restricted access 9 Community Health Assessment or Healthy Community Assessment
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9 Community Health Assessment or Healthy Community Assessment Whose Community? Whose Health? Whose Assessment? TREVOR HANCOCK MEREDITH MINKLER 153 Many questions need to be asked concerning the performance of a community health assessment. In this chapter, we discuss a number of these questions and provide examples of assessment processes that we believe illustrate promising approaches. As our title implies, we believe that to be truly empowering and health promoting, assessment should be of the community, by the community, and for the community. Why Assess? In a seminal article written almost thirty years ago, Sylvia Marti-Costa and Irma Serrano-Garcia (1983) argued that, far from being neutral or objective, needs assessment is in reality an ideological process that can serve political purposes ranging from system maintenance and control to the promotion of social change and consciousness-raising. At one end of the ideological continuum are needs assessments designed to support and justify the status quo. Although they may include some efforts at “fine-tuning” the way the system functions, they do not question or wish to change the ideological commitments on which that system is based (Marti-Costa and Serrano-Garcia 1983). The health educator trying to increase attendance at agency-sponsored community health fairs, for example, might well conduct an assessment to determine whether the event’s hours and location were problematic for local residents. But if the agency had already committed to health fairs as its modus operandi for community health outreach, the health educator would not be expected—or would not want—to determine residents’ perceptions of whether the fairs really addressed their primary health needs. In contrast, an assessment open to higher-level change would actively involve community residents not only in helping the agency or organization critically rethink its mission and activities but also becoming more skilled and empowered themselves in the process. The purposes of such an assessment, as Marti-Costa and Serrano-Garcia (1983) have suggested, would be to ■ measure, describe, and understand community lifestyles; ■ assess community resources to lessen external dependency; ■ return needs assessment data to facilitate residents’ decision making; ■ provide skill training, leadership, and organizational skills; ■ facilitate collective activities and group mobilization; and ■ enable consciousness-raising. The purposes of a “needs” assessment and the values and assumptions underlying this process, in short, heavily influence the choice of assessment techniques , the interventions proposed, the use of data obtained, and the perceptions of who owns the data in the first place. Rationale behind Community Health Assessment For professionals concerned with community organizing and community building for health and welfare, there are two reasons for the imperative placed on effective and comprehensive community health assessments: information is needed for change, and it is needed for empowerment. Information for Change The first kind of information has three purposes: to stimulate change or action, to monitor change or action, and to assess the impact of change (Hancock 1988; Hancock et al. 2000a, 2000b). Information that will stimulate change must carry “social and political punch.” Such information includes hard data and stories that point up differences, particularly inequalities in health and the social and physical determinants of health among different groups and sectors in the community. Given the short-term basis of much social and political action, such data also must be sensitive to short-term change, focusing on inequalities where there is a reasonable chance of seeing some change in a comparatively brief period of time. Although it is critical to document differences in mortality rates for lung cancer or heart disease, for example, this needs to be balanced by information on people’s perceived state of health, their social and physical living conditions, and their behaviors, all of which may be more likely to reflect changes in the short term following some policy or community action. The change rationale for community assessment also involves the need for information about the processes of change or of action. As a result, such assessment must put a heavy accent on stories and observations that may help unearth, for example, potential precursors to change. These might include widespread community knowledge of a new project, the establishment of participatory mechanisms such as intersectoral committees, evidence of the development of new skills (e.g., in leadership and media advocacy), and indicators of political TREVOR HANCOCK AND MEREDITH MINKLER 154 commitment to the project at the local level. Such intermediate-level activities may in turn lead to other actions (such as health-promoting policies) that will ultimately lead to better health. Information...


Subject Headings

  • Health promotion.
  • Community health services -- Citizen participation.
  • Community organization.
  • Community development.
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