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Prior to the September 21, 2011, conference call to establish criteria/ground rules for the Healthy
Montgomery Priority-Setting Process Retreat on October 26, 2011, please read the following:
Prioritization (http://www.cdc.gov/nphpsp/documents/Prioritization.pdf)
A summary by NACCHO that outlines the types of priority-setting process methods includes a
summary table of all the methods evaluated, and documents the advantages, disadvantages, and
conducive group settings/environments that are effective