The committee has based its work on a vision for community health improvement that relies on shared responsibility across a broad range of community stakeholders, combined with individual accountability to ensure that responsibilities are not ignored or abandoned. This has led to a proposal for a community health improvement process (CHIP), described in more detail in Chapter 4, through which a community can assess health needs in the population and also develop interventions and monitor performance and outcomes.

A Process to Support Health Improvement

A CHIP would operate through two primary interacting cycles, both of which rely on analysis, action, and measurement (see Figure 1-1). A broad problem identification and prioritization cycle focuses on building a community stakeholder coalition, monitoring community-level health indicators, and identifying specific health issues as community priorities. The second cycle—an analysis and implementation cycle—is a series of processes to devise, implement, and evaluate the impact of health improvement strategies for priority health issues. More than one analysis and implementation cycle may be operating at the same time if a community is responding to multiple health issues. The overall process differs from other health assessment and health-related performance monitoring models primarily because of its emphasis on measurement to link performance and accountability.

As envisioned by the committee, a CHIP can be implemented in a variety of community circumstances, and communities can begin working at various points in either cycle and with varying resources in place. The process must be seen as iterative and evolving rather than linear or short term. One-time activities, briefly assembled coalitions, and isolated solutions will not be adequate. The process must also be able to accommodate the dynamic nature of communities and the interdependence of community activities. Both community-level monitoring data and more detailed information related to specific health issues must feed back into the system on a continuing basis to guide subsequent analysis and planning. This information loop is also the means by which a CHIP links performance to accountable entities among the community stakeholders.

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