacco smoking as well as preventive measures. The implementation of the educational programs should be done within eight weeks and after that sustained through close collaboration between committee members, school officials, and county officials. In terms of educating the entire community, the committee members will collaborate with the Burbank City Council to create posters and handouts that may be given to members of the community at strategic points. Consequently, being a hub of media and entertainment, the committee members will collaborate with City Council to provide public education using the local television and radio stations. This will reach more audiences and produce effective outcomes. Consequently, the fore-mentioned addiction treatment centers and other clinics will be used in rehabilitating and treatment of the individuals who are already addicts of the drugs. The community leaders, business owners as well as the county officials will be tasked with the responsibility of enforcing the already existing “No smoking sign” in building and public areas to eliminate the cases of second-hand smoking. The Committee members will collaborate with city officials to put up more signs at strategic places.  The implementation of the following strategies should start immediately with the bi-annual assessment of the measures of success.  Every year, the members of the committee will meet to evaluate the progress and make any necessary adjustments. The key metrics of evaluating the success of the strategy among schools measure the smoking rate among teens who are between 13 and 17 years of age. Among the adult community members, the metrics would the number of respondents in the designated clinics seek cessation assistance as well as the adult drug abuse report.

Priority #2- physical Activity in Burbank City

To enhance physical activity within the community, the implementation committee will hold meetings with county officials and school officials. The meetings will result into the development of plans implement the “5-2-1-0” program in schools. Students and generally teenagers are at enhanced risks. This strategy will foster enhanced physical activity and promote better eating habits. Children and their parents will be sufficiently educated about the initiative through school meetings. This will enhance the adaptability of the program, even at individual homes. Via effective collaboration with the school officials, the committee can ensure students access ample resources and room for comprehensive physical education to promote better outcomes. The committee will then meet the City officials to deliberate on infrastructural improvements and environmental adjustments such as bike paths, sidewalks and adequate number of parks. Improving the available areas for safe and physical activity is important for enhancing the community’s level of activity. Implementation of these action plans should immediately start with a bi-annual assessment of outcomes. The measures of success will for these interventions be the rates of obesity among all age groups represented in the community as well as noticeable positive environmental adjustments in bike paths, sidewalks, and parks.

To enhance access to individual’s access to healthy foods, the members of the community will hold meetings grocers, school officials, and owners of the produce farms, local government officials, and market leaders. Consequently, the “5-2-1-0” program could also meet the needs of this priority. Implementation committee members will collaborate with government officials, School and grocers to support the implementation of practices and policies which restricts children’s exposure to beverage marketing and unhealthy food. The committee members will discuss with the SNAP-ed program officials to roll out the SNAP-ed program within Burbank city. This is a collaborative program between Calfresh and the public health services to identify car fresh eligible members of the population and provide them with education on nutrition and obesity prevention. Lastly, the Committee members will meet with local and state government agencies to implement the Community Transformation Grants (CTG). This initiative supports local governments, territories, tribes, and communities. The fundamental objective of CTG is to ensure healthier communities through addressing healthcare disparities and reducing the prevalence of chronic diseases, among others. The implementation of the action plans should immediately begin with a bi-annual assessment during the first year to make the necessary changes. Obesity rates across all groups represented in the population will be the main metrics for evaluating success.

Evaluate the Progress

It will be the fundamental duty of the committee members to evaluate the success of the implemented strategies diligently. The metrics that have been mentioned in each section of the priority needs will be used. However, it will not be limited to obesity rates, teen smoking rates, pre-teen smoking prevalence, and percentage of people on SNAP-ed and CGT programs. Reduced obesity rates will be an indicator that community members are eating a healthier diet and exercising more. An evaluation of the rates of newly acquired conditions such as Type 2 diabetes will also assist in determining whether the population is maintaining a healthy weight and eating healthy. Consequently, a decrease in the cases of lung cancer or smoking-related pulmonary disorders, as well as the reduced sale of Tobacco, will imply that interventions are effective in bringing the expected outcomes.

Their measures mentioned above are useful in determining the failure or success of strategies. However, some other indicators and metrics are useful in continuously evaluating the overall community wellbeing. The committee will utilize the outcome metrics and frameworks from the live well San Diego’s vision for San Diego County. The top Ten indicators from the vision providers an effective framework that will shape the progress assessment of the committee’s shared vision. The Live Well San Diego indicator framework brings an effective metric and structure for measuring the progress. The framework incorporates a variety of factors that influence the wellbeing of an individual. These indicators include quality of life, life expectancy, unemployment rates, education, security, income, physical environment, vulnerable population, income, built environment, and community involvement.

Conclusion

The Community Health Improvement Plan (CHIP) is fundamental in addressing community needs.