Focus on What's Important:
Key Activities

Options for Reviewing

• Prepare a summary or overview to present to your team.
• Have members review what was shared with the community (e.g., community presentations, fact sheets, reports, local media stories).

Helpful Tips

• Use the Rankings model as a framework for sharing what you’ve learned. For example, if you discovered that there are few healthy food outlets in your community, use the visual of the Rankings model to show that data as part of “diet and exercise” health factors.
• Zero in on the biggest opportunities for improvement. For example, obesity is an issue in most communities. Digging deeper into obesity by population groups and zip code/neighborhood can help you focus where there’s greatest need.

Your guiding question will help you keep the big picture in mind as you select priorities, and can act as a good check on your final selection of priorities.

Are you striving for the quickest improvement in health, the greatest impact on health in the long term, the greatest improvement for vulnerable populations, and/or the most efficient use of resources?

Suggested tools:

• Your team’s vision and mission statements

Benefits of Brainstorming

Traditionally, brainstorming exercises start with a question or problem and participants respond with whatever comes to mind. This is a great place to use your guiding question(s). 

Choosing priorities is challenging. It’s not uncommon to feel like everything is a priority, but it’s important to recognize that your resources are limited and being selective about the number of issues to focus on will help you successfully make changes in your community.

The number of issues you can address will depend on the people power you have available. Strong, multi-sector partnerships with the commitment and capacity to tackle multiple areas may be able to organize multiple action teams around different health priorities. Other communities may choose to work on a single complex problem (e.g., teen pregnancy, high school dropout rate). Consider your readiness to apply a Collective Impact approach to coordinate work across teams toward a shared vision.

A few tips

• We recommend focusing on no more than five priority areas, but the number will depend on your resources and whether you can add to ongoing efforts in your community.
• It is better to pick fewer priorities and succeed than to choose too many and find you can’t be effective in any of them.
• An important rule for brainstorming is not to evaluate ideas--the more ideas the better. Encourage participants to note ideas as they come to mind, without worrying about whether they are “good” or “bad”. This will allow creativity to flow.
• You may brainstorm as a group, having everyone respond to each guiding question and a note taker to capture the ideas generated. Another option is to have  participants brainstorm individually before the group activity then later share them with the group. A third option is to ask participants to review the data and guiding question ahead of time and come prepared with their ideas of two to three issues on which to focus.¹
• Consider an alternative to traditional brainstorming, such as having participants brainstorm individually before the group activity then later sharing them with the group or asking them to review the data and guiding question ahead of time and come prepared with their ideas of two to three issues on which to focus.¹
• Record the ideas where everyone can see them, or alternatively, use the Affinity Diagram process to generate ideas on sticky notes and group them in categories. This can be done in-person with actual sticky notes and large sheets of paper, or virtually using tools like a virtual whiteboard.
• Be sure you involve people from across your community in brainstorming, including employers, community advocates, health care and public health professionals, government officials, grantmakers, policymakers, educators, nonprofits, and others. Most importantly, include community members, including those who are most vulnerable and are experiencing the worst conditions for good health (such as members of low-income communities and youth).

Your decision will depend on the size of the team you’re working with, the amount of time you have, and how much community participation you want. 

Criteria for comparing options

Criteria express the values, standards, and basic ideas your team will consider when making choices and deciding priorities.¹ Try to limit yourself to no more than four or five criteria to select your priorities.

Keep your vision of everyone having a fair and just opportunity for good health, and your guiding question handy as you think about criteria.

Following are some questions to help you identify potential criteria:

• Who is affected?
• How many people are affected?
• Are there groups that are affected more than others? This type of difference is called a health inequity – a difference in health experienced by certain groups that is unfair and reflects injustice. 
• Where are the greatest opportunities for improvement?
• How severe are the effects? Based on the County Health Rankings model, how much does this issue contribute to health outcomes?
• What are the consequences of not intervening?
• Are there strategies that have been shown to effectively address this issue?
• How might the strategies work in your community? Consider the community’s context – its residents, culture, history, environments, location, assets and challenges.
• What does the community think? Do they support this issue?
• What do policymakers think? Do they support this issue?
• What assets and resources can partners bring to address this issue?
• How long will it take to reach an outcome or have impact in the community?
• What are the potential negative impacts of addressing the problem?
• What has been tried before? What were the barriers and successes of those attempts?

Processes to prioritize options

With any process you choose, be aware of power dynamics and how they might negatively impact your selection of priorities. Ensure that community members feel empowered to speak. Community members with direct or lived experience with a health-related issue should be given as much, if not more influence in selecting priorities.

