community diagnosis

Community Diagnosis

Dr. Ahmed-Refat AG Refat

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Learning Objectives

1. Describe the meaning of health, Public H, Community

Medicine

2. List the 10 essential PH services

3. Compare and contrast clinical medicine vs community

medicine

4. Explain value , uses of community diagnosis

5. Describe health indicators.

6. Describe the steps of conducting community diagnosis.

7. Discuss priority setting process

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Health – PH - CM 3

What is Health?

“[Health is]

the state of complete physical,

mental and social well-being and not

merely the absence of disease or

infirmity”

(WHO, 1948)

Health Indicators, Part I

4

What is Health?

Health is a resource for everyday

life, not the objective of living; it is a

positive concept, emphasizing social

and personal resources as well as

physical capabilities”

(WHO, 1984).

Health Indicators, Part I

5

Public Health

What is Public health?

“the science and the art of preventing

disease, promoting health and

prolonging life through the organized

efforts and informed choices of

society, organizations, public and

private, communities and individuals. 6

15/10/2014

Clinical Medicine

Vs

Community

Medicine

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Clinical Medicine Vs

Community Medicine : Focus

Clinical medicine focuses

primarily on the individual, while

public health focuses on the

community.

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C Relevant time frames in Clinical Medicine are

usually single lifetimes,

while public health thinks in terms

of generations.


Community Medicine : Time Frame

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C

From an ethics perspective, clinicians

advocate for individual people.

Public health practitioners advocate for the

community, for a group of

people.


Community Medicine : Ethics

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C

In clinical medicine we focus on

individual rights of a patient. In

public health, we think about human

rights, social, and

environmental integrity.


Community Medicine : Ethics 11

C From an education perspective, in clinical medicine

In clinical medicine we focus on the

biomedical model with more emphasis

on cure than prevention. In public health, we

learn more about sociology,

epidemiology, cultural

anthropology, economics and

more.


Community Medicine : Education

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C From an education perspective, in clinical medicine

In clinical medicine the evidence was drived

from Randomized Clinical Trials . In public health, we depend mainly upon

Epidemiological Field Studies.


Community Medicine : Evidence 13

Community Diagnosis Component

Community Medicine has been

defined as that specialty which deals

with populations, and comprises

those doctors who try to measure

the needs of the population, both

sick and well, who plan and

administer services to meet those

needs, and those who are engaged in

research and teaching in the field.

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Community medicine

The field concerned with the study of health and

disease in the population of a defined community or

group

Its goal is identification of the heath problems and

needs of the community and to plan implement and

evaluate interventions

It involves provision of health care at the

community level with their full participation

Community health/ Community medicine

Community health deals with all the services

that is aimed at protecting the health of the community

Preventive

Promotive

Curative

Rehabiltative

Community medicine looks at the medical

and clinical services provided by physician and nurses but in a defined community

Definition of a “Community”

A cluster of people with at least one common characteristic (geographic location, occupation, ethnicity, housing condition……)

A group of people with a common characteristic or interest living together within a larger society

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Dimensions of the Community

Any community having three features:

(1) Location,

(2) Population

(3)Social system

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Community Profile Relating

to location variables?

Boundaries (incidence of wellness and illness and spread of disease)

1. Where is the community located?

2. What is its boundaries?

3. Is it part of a larger community?

4. What smaller communities does it include?

Health services locations (availability and accessibility)

1. Where are the main health services?

2. Are there necessary health services outside the community? Where?

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Geographic features

Climate

1. Is the community prepared to cope with emergencies?

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A- location: Community Profile Relating


Plant and animals

1. What plants and animals pose possible threat to health?

Human- made environment

1. What are the major industries?

2. How have air, land, water been affected by humans?

3. What is the quality of housing?

4. Access to health institutions?

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A- location: Community Profile Relating


b. Population

The health of any community

is greatly influenced by the

population that lives in it

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B- Population Variables

Size: Affects number and size of health care institutions

Homogeneity of population and its needs

What is the population? Is it urban suburban or rural?

Density: What is the density per square mile? Increased density increases stress. High and low density affect the availability of health services

Composition: What is the age composition? Sex composition? Marital status? Occupations and %

Rate of growth or decline: How has population size changed over the past two decades? Health implications of this change?

