Seminar: Community Health Assessment

Presenters: Kevin Lien & Jagdeep Virk

Learning Objectives:
Through this seminar, students will:
1. Understand the similarities and differences between the four types of community health
assessments (CHA)
2. Be able to describe the five basic steps of a community health assessment as described by
Cavanagh & Chadwick (2005)
3. Apply community health assessment and transdisciplinary research to a current public
health example; fluoridation
4. Develop an understanding of the role of community health assessment in global health
research
Agenda for Seminar:
1. CHA explanation (15min)
1. CHA video and discussion
2. Explain the different types of community health assessment
3. Provide definitions, 5 steps of HNA
b. Community health assessment simulation using fluoridation as case study (27min)
c. Viewing of YouTube video entitled: Fluoride in the Water Isnt Going to Hurt You and
Discussion (15min)
d. Summary and take home message (2-3 min)
Seminar Details:
CHA explanation:
Hello everyone, today we will be running our seminar on community health assessment. We
would like to start off by showing everyone a video. We will pose questions (eg. what is a
community health assessment?, what is the difference between a HNA and HIA?) before
showing the video. A discussion will follow this 3-4 min excerpt from the video.
Video: http://www.ncchpp.ca/546/Video.ccnpps?id_article=1194 from National Collaborating
Centre for Healthy Public Policy
Our Answer:
Community health assessment (CHA) is an iterative, ongoing and dynamic process that
addresses community health priorities by recognizing the strengths and needs of the population
(Government of Manitoba, 2009). CHA involves the collection, analysis and presentation of
health information in the population. These information are then used to inform health service
planning or project planning. Therefore, CHA can be used to inform health promotion and health
protection initiatives as part of the health surveillance process and research procedure.

Based on our required readings, health needs assessments (HNA) is a systematic method for
reviewing the health issues facing a population leading to agreed priorities and resource
allocation that will improve health and reduce inequalities (p. 3, Cavanagh & Chadwick, 2005).
Aside from HNA other approaches can be used to undertake community health assessment. The
major difference is the starting point:
Health needs assessment: proposals and initiatives are implemented by initially
addressing the health needs of the population
Health impact assessment: the impact of an initiative is predicted/assessed based on an
initial policy or project addressing the health of the population
o Equity-focused health impact assessment: applying equity lens into HIA with the
goal of reducing social inequities; impact should not negatively impact those who
are already disadvantaged (Sudbury and District Health Unit, 2011)
Integrated impact assessment: the impact of environmental, economic and social
outcomes is predicted based on an initial policy or project
Health equity audit: local partners systematically review health inequities by initially
assessing a defined population. HNA may be an action undertaken in response to the
audit or be used as data to inform inequities.
These approaches apply similar research methods and the selection of approach is dependent on
the aims and objectives of the project being undertaken.
Discussion Question (Linking to Objective 4): Which of these assessment methods do you think
would be most appropriate for LMIC? Consider the SHINE Project.
Our answer: Trick question. They are all appropriate. However, health equity audit seems to be a
great starting point to identify health inequities, especially in LMIC. Policies and initiatives can
follow suite to address the inequity.
The SHINE project though, given that it is already a health promotion initiative, may benefit
more from a health impact assessment to evaluate the effectiveness of the program. Based on
some feedback from the previous seminar, another reason to do HIA is to obtain evidence that
the project is successful in order to gain continual support.
HNA outlines fives steps in the procedure:
1. Getting Started/Basics: identifying purpose, target population, stakeholders, resources,
potential risks
2. Identifying Health Priorities: profiling the population, gathering data, identifying and
assessing needs, health conditions and determinants
3. Assessing a Health Priority for Action: selecting a health priority with most significant
impact, determining possible interventions and actions
4. Planning for Change: confirming on the monitoring/evaluation strategy of
the intervention, including risk managementactually implementing and monitoring the
intervention (in this case is the defluoridation)
5. Moving on/Project Review: assessing the success of the initiative, determining the next
steps

