Assess Needs & Resources:
Key Activities

From your snapshot, you’ll be able to review data used to calculate your county’s current rank. Your snapshot can help you understand how long and how well residents in your county are living.

Find your county snapshot

1. Go to Explore Health Rankings on the orange navigation bar above.
2. Enter your state or county name under Find County Rankings.
3. Select your county.

Use the Areas to Explore and Areas of Strength buttons at the top of your county snapshot to highlight potential challenges your community may want to examine more closely and factors that are assets in your community. 

You can also find data by race/ethnicity for many of our measures. In your county's snapshot, disaggregated data can be found in measures with blue underlined values. Click on the value to learn more about the size and nature of health differences by race/ethnicity in your community. 

What does it mean?

Explore Your Snapshot will help you interpret your county’s data. It can also help you think about additional questions to ask and sources of data to explore.

Beyond county lines

The work of improving health doesn’t always fit neatly into county lines. The community you’re focused on might extend across multiple counties or sit within a small area of a county. If county-level data doesn’t feel relevant, consider using your snapshot to:

• Understand the broader context in which your community exists

• Review the types of measures communities around the nation are using for their assessments
• Compare to your community data

Why assess needs and resources?

As you begin an assessment of your community’s health, be clear about your goals. For example, your community can use an assessment to:

• Identify differences in opportunities and outcomes.
• Guide your efforts to address areas of greatest need.
• Identify and make the most of existing assets and resources.
• Secure additional funding for your work.
• Meet federal, state, or local requirements.

Nonprofit hospitals and many public health departments are required to assess their communities on a regular basis. These assessments often follow specific requirements. Work with partners to align any assessment requirements at the beginning of your process.

What does community mean to you?

You may define your community by:

• Geography such as neighborhood, city, county, or hospital catchment area.
• A specific priority population such as immigrant communities or those facing inequities.

Depending on how your define your community, you may need to collect your own data to assess your community’s needs and opportunities

Who will be involved?

Your assessment is an opportunity to build trust and ownership within the community. Make a plan for engaging the community so all voices can be heard. What is your goal for involving the community? What is your commitment to those you engage?

The International Association for Public Participation’s Spectrum can help you define the public’s role in your efforts. Thinking about this now can help ensure your engagement is meaningful, which is key to understanding the full range of needs and opportunities for good health.

We like the strategies for gathering community input included in Rotary International’s Community Assessment Tools. This is a go-to resource for trying to decide which strategy to use to gather input and how to implement that strategy.

How will you conduct your assessment efforts?

The remaining Key Activities in this step are dedicated to the work of assessing your community, from generating questions to collecting data to sharing your results. Here we’ll focus on where to start and where to go next.

Where to start. You can often find and build off of existing data. Start by checking out assessments or studies conducted by:

• Local or state government agencies, such as planning or public health departments.
• Healthcare organizations, such as nonprofit hospitals or Federally Qualified Health Centers.
• Other partners such as Community Development Corporations, Community Action Programs, University Extension programs, Chambers of Commerce, and nonprofit organizations.

WORK TOGETHER NOTE: If you haven’t already reached out to these organizations, this is an opportune time to connect. Could you share data? Collaborate on the process? Partner on the action your assessment will drive?

Where to next?

• What other information will you need to know?
• How will you get that information?
• Who will collect the data?
• Who will analyze the data? How?
• Create your timeline.

Get curious

Think about various layers of questions.

Health Outcomes & Factors: The County Health Rankings model can help you think about additional information you might want to gather about your community. Communities we work with find the Broadening Your View section of our Use the Data tool helpful. This section asks questions that take you beyond what the Rankings tell you. Here are some examples:

• What are the leading causes of death in our community?
• What percentage of 3-year-olds are enrolled in an early childhood program or preschool?
• What are our biggest employment sectors or industries?

Inequities: You may see differences in opportunities for good health across county lines or between groups within communities. Look at your community's health by race, ethnicity, age, income, education, or sexual orientation, among others, to reveal gaps. Here are some example questions to ask:

• How does life expectancy differ by age, race, neighborhood, etc.?
• How do graduation rates differ by race, neighborhood, etc.?

Root causes and systems: In order to create long-term health improvements, it is important to uncover the underlying issues or root causes of inequities. Differences in opportunities and health outcomes are often the result of unfair and discriminatory policies and practices at many levels throughout society that have created deep-rooted barriers to health. Identifying the root causes of a health issue will enable communities to address the most pressing needs and understand what resources you need to address them 

These questions help you start moving toward root causes. To dig deeper, follow-up with “but why …” questions.

• What are the drivers of these inequities? 
• What systems in our community perpetuate inequities?
• How does our community’s physical environment perpetuate inequities?
• What long-standing policies or cultural norms perpetuate inequities?

Try using the "But, why?" activity in our Understand and Identify Root Causes of Inequities Action Learning Guide to start to uncover root causes of specific health problems in your community. Keep in mind, it's most useful when people who are most affected by this problem are involved in contributing to the solution.

We also really like the questions included in the Equity and Empowerment Lens: 5 Ps Worksheet. This worksheet asks questions in the areas of People, Place, Process, Power, and Purpose. The questions are helpful to revisit throughout your process.

Who’s asking?

The people who you invite to help generate and answer questions bring their own lens to the conversation.

• Reach out to diverse stakeholders.
• Convene discussions on health gaps in your community.
• Create safe spaces for people to tell their truth.

Get real

Decide which questions you’ll take action on and what you need to do.

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In 2020, the County Health Rankings State Health Reports had a focus on persistent gaps in opportunity that contribute to poor health outcomes. Building on our efforts to call attention to the many factors that influence health, these reports highlighted data on social and economic disparities based on place and on race and ethnicity, in addition to providing evidence-informed strategies and examples of communities taking action to address equity.

These reports illustrate:

1. What health equity is and why it matters.
2. Differences in health outcomes within states by place and racial/ethnic groups.
3. Differences in health factors within states by place and racial/ethnic groups.
4. What communities can do to create opportunity and health for all.

Put the data into context

As you explore your 2020 State Report, use the following questions to put what you see into context.

• What differences do you see among counties in your state?
• What differences do you see by racial/ethnic groups in your state?
• How do counties in your state compare to all U.S. counties?
• What patterns do you see? For example, do some racial/ethnic groups fare better or worse across measures?

Keep talking

The State Reports are a snapshot of your state’s health. They are a tool to help communities understand how opportunity and health differ by place or race/ethnicity. They also begin to show what the intersection of place, race, and health looks like in your state. Use these reports to begin or continue conversations about health gaps.

Be clear on your goal as you explore the assets and resources in your community. What will help you get there? Identifying your community’s assets prepares you to:

• Mobilize the diverse skills and capacities of people in your community.
• Leverage assets to make change faster and more sustainable.
• Align existing efforts and resources.
• Build agency among residents to tap into their power and abilities to transform their community.

We like the Community Assets Brainstorm Exercise and Community Assessment Tools to prompt a group brainstorm or discussion. These tools offer discussion questions or brainstorm prompts. Neither tool offers detailed direction for facilitating an activity. Discovering Community Power: A Guide to Mobilizing Local Assets and Your Organization’s Capacity is a more in-depth resource that includes examples and template worksheets.

The Use the Data tool can point you toward existing data to answer your questions.

• The Digging Deeper section lays out which County Health Rankings data sources also have data for specific demographic groups or geographic areas smaller than counties.
• The Finding More Data section provides an overview of and links to state and national data sources.

Break it down

Sometimes information that provides summaries for groups of people can mask important differences among them. Understanding the size and nature of these differences is important to closing health gaps. As you gather existing data, look for data that you can break down by demographic groups or geographic areas. Will your data allow you to see how different populations are impacted by health outcomes and health factors?

A word of caution

It’s easy to go down a data rabbit hole. Remember which questions are most important to answer and focus on the data that can help you answer them.

Types of data 

There are two types of primary data: quantitative and qualitative. 

You can collect data in a variety of ways. We often turn to Listening to the Community: A Guide to Primary Data Collection when communities are thinking about how to collect data. It’s a deep resource that offers guidance on when and how to use key informant interviews, focus groups, community surveys, community forums, and observation.