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)

c. Social System the circumstances in which people are born,

grow up, live, work, and age, as well as the

systems put in place to deal with illness. These

circumstances are in turn shaped by a wider set

of forces: economics, social policies, and politics.

http://www.who.int/social_determinants/en/

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3. Social system variables: Health system

Family systems

Economic system

Educational system

Religious system

Welfare system

Political system

Recreational system

Legal system

Communication system

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c. Social System

http://www.cdc.gov/socialdeterminants/FAQ.html#a

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Health Multifactorial 27

Vision: Healthy People in Healthy

Communities

Mission: Promote Physical and Mental Health

and

Prevent Disease, Injury, and Disability

Public Health

Prevents epidemics and the spread of disease

Protects against environmental hazards

Prevents injuries

Promotes and encourages healthy behaviors

Responds to disasters and assists communities in

recovery

Assures the quality and accessibility of health services

Essential Services of Public Health

• Monitor health status

• Diagnose and investigate

• Inform, educate, and

empower

• Mobilize community

partnerships

• Develop policies and plans

• Enforce laws and

regulations

• Link people to needed

services / assure care

• Assure a competent

workforce

• Evaluate health services

• Research

Monitor Health to Identify

and Solve Community Health Problems

Accurate, periodic assessment of the

community’s health status, including:

Identification of health risks

Attention to vital statistics and disparities

Identifications of assets and resources

Utilization of methods and technology (e.g., GIS) to interpret and communicate data

Population health registries

Diagnose and Investigate Health

Problems and Hazards in the

Community

Timely identification and

investigation of health threats

Availability of diagnostic services,

including laboratory capacity

Response plans to address major

health threats

What is community diagnosis?

What is

community

diagnosis?

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According to WHO definition

it is “a quantitative and qualitative

description of the health of citizens

and the factors which influence

their health. It identifies problems,

proposes areas for improvement

and stimulates action”.

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Community diagnosis is a

comprehensive assessment of

health status of the community

in relation to its social, physical

and biological environment.

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Community Diagnosis

Community Diagnosis

It should be the first stage in planning health

programs for the betterment and the improvement

of any community .

It includes:

Definition of the community’s demographic

characteristics .

Environment .

Health status ..

Available health and social services. .

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The purpose of community diagnosis

is to define existing problems,

determine available resources and

set priorities for planning,

implementing and evaluating

health action, by and for the

community.

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Community Diagnosis

Community analysis is the process of

examining data to define needs

strengths, barriers, opportunities,

readiness, and resources. The

product of analysis is the

“community profile”.

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Community Analysis

the regular collection,

analysis and sharing of

information about health

conditions, risks and

resources in a community.

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Community Assessment

Uses and value of CD 44

Identify trends in illness, injury, and death and

the factors, which may cause these events.

Identify available resources and their

application

Identify unmet needs

Identify community perceptions about health

issues.

Collect data regarding specific populations.

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Community Diagnosis : Uses

Identify at risk and high-risk populations, i.e., frail

elderly, unemployed/underemployed people,

women without prenatal care, troubled teens,

children behind on immunizations, low birth weight

Assess nutritional trends/needs; housing, jobs,

healthcare providers, social services, etc.

Monitor changing community needs

Assess changing population trends

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Community Diagnosis: Uses

Importance of Com. Diagnosis

Provides baseline information about the health

status of community residents.

Ensures that decisions are based on solid

information and evidence.

Helps set priorities.

Helps Regional Health Authorities assess

outcomes and results in the longer term.

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Gets community members, stakeholders and a

wide variety of partners

involved in the decision-making process, helps

them understand the difficult choices that need

to be made, and builds support and

commitment for addressing health needs on a

community-wide basis..

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Can be used to guide policy and program

development.

Can assist in mapping out links and

interdependence to other sectors.

Can provide insight into the fundamental

causes and pathways of identify opportunities

for disease prevention, health promotion and

health protection.

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Community can be

diagnosed by using:

Health

Indicators

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Health Indicators

Health Indicators

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Health Indicators

Health Indicators

Indicator (health indicator) - A key statistic that indicates

or points to another measure.

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Health indicators

Health indicators are summary

measures that are designed to

describe particular aspects of

health or health system

performance.

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Health Indicators

Characteristics of Good Indicator 54

Characteristics of Indicators:

a. should be valid, i.e., they should actually measure what they are supposed to measure;

b. should be reliable and objective, i.e., the answers should be the same if measured by different people in similar circumstances;

c. should be sensitive, i.e., they should be sensitive to changes in the situation concerned,

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Characteristics of Indicators:

d. should be specific, i.e., they should reflect changes only in the situation concerned,

e. should be feasible, i.e., they should have the ability to obtain data needed, and;

f. should be relevant, i.e., they should contribute to the understanding of the phenomenon of interest.