We will also incorporate points that were made in the twitter discussion on the barriers for CHA.
Some barriers include: lack of resources (i.e. financial, man-power), and lack of trust/rapport
(i.e. members of LMIC may not trust newcomers).
In order to carry out these steps, intersectoral action is required such as community engagement
(Sudbury and District Health Unit, 2011). Academia, policy planners, clinicians, and community
leaders are examples of several sectors that should be involved. HIA is one of ten important
aspects of public health that reduces inequities. Inequities can be addressed through careful
assessment and multi-sectoral action.
Community Health Assessment Simulation Portion
The students in the class will be divided into different stakeholders for the interactive discussion.
These stakeholders will correspond to the concentrations of the student. However, as there may
be a surplus of certain concentrations, such as psychology, these students may be assigned to be
regular citizens. Though they may be coming from a certain demographic group (e.g., Aboriginal
population, mother). The division of the class into various stakeholders before the community
health assessment simulation emphasizes the importance of community engagement and
partnerships in CHA (Cavanagh & Chadwick, 2005). This is also part of the first step in HNA
outlined in the required reading.
After the division we will lead the class into assessing the discontinuation of water defluoridation
in Calgary through the HNA steps outlined by Cavanagh and Chadwick (2005). As water
defluoridation is already a policy in Calgary, this will be most likely be a health impact
assessment. So some steps may already be pre-determined, and could be different from health
needs assessment. However some questions may still be worthwhile to go over, whether that is
for confirmation or to go over in detail.
The different stakeholders will not break up into separate groups, rather we will have one large
discussion for each step of the CHA. Each stakeholder will, hopefully, bring a unique perspective
to the team. The purpose of identifying students as specific stakeholders is to demonstrate the
importance of a transdisciplinary approach. So, working together, we will work through each
step of the CHA.
Step 1: Getting Started
Population: Show a map of Canadian cities that have discontinued water fluoridation. Then focus
on Calgary. Map can be found here: http://o.canada.com/health/hows-that-fluoride-free-watertreating-you
Policy: Discontinuation of water defluoridation
Background: A motion was brought forth in city council in 2011 to discontinue
fluoridation. It was passed 10:3. Twenty years of water fluoridation has been terminated.
Fluoridation began in 1989 after successful plebiscite (McLaren and McIntyre, 2011).
o However plebiscite was not passed in 1961, 1966, 1971

o Plebiscite was passed in 1998 to continue fluoridation

Purpose: Critically assess the potential benefits and consequences of the policy that has been
instated.
Stakeholder: Although, we will have assigned the stakeholders before the simulation we will ask
the class if any students feel that we are missing any important stakeholder and provide their
rationale. It would be interesting to see the perspectives of students. This will create different
responses in the community health assessment simulation as we go through the steps. It is
important to note that while students are asked to frame their answer depending on their role,
they are not limited to providing input using their given role.
Discussion Question: What types of resources are required to take on an initiative like a HIA on
fluoridation in Calgary?
Our Answer: There are a number of different resources needed for a HIA, these include broadly:
financial resources, human resources, and computer resources.
Step 2: Identifying Health Priorities/Step 3: Assessing a Health Priority for Action
We are considering oral health as a health priority. It may or may not be a health priority but we
are assuming that it is for this simulation. Water fluoridation is also used as a case study.
Discussion Question: What are some of your thoughts on the discontinuation of fluoride in the
water supply? What might different stakeholders say?
Our Answer:
Researchers might say: Fluoridation has been a major public health initiative. Water fluoridation
enables equitable oral health impacts within the population (McLaren, 2012). No consensus, but
general pop says its bad. Research also shows that increased fluoride intake can lead to fluorosis
(McLaren, 2012).
The general population might say: that fluoridation is more harmful than good. It is also
unnatural and harmful to the environment to add fluoride into drinking water (McLaren and
McIntyre, 2011).
Danielle highlights the importance of a transdisciplnary team working together, just like the
stakeholders needs to work together in this case.
Step 4: Planning for Change
A study undertaken by Dr. Lindsay McLaren (2014) at the University of Calgary is looking to
assess the oral health consequences of Calgarians after the discontinuation of water fluoridation.
(this is an example of planning for change)
Discussion Question: The discontinuation of water fluoridation in 2011 did not have a plebiscite.
How does this affect the implementation of the policy? What should have been done?

