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Improving Health in the Community: A Role for Performance Monitoring
a final product. The indicators chosen reflect the committee's judgment in balancing three considerations: (1) importance in shaping or contributing to understanding community health, (2) usefulness across a broad range of communities, and (3) feasibility of measurement. Communities may, through their health improvement activities, identify topics of local importance that should supplement the basic profile. Indicators that address issues beyond the traditional realm of "health" (e.g., education, literacy, employment, crime, housing, community participation) may be relevant. For example, the categories of measures for the National Civic League's (1993) Healthy Community Indicators include health, family income, housing and homelessness, food assistance, child care, education, youth employment, transportation, public safety, and environmental issues. The Sustainability Indicators developed by the Regional Municipality of Hamilton-Wentworth (1996) in Ontario, Canada, include measures such as air quality, water and electricity consumption, voter turnout, and applications for affordable housing.
Access to a wide array of data, perhaps through state sources, can also support an expanded health profile. In expanding the profile, however, communities should not be aiming to produce a comprehensive health assessment tool. Such assessments are valuable, but if resources are limited, comprehensive assessments should probably be prepared less frequently than updates to a health profile. For a profile, communities should focus on indicators that can contribute most to an understanding of the population's health status and the factors that affect it in a positive or negative way. As was the case with the basic profile, the field model will be a useful guide for examining a broader array factors that may be determinants of a community's health and for selecting indicators to add to a profile.
Part of the committee's intention in proposing a basic set of indicators for a community profile is to encourage the development of common indicator definitions and common practices in data collection, analysis, and reporting that will facilitate comparisons over time and among communities. State programs that provide data to communities can promote this kind of comparability. Activities at the national level related to Healthy People 2000 and the consensus indicators, including reporting requirements for some block grants (e.g., CDC, 1994; MCHB, 1995), should also contribute to standardization of measures suitable for community health profiles. In addition, the work being done to develop indicators for state reporting for the proposed federal public health