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Classification of health Indicators

Mortality indicators

Morbidity indicators

Disability rates

Nutritional status indicators

Health care delivery

indicators

Utilization rates

Indicators of social and

mental health

Environmental indicators

Socio-economic indicators

Health policy indicators

Indicators of quality of life

Other indicators

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Indicator Types :WHO Classification

http://www.who.int/whosis/indicatordefinitions/en/index.html

Health Status Indicators: Mortality

Health Status Statistics: Morbidity

Health Services Coverage Statistics

Risk Factors Statistics

Health Systems Statistics

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http://www.who.int/whosis/indicatordefinitions/en/index.html

Types of Community Diagnosis 61

Types of Community diagnosis

Comprehensive community diagnosis

Aims to obtain general information about the

community

Problem Oriented community diagnosis

Responds to a particular need

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Elements of Comprehensive

Community diagnosis

1- DEMOGRAPHIC VARIABLES

Total population & Geographical distribution

including Urban-Rural index & Population Density

Age & Sex composition

Selected vital indicators e.q. Growth rate, CBR,

CDR & Life expectancy rate

Patterns of migration

Population projection

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Community diagnosis-cont..

2- Socio-economic & Cultural variables

Social indicators

Communication network

Transportation system

Educational level

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Socio-economic & Cultural variables

Social indicators

Communication network

Transportation system

Educational level

Economic indicators

Poverty level income

Employment rate

Types of industry present in the community

Occupation common in the community

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Environmental indicators

Physical/geographical/topographical

characteristics

Water supply

Waste disposal

Air, Water and Land pollution

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Cultural factors

Variables that may break up people into groups

within the community e.q.

Ethnicity

Social class

Language

Religion

Race

Political orientation

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3-Health & illness patterns

Leading cause of mortality

Leading cause of morbidity

Leading cause of infant mortality

Leading cause of maternal mortality

Leading cause of hospital admission

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4-Health resources

Manpower resources

Material resources

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5-Political/Leadership patterns

Reflects the action potential of the state and its

people to address the health needs and problems

of the community

Mirrors the sensitivity of the government to the

people’s struggle for better lives

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Indicator Types :EC Classification

88 Indicator

Demography and socio-economic situation

Health status

Determinants of health

Health interventions: health services

Health interventions: health promotion

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USA 2020 LHI Topics

The Leading Health

Indicators

are composed of 26

indicators organized under

12 topics.

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Performing Community Diagnosis

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Community Diagnosis :

Steps in Implementation Phase

.1- Determine the objectives

2- Define the study population

3-Determine the data to be collected

4- Collecting the data

Records review

Surveys & Observations

Interviews

Participant observation

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Sources of Data

Routine reporting from health facilities

Surveillance :active, passive.

Screening

Special surveys

Rapid surveys

Contact tracing

Vital registration

A combination of several methods

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Steps in Implementation Phase-cont.

. 5- Developing the instruments

Survey questionnaires

Interview guides

Observation checklist

6- Actual data gathering

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Steps in Implementation Phase-cont.

7-Data collection & Data summarization

8- Data Presentation

9-Data Analyses

10- Problem identification :

( Magnitude, Trend, Comparison ) -

(Health Status , Health –related, Health

Resource)

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B- Steps in Implementation Phase-cont.

. 11- Priority-setting Nature of the condition/problem presented

Classified as health status, health resources or health

related problems

Magnitude of the problem

Severity of the problem which can be measured in terms

of the proportion of the population affected by the

problem

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B- Steps in Implementation Phase-cont.

. 11- Priority-setting Modifiability of the problem

Probability of reducing, controlling or eradicating the

problem

Preventive potential

Probability of controlling or reducing the effects posed by

the problem

Social concern

Perception of the population or the community as they are

affected by the problem and their readiness to act on the

problem

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11- Priority-setting A. Factors inherent in the disease (or health

problem)

B.Technical resources for dealing with the

problem:

C. Reaction of the public:

D. Economic aspects:


Steps in Implementation Phase-cont. 82

11- Priority-setting

Nature of the condition/problem presented

Classified as health status, health resources or health related problems

Magnitude of the problem

Severity of the problem which can be measured in

terms of the proportion of the population affected by the problem

Modifiability of the problem

Probability of reducing, controlling or eradicating the

problem

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Preventive potential Probability of controlling or reducing the effects posed by the

problem

Social concern Perception of the population or the community as they are

affected by the problem and their readiness to act on the problem

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11.Priority-setting

community diagnosis

Health & Medicine