Pinning down what ‘good health’ really means

• Needs assessment seeks to establish community health improvement plan

By Naomi Klouda
Homer Tribune
How is your town’s overall health?
It’s a question a broad group of community officials from all walks of life hope to answer by compiling a report on health issues and concerns facing residents from Ninilchik to Homer to Nanwalek.
Perceptions are one thing – such as there being a high proportion of our population suffering from cancer – but only the hard numbers will show a more definitive picture.
The group of health professionals continue to comb through data to check for the reality behind perceptions that might not be true, such as marijuana-use is high among teens, or that many people cannot afford to see a doctor to prevent health problems.
A community’s notions of itself can be as varied as the number of individuals – and they are subjective. When health professionals came together, they defined Homer as a place where people collaborate well to solve problems.
Or not – some colleagues responded.
Some say the town lacks tolerance and it lacks diversity.
Sharon Whytal, project coordinator for the Southern Kenai Peninsula Communities Project, said the goal is to create a health-needs assessment that will give way to a Community Health Improvement Plan. But before they can figure out what needs improving, they need to uncover the problems.
The group gathered last Wednesday to discuss a range of factors impacting health, from whether the city has enough outdoor walking trails, to not having access to affordable, nutritious foods. Nearly 100 community leaders, from services providers to business owners, voiced comments and ideas for the in-depth survey project.
“It can be overwhelming to define health as broadly as we have, then to pare it down to what needs to be addressed,” Whytal said. “In the end, though, we hope we can identify some root causes, then we can say, ‘Oh, we can do something about that,’ and make a difference on some things.”
Whytal, fortunately, isn’t overwhelmed by the project. The public health nurse has helped other communities set up this process, and was recruited on contract by South Peninsula Hospital to coordinate it.
At last winter’s Rotary Health Fair, the project found its start by surveying everyone who participated. They collected some 610 surveys from the fair to help begin gaining a glimpse into what might be identified as barriers to good health. Surveys compiled from around the community brought the total to 1,441 responses.
In order to facilitate discussion, community leaders were asked open-ended questions:
From your position, what are the strengths and assets of the community?
What are important issues based on your role?
What are solutions to those issues?
“A lot of how healthcare has been approached is in pieces, and we exist more in our whole selves,” Whytal explained. “Some of the comments were to be more holistic, encompassing mental health, physical self and barriers to those. For example, if we can’t pay the bills, our economic health can impact everything else.”
The group is about halfway toward its final product, with a decent distance to go in gathering more data.
“The biggest piece we have in front of us is to look for research and numbers to demonstrate either what illuminates or disputes our community perceptions about what we are facing,” Whytal said. “Then we need to look at our numbers and see how we compare as a state, and nation.”
Ideas knocking around so far are fairly thought-provoking. For example, when asked about health issues, perceived barriers included complicated billing processes with doctors, as well as a low-population density that works against funding help. Others suggested that more open space, trails for walking and services within walking distance might also help improve a community’s health.
Since the Community Health Improvement Plan takes so many factors into account, it sought the input of a wide range of officials. The Homer City Planning Office took part in the Wednesday discussion, with City Manager Walt Wrede sitting in. South Peninsula Hospital CEO and Administrator Robert Letson also attended, as did Community Mental Health Director Nina Allen and staff from the Independent Living Center. The director of the Kachemak Bay Campus, Carol Swartz, is on a core committee, as is Becky Noble from the Seldovia Village Tribe, and Kyra Wagner from Sustainable Homer.
A picture of community health also has to take into account the knowledge of educators, health professionals, police, clergy and counselors. The theory is that Mobilizing for Action through Planning and Partnerships provides the framework for convening a variety of organizations and individuals that comprise the local public health system. MAPP was developed in collaboration with the Centers for Disease Control from 1997-2001 to fill a gap: public health practitioners previously didn’t have structured guidance on creating strategic plans.
“In the end, we may find we are average in a given area, and maybe that is OK,” Whytal said. “But in other cases, maybe we don’t want to be average. It will be useful to have the data. We can see what our problems look like, and what our priorities are.”
Individuals in the community are assigned to locate the data that best answers quantitative questions, such as how many people use the emergency room because they do not have a primary care provider? What kinds of drugs pose the biggest threats and how frequently is alcohol or drug use at the root of health problems?
Police, courts, hospitals and other local agencies have the numbers they can share in creating the assessment. The deadline for individuals to submit data to their work groups is Sept. 18.
“It could tell us that we are doing more than we are aware of. Maybe we just hear about the difficulties and believe they reflect everyone, and maybe they don’t,” Whytal said. “It matters what we care about, and we can be more informed as we go forward. This will give us a consensus about where to start.”
Whytal said members of the public will have opportunities to review findings and provide input on the assessment and plan later this fall and winter.

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