Discussion

Although we initially sought to review literature on the evaluation of community health assessment with respect to their usefulness and describe the findings of these evaluations, we found that there is very limited work in this area. We found no rigorous, systematic reviews of CHAs, nor any comprehensive summaries of CHA strengths, weaknesses, and outcomes. However, we used this opportunity to review reports on a number of CHA processes throughout the US and in New York State and learn about and enumerate common—and not so common—characteristics.

We found substantial variation among CHAs, although there were a number of common characteristics. The variability we saw was not surprising, and like much else in public health, is likely due in part to the varying accountability, structure, and community involvement of LPHAs. Whereas some states have prescribed a particular format or process for CHAs, many more have not.

Few CHAs seem to focus narrowly on health care, without attention to other community issues that can affect health. This seems inevitable with the recent attention to population health and contextual variables that can affect it. Additionally, most CHAs seem to include an improvement aspect—going beyond assessing the problems in a community to develop a plan for addressing them. An evaluation of CHAs across Kansas found that 72% of responding communities that had included an intervention process as a result, but the evaluation did not collect data describing the scope or nature of these processes.

Additional research into CHA implementation and outcomes is needed. In particular, there is little existing data describing the actual impact of CHAs on health outcomes, although we know something about immediate products and resulting programs. Beyond work done by the New York State Public Health Agenda Committee, we could not find any critical reviews comparing different CHAs approaches that addressed processes, data used, and outcomes. Such a review would help New York and other states develop criteria for effective and cost-effective future CHAs.