Community diagnosis

Community Diagnosis
Dr. Ahmed-Refat AG Refat
1

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
2

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
7

Clinical Medicine Vs
Community Medicine : Focus
Clinical medicine focuses
primarily on the individual, while
public health focuses on the
community.
8

C
 Relevant time frames in Clinical Medicine are
usually single lifetimes,
while public health thinks in terms
of generations.
Community Medicine : Time Frame9

C
 From an ethics perspective, clinicians
advocate for individual people.
Public health practitioners advocate for the
community, for a group of
people.
Community Medicine : Ethics10

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 : Ethics11

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 : Education12

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 : Evidence13

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.
14

Community medicine
 The field concerned with the study of health and
disease in the population of a defined community or
group
 Its goalis 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
 Communityhealthdeals with all the services
that is aimed at protecting the health of the community
 Preventive
 Promotive
 Curative
 Rehabiltative
Communitymedicinelooks 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
17

Dimensions of the Community
 Any community having three features:
(1) Location,
(2) Population
(3)Social system
18

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?
19

Geographic features
Climate
1. Is the community prepared to cope with emergencies?
20
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?
21
A- location: Community Profile Relating

b. Population
The health of any community
is greatly influenced by the
population that lives in it
22

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?
23

)
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/

24

3. Social system variables:
 Health system
 Family systems
 Economic system
 Educational system
 Religious system
 Welfare system
 Political system
 Recreational system
 Legal system
 Communication system
25
c. Social System

http://www.cdc.gov/socialdeterminants/FAQ.html#a
26

Vision:
Healthy People in Healthy
Communities
Mission:
Promote Physical and Mental Health
and
Prevent Disease, Injury, and Disability

Public Health
 Preventsepidemicsand the spread of disease
 Protectsagainst environmentalhazards
 Preventsinjuries
 Promotesand encourageshealthybehaviors
 Respondsto disastersand assists communitiesin
recovery
 Assuresthe quality and accessibilityof 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?
37

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”.
38

Community diagnosis is a
comprehensive assessment of
health status of the community
in relation to its social, physical
and biological environment.
39
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. .
40

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.
41
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”.
42
Community Analysis

the regular collection,
analysis and sharing of
information about health
conditions, risks and
resources in a community.
43
Community Assessment

 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.
45
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
46
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.
47

 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..
48

 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.
49

Community can be
diagnosed by using:
Health
Indicators
50
Health Indicators

Health Indicators
51
Health Indicators

Health Indicators
Indicator (health indicator) -
A key statistic that indicates
or points to another measure.
52

Health indicators
Health indicators are summary
measures that are designed to
describe particular aspects of
health or health system
performance.
53
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,
55

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.
56

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
57

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
60

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
62

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
63

Community diagnosis-cont..
 2- Socio-economic & Cultural variables
 Social indicators
 Communication network
 Transportation system
 Educational level
64

 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
65

 Environmental indicators
 Physical/geographical/topographical
characteristics
 Water supply
 Waste disposal
 Air, Water and Land pollution
66

 Cultural factors
 Variables that may break up people into groups
within the community e.q.
 Ethnicity
 Social class
 Language
 Religion
 Race
 Political orientation
67

 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
68

 4-Health resources
 Manpower resources
 Material resources
69

 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
70

Indicator Types :EC Classification
88 Indicator
 Demography and socio-economic situation
 Health status
 Determinants of health
 Health interventions: health services
 Health interventions: health promotion

73

USA 2020 LHI Topics
The Leading Health
Indicators
are composed of 26
indicators organized under
12 topics.
74

Performing
Community Diagnosis
75

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
76

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
77

Steps in Implementation Phase-cont.
. 5- Developing the instruments
 Survey questionnaires
 Interview guides
 Observation checklist
6- Actual data gathering
78

 7-Data collection & Data summarization
 8- Data Presentation
 9-Data Analyses
 10- Problem identification :
( Magnitude, Trend, Comparison ) -
 (Health Status , Health –related, Health
Resource)
79

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
80

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
81

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:
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
83

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
84
11.Priority-setting

Community diagnosis

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