News & Analysis

The Public Health CHA: Time for a Temperature Reading

Headshot of Brian Ackerman, partner at Ascendient

Brian Ackerman

A digital thermometer||

Back in the old days (say, 2019) county health departments rarely made news unless a popular restaurant got shut down after failing inspection. But two years of pandemic restrictions have changed all that. Headlines are now frequent and foreboding, like this one from KHN: “Missouri’s War on Public Health Shows Extent of National Rift.”

The article notes that “over half of states have rolled back public health powers during the pandemic,” leading to a wave of firings, resignations, and retirements among local health officials.

As the leader of the public health practice at Ascendient, I’ve had the privilege of working with many state and county health leaders over the past 20 years, and I know their sense of passion and purpose. Health departments play a huge role in keeping people safe and well, so I’m personally troubled by the rising tide of resentment.

But here’s the thing: It’s probably not going away. Like the virus itself, this strain of resentment will probably become endemic – something that requires constant monitoring and awareness.

Fortunately, health departments already have the perfect diagnostic tool available to them. It’s called the Community Health Assessment, and now more than ever, it should be viewed as a strategic asset, rather than an exercise in box-checking.

The public health CHA is a way to take the temperature in your community with surveys and focus groups that “identify key problems and assets,” according to PHAB. As we’re seeing today, public opinion toward the local health department can be very much a problem or an asset, and leaders need to know exactly what they’re dealing with.

But getting an accurate read on community attitudes can be tougher than it sounds. Surveys and focus groups often over-sample residents inclined to support the role of public health departments – government officials, nonprofit executives, and education leaders, for instance.

Even when a CHA is specifically designed to elicit “proactive, broad, and diverse community engagement,” as prescribed by the CDC, diversity usually gets defined in terms of race, ethnicity, and socioeconomic status. Those measures of diversity are absolutely essential, but current events have taught us that they are not enough. If we really want to get an accurate read on any community, we have to design research that accounts for ideological diversity, as well.

How to begin? First responders have famously low vaccination rates, so try reaching out to the local Fraternal Order of Police lodge. Some conservative churches have opposed public health mandates, and members of veterans’ organizations often skew right-of-center in their political views. These are the people who could go unheard in the CHA research process, but we ignore them at our own peril.

If it’s been a while since your last public health CHA, now might be a good time to take your community’s temperature again. Just make sure the research is intentionally designed to bring in critical voices and viewpoints, no matter how uncomfortable that might be.

One other tip: Consider doing a joint CHA with the hospitals in your county. Hospitals are generally perceived as less “political” than government agencies, so a collaborative effort might help to encourage participation from across the ideological spectrum. As a bonus, county-wide CHAs save money by pooling research, so you get more – and broader – participation at a lower cost.

For more on this topic, read our in-depth report, The Ascendient Guide to Public Health Strategic Planning.