Community Health Assessment Model in Action

THIS MODEL CLOSELY parallels the presentation by Dr Mark Smith, Identifying Strategies to Improve Community Health: 2012–2013 Community Health Assessment sponsored by the Department of Public Health, Cone Health, High Point Regional Health System, and University of North Carolina Greensboro. The event took place oMarch 8, 2013.

The County Rankings Health Model weighs Health Factors listed on the chart’s left (shown below) as Physical Environment, Social and Economic Factors, Clinical Care, and Health Behaviors. These in turn are assigned influence in percentages.

To Mark’s original illustration demonstrating how local gardens in the Physical Environment might eventually effect Health Outcomes and real dollars, I have substituted actual examples from our work with Dr H Wier Siu, Khin H and Kwol Ksa, the community health workers, and members of the Women’s Learning Group.

Mark’s original concept map...

Revised Women’s Learning Group map...

Plotting the first model, cause and effect...
 
Which actually turned out to be more complicated, because it required community intervention...
 
... And encouragement through classroom discussion initiated by cultural intermediaries like myself...

This model is probably true. Families which can keep to traditional foods probably stave off the worse effects of poverty, but they can’t stop disease, American lifestyle influences, school lunches, etc. forever.

This model is probably true but doesn’t fully take advantage of community resources and talents...

As in the above model, probably true...

Although the Montagnard MDs and CHWs are not formerly ‘in the System’, in this diagram I place them there...

At this point we must consider what would happen if former MDs and CHWs really were supported — just imagine the huge impact on Health Outcomes in the Montagnard community...

What makes the support of refugee communities with strong agricultural traditions so attractive is that their Health Behaviors, Social Economic Behaviors and ability to master their Physical Environment can be aligned to generate positive Health Outcomes—as Women’s Learning Group strongly suggests — if only American funders were willing to directly and more fully support these efforts and to do them on a bigger scale.

In the past, communities like the Montagnards were considered by Americans to be insular, too difficult to reach, too costly to change — and let’s be frank, too ill-educated, simple and unlike us. Our work challenges those assumptions. Montagnards are fully able to work within a Health Assessment Model that lead to better Health Outcomes.

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Notes on some of the photos used in the chart

PHYSICAL ENVIRONMENT
Built environment / Environmental quality
Farmers switch to a community garden model to harvest and sell veggies.

Notorious slum that housed refugees for 20+ years.


Inexpensive rain barrels save water bills.

Rosewood Park
SOCIAL-ECONOMIC FACTORS
Community safety / Family and social support / Income / Employment / Education
Walking and talking class in the neighborhood.

Recipe demo at the Farmers Market is also an 
extension of a classroom exercise.

Team’s first sale, or validation of their English skill

Harvesting veggies at NCAT Research Farm, sharing 
the bounty with family and needy neighbors.

Walkable neighborhood class

Young women in action.

Traditional farm hoe, exercise tool and cultural artifact.

CLINICAL CARE
Quality of care / Access to care
Expensive clinical care

The fees for billboards would pay for community health workers.

Community health workers at a fraction of physicians’ costs. 
Cultural competency and language fluency come free.


Former medical doctor interprets for neighborhood class.
HEALTH BEHAVIORS
Sexual activity / Alcohol use / Diet and exercise / Tobacco use
Cassava
Bitter melon

Learners walk to class.

Learners walk during class.

Seventy-year old is nimble enough to do hard garden work.

Cardiovascular and core workout.

Neighborhood class doing communal exercise.

Most women remain agile until very old age.

Traditional backstrap weaving, 10 AM in the neighborhood.

HEALTH OUTCOMES
Natural helpers: Former MD H Wier Siu and
 community health worker Kwol Ksa.

With a neighborhood center, proper office and support,
Montagnard former doctors and CHWs could work with 
community members to achieve positive Health Outcomes
 for chronic diseases, newborns, and other problems.
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People First
Seeing Mark’s presentation was inspiring. It showed me how health officials, medical professionals and analysts regarded community health problems and that we were on track with our emphasis on food, health, family, neighborhood learning and a cultural approach to resettlement and community-building.
     But the heart of the connection is people. Mark is active in Share the Harvest and other local food, sustainability, and food insecurity and food justice projects. Women’s Learning Group members have harvested veggies at NCAT’s Research and Demonstration Farm for Share the Harvest. At the Farmers Curb Market in April, H Anup (about to retire from Moses Cone Hospital), John (volunteer teacher), HVung (about to be accepted at Guilford College as a Bonner Scholar) answer Mark’s questions about farm hoes and hand-woven goods for sale at their market table.