Our Answer: The decision made by the Calgary City Council could potentially be biased. A
range of stakeholders should be involved to voice their needs in order to implement a policy
change. A health needs assessment could/should have been conducted.
Step 5: Moving On
Benefits or consequences of the discontinuation of fluoride is currently unknown. This is the
reason why Dr. McLaren`s study is anticipated as we would get to know the oral health impacts
of Calgarians (in comparison to Edmontonians). However, what are some future steps?
Assuming that fluoridation is truly beneficial, what are some barriers to reinstating the
fluoridation of water?
Our Answer: given the Precautionary Principle, we cannot do anything because we are
uncertain whether something leads to a health threat. If we can do something to prevent a
negative health outcome even though the determinants are unknown, it is much better to do so. In
the fluoridation example it would be better to keep fluoride than remove it, if we abide with this
principle. Some barriers include: negative perceptions of fluoride in the population, difficulty
persuading politicians, and the lack of community input (eg. plebiscite).
Discussion Question: How can we apply this fluoridation example, which is in a local context, to
a larger scale/global health? --This aims to address objective 4
Our Answer: Global is Glocal, remember that in the beginning of the semester global health
does not have a set geographical boundary. Therefore, this local example is already part of the
realm of global health. The emphasis on community engagement and involvement of different
stakeholders in CHA parallels global health in which a transdisciplinary team is present (Koplan
et al., 2009). Fluoridation has been shown to benefit the entire population, even those with little
access to dental care (eg. homeless, low SES). This addresses the inequities that exist in oral
health
However, we can also look at oral health in a more international setting. HNA may be more
applicable as policies or programs may not have been implemented in LMIC.
YouTube Video
Ask this question to the class initially:
Discussion Question
What is your initial response to this video? How much of an impact do you think that media
plays in how health priorities are interpreted and seen in the public?
A 8:38 minute video will be shown to the class to provide the perspective of water fluoridation in
the majority of the scientific community. The video will briefly mention about the misuse of

scientific studies that brought upon the general publics concern of fluoride being harmful. The
video serves as a good summary of the fluoridation debate.
The link to the video can be found here: https://www.youtube.com/watch?v=6Hml1CL0Idk
Our answer to the discussion question:
The point of showing this video is to emphasize the impact that media can have on the perceived
needs of the population. Media often misinterprets and distorts scientific information. So it is
important to take into account the media when preforming CHA in the population. This is
important in LMIC as well because technology is advancing and spreading globally. (The
YouTube video and the discussion relates to objective 4).
Summary and Conclusion:
The take home message is that the community health assessment (CHA) is a critical approach in
global health that incorporates the population health approach (i.e. health surveillance, health
promotion). In essence, the CHA is a transdisciplinary approach that works to improve the health
of a population by reducing health inequities.
Take-away messages

four types of CHA are interrelated but distinctively different based on their starting point
CHA is a fluid process, that involves multiple disciplines following the components of
the 5 steps outlined by Cavanagh and Chadwick
CHA is tool that can inform global health research

References:
Cavanagh, S., & Chadwick, K. (2005). Health needs assessment: a practical guide. National
Institute for health and Clinical Excellence, 1-101.
Government of Manitoba (2009). Community Health Assessment Guidelines 2009. Retrieved
from: http://www.gov.mb.ca/health/rha/docs/chag.pdf
Koplan, J., Bond, C,, Merson, M , Reddy, S., Rodriguez, M., Sewankambo, N., and Wasserheit,
J., (2009). Towards a common definition of global health. The Lancet. 1993-1995.
McLaren, L., & McIntyre, L. (2011). Drinking water fluoridation in Canada: Review and
synthesis of published literature. Report commissioned by the Public Health Agency of Canada.
McLaren, L., & Emery, J. H. (2012). Drinking water fluoridation and oral health inequities in
Canadian children. Canadian Journal of Public Health/Revue Canadienne de Sante'e Publique,
S49-S56.

McLaren, L. (2014). The Impact of Removing Fluoridation from Municipal Water Supplies in
Canada: a Tale of Two Cities.
Sudbury & District Health Unit. (2011). 10 promising practices to guide local public health
practice to reduce social inequities in health: Technical briefing. Sudbury, ON: Author.