Community health programs are as wide-ranging as the health needs of the US. The basic objectives of community health programs are to provide health education and health promotion activities to address health problems and to promote overall wellbeing in a community, whether the community is an entire city, a school, neighborhood or workplace. These non-traditional sites for health promotion and health education are a defining characteristic of CHPs. By focusing on where people work or go to school, for example, health messages are efficiently delivered and no new resources for infrastructure are required (HealthPeople.gov).
What kinds of activities define CHPs?
According to Healthy People 2010, CHPs work through the following types of activities: “instituting new programs, policies and practices; changing aspects of the physical or organizational infrastructure; and changing community attitudes, beliefs, or social norms” (HealthyPeople.gov).
The Centers for Disease Control and Prevention funded 50 communities to prevent key chronic health issues facing America: tobacco use, exposure to second-hand smoke, and obesity (Bunnell et al. 2012). The communities ranged from sparsely populated rural counties, to tribal lands, to urban neighborhoods. These CHPs included a policy component, for example nutrition labeling in restaurants and designating areas as smoke-free zones. These CHPs were notable in that CDC also provided technical assistance, media support and, critically, evaluation services (Bunnell et al. 2012).
Federally-funded community health centers
Federally-funded community health centers provide direct patient care, regardless of the ability to pay, to millions of Americans. Services include medical and dental visits, behavioral and mental health care, help with substance abuse, and coordinating social services for individuals and families. Community health centers were established in the 1960s as part of the Johnson Administration’s War on Poverty. They can be considered a community health program to the degree that the centers provide preventive services.
School-based programs target prevention of common conditions of childhood and adolescence, including violence and injury prevention, tobacco and substance abuse prevention, pregnancy and STI prevention, and healthy eating and exercise. Schools are the most common site for mental health services for children (Langley et al. 2010). Worksite programs usually focus on prevention, screening, and management of chronic conditions such as diabetes.
Hallmarks of effective programs
Effective programs are responsive to the health needs of a community and engage community members. The involvement of community members helps ensure the acceptability and sustainability of a program. Ongoing and iterative needs assessments also are critical to success of a CHP. Needs assessments track changing demographics and shifts in a community’s epidemiological profile, enabling the CHP to remain aligned with the community. Finally, evaluation is the assessment of program implementation, the degree to which the program is successful in carrying out its objectives, and the measurement of changes in health behaviors and outcomes for the target population. Program evaluation is a tool to promote accountability both to the community served and to the program’s funders.
Challenges facing CHPs
Adequate resources and program sustainability remain challenges for CHPs. Research also has found several systemic issues that can limit CHPs’ scope and influence on health outcomes, including programs that are not customized to the unique needs of the specific community; programs whose reach is too narrow or limited, and are therefore inadequate to shift community health in a meaningful way; and, finally, programs that are too short in duration to have a meaningful impact on community health (Merzel and D’Affilitti 2003). Even in cases of evidence-based programs, there can be challenges with program implementation and consequently, health impact. For example, in a study of school-based mental health programs, competing responsibilities and lack of administrative support and infrastructure hindered implementation (Langley et al 2010).
Healthy People 2020 cites three “emerging issues” for CHPs (HealthyPeople.gov). Programs should focus on the “whole child”, which means both addressing the child’s well-being (and not only the absence of disease) as well as the multiple environments that play a role in child well-being. Second, CHPs should be evidence-based. CHPs do not need to build new programs ad hoc; rather there are data-driven programs that can be adapted for unique communities. Finally, Health People 2020 calls for increasing professionalism of the CHP workforce as the final goal in assuring CHPs maintain a vibrant and responsive component of the US public health system.
About Cynthia Ronzio
Cynthia Ronzio is a Professional Lecturer in the Department of Health Studies at American University. She earned a doctorate in Health Policy from the Johns Hopkins Bloomberg School of Public Health and has a Masters in Community Counseling from George Washington University. Cynthia has over a decade of experience in social epidemiological research. Her teaching and research interests include women’s mental health, measurement of poverty and health disparity, and children with special health care needs. Her vision for her students is that they develop a lifelong interest in public health and apply research and policy perspectives to the public health issues they encounter throughout their careers.
Langley, A.K., Nadeem, E., Kataoka, S.H. et al. School Mental Health (2010) 2: 105. doi:10.1007/s12310-010-9038-1
Sparling PB. Worksite health promotion: principles, resources, and challenges. Prev Chronic Dis 2010;7(1):A25. http://www.cdc.gov/pcd/issues/2010/ jan/09_0048.pdf. Accessed Nov 18 2016.
Bunnell, R., O’Neil, D., Soler, R. et al. J Community Health (2012) 37: 1081. doi:10.1007/s10900-012-9542-3
Merzel, C and D’Affilitti, J. Reconsidering Community-Based Health Promotion: Promise, Performance, and Potential. Am J Public Health. 2003 April; 93(4): 557–574.
Healthy People 2020. Office of Disease Prevention and Health Promotion. https://www.healthypeople.gov/2020/topics-objectives/topic/educational-and-community-based-programs
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