First Things First: Prioritizing Health Problems describes five prioritization methods:

• Multi-voting – use when you need to narrow down a long list of issues to a top few.
• Strategy grids – use when you have limited resources but want maximum impact.
• Nominal Group Technique – use when you want to generate many ideas in a short time with input from many people and you want to reduce the final list of ideas.
• Hanlon Method – use to generate an objective list of health priorities based on baseline data and numerical values.
• Prioritization Matrix – use to evaluate ideas against a large number of criteria or when you want to focus on only one priority health issue.

Roles and processes to make the final choices

The Role of a Facilitator suggests some factors and options to consider when deciding the process you will use to make group decisions.

• The number of participants. If you have a large group, you might consider using smaller “break-out” groups.
• The level of participation you want to ensure. If you’re concerned about participation, giving participants time in the agenda to write down their thoughts may be a good strategy.
• The background and positions of the participants.
• How well participants know the subject and each other.
• The time you have available.²

In addition to a formal process, some communities will take their potential priority issues to the public for their input. There are a variety of ways to get input from the public such as holding community forums, making presentations to various community organizations, and conducting community surveys. Remember to plan community input activities so they are accessible and feel safe for community members and key stakeholders to engage. 

There are a variety of tools and processes to help you effectively prioritize. If a more formal process is useful you can use techniques like the Hanlon Method or Prioritization Matrix. When decision criteria are subjective and it's critical that you gain consensus, you can use techniques like Nominal Group Technique and Multivoting to help a group agree on priorities. Be sure to allow enough time for full and open discussion after these voting procedures so that the group doesn’t fall into Group Think, which occurs when the desire for group consensus overrides people's common sense desire to present alternatives, critique a position, or express an unpopular opinion. Group Think can also lead to unfair power dynamics, in which community members are not empowered to engage equitably in the prioritization process. 

Don’t be afraid to take on complex social problems! Focusing on social and economic factors is a big undertaking, but in the long run, it’s these factors that will have the greatest long-term impact on a community, especially for community members who are experiencing health inequities. 

Quick tip

• Logical order — Present issues in the sequence in which they should be addressed. This is useful where the resolution of one issue is contingent on resolution of another.
• Impact order — How important are the consequences of this issue? How complex is an issue? Resolving easier issues first can build the momentum, teamwork, and consensus that can lead to solutions for more complex, controversial issues.
• Temporal order — Resolve issues according to a timeline, using information such as coordination with upcoming events. For example, an issue that seems to require a policy strategy may be timed to coincide with the state legislative cycle.¹

Tips to consider

• Use The “But Why?” Technique to dig deeper into the cause of a problem. Each time an answer is given, a follow-up "But why?" is asked. For example, if you’ve learned from your assessment that teen pregnancy is a growing problem, an answer to “why?” may be that they don’t see a future for themselves. Asking “why don’t they see a future?” may lead to a discussion about the lack of jobs in the area, particularly for youth, which may in turn lead to a focus on education and/or employment.
• Be sure to work closely with community members, including those who are experiencing the worst conditions for good health, to identify why those conditions exist and what’s most important to them.
• For more complex issues, you may want to use the Affinity Diagrams for Root Cause Analysis. This can help you identify the basic reasons behind a problem or issue you’re seeing in your community and highlight where you need to start to most effectively address the issues. In using the Affinity Diagram, you may find that several of your potential focus areas have the same or similar root causes.
• Many communities are using a Collective Impact approach, where organizations from different sectors agree to solve a specific social problem using a common agenda, aligning their efforts, and using common measures of success. However, not all social problems are a good fit for Collective Impact solutions—it’s best used for problems that are complex and systemic rather than technical.

Does it make sense? Does it resonate with your multi-sector members? Will these priorities resonate with the community? What is the impact of these priorities on achieving equity?  

If you haven’t sought public input, this is another opportunity to do so. Hold final decisions until you have evidence of community support for your chosen priorities. This is also a good time to review your priority-setting process to ensure that it aligns with your vision and mission, and is helping your community ensure that everyone has access to opportunities for good health. 

Consider the following questions when deciding how to communicate your priorities:

• Who must understand and support your plans to address priority issues? Be as specific as possible.
• Who should tell them?
• What media or methods should be used to tell them (e.g., stories, reports, news media, social media)?

Visit the Communicate step of the Action Center to learn more about effective ways to communicate your priorities and work.