Who are you asking?

As you decide which methods you will use to collect data, think about who you’re going to ask:

• Will you ask individuals or groups?
• How are the individuals or groups you will collect information from representative of those living in your community?
• Who will do the asking and analyzing? Be sure to meaningfully engage those who have lived experience in the process of understanding issues and taking action together.

We like to use the Photovoice technique to engage community members, especially those who may not traditionally be brought into these conversations. For example, it’s a great way to bring the youth voice into the conversation.

Keep the end in mind 

As you decide which methods you will use to collect data, keep your vision for the community in mind. How will the data you collect help improve health and achieve health equity?

In-depth resource. Assessing Community Needs & Resources in the Community Tool Box provides an in-depth description of a variety of methods for collecting data. Each section describes the method and why, when, and how you should use it.

Go back to the questions you generated about your community. How do the data you’ve collected answer those questions?

Pick comparisons 

It can be difficult to understand your community’s data without context. Comparing your community’s values to the data from other communities can help. Most assessments include comparisons to:

• Other similar or nearby communities
• State or national values
• Your community’s past values

Our downloadable Peer Counties spreadsheet can help you identify counties that could be considered peers based on key demographic, social, and economic indicators.

Examine the trends

Look at five or more years of data to detect trends in your community.

• Use a graph to visualize your trends.
• Quantify your trends. You can approximate your county’s trend and its differences from the state and nation by calculating the percent change over time. Our Trend Analysis and Interpreting Trend Graphs pages provides more technical guidance for examining and interpreting trends over time. 

You may want to connect with data analysis experts to better understand how you can move your data to action. People who have this type of expertise are often found in public health departments, local colleges or universities, or consultant groups.

Consider four key questions to help you prepare to communicate your results:

1. What data are most important to share?
2. How should numbers be shown?
3. How should the results be presented?
4. How should the results be distributed?¹

Visualize the data 

Maps and infographics can be powerful ways to convey important information. Maps can help you uncover important patterns. The Visualize the Data section of our Use the Data tool provides a list of resources where mapped data is available for download.

Get the word out 

You can communicate your results in a variety of ways.

• Community presentations or forums
• Publishing and distributing fact sheets
• Websites
• Social media
• Local media

Find more guidance and tools for sharing results in our Communicate guide.

Create a feedback loop 

How will you incorporate community feedback? Does the community perceive your data and findings to be valid? Take time to explain your methodology and raise awareness about the problems identified during your assessment.

If your results don’t resonate with the community, spend some time listening – what do community members see as the most pressing issues?

If members of your multi-sector team are planning to use your assessment effort to meet requirements related to the Affordable Care Act Provisions and Community Benefits or Public Health Accreditation, you may want to review additional resources.

Affordable Care Act Provisions Regarding Tax-Exempt Hospitals: Not-for-profit hospitals are now required to conduct a community health needs assessment at least once every three years. These assessments must use public data, engage community stakeholders, and result in an implementation plan. Implementation plans must account for how current needs and ongoing gaps will be addressed. Use The Hilltop Institute’s Community Benefit State Law Profiles to learn more about your state’s community benefit law.

Assessing and Addressing Community Health Needs, developed by the Catholic Health Association, is a comprehensive guide to community health assessments. It incorporates requirements from both the 2010 Patient Protection and Affordable Care Act (PPACA) and the Internal Revenue Services.

Principles to Consider for the Implementation of a Community Health Needs Assessment Process identifies guiding principles to inform the implementation of the Affordable Care Act’s community health needs assessment provisions applicable to not-for-profit hospitals that seek federal tax-exempt status.

Public Health Accreditation uses standards and measures developed after a thorough process of study, vetting, and testing. The governmental entity that has the primary statutory or legal responsibility for public health in a tribe, state, territory, or at the local level is eligible to apply for accreditation. Domain 1 (pp. 13-59) of the Public Health Accreditation Board’s Standards & Measures Version 1.5 document discusses the accreditation requirements related to assessment. Version 2.0 of this document is being developed, which may impact future accreditation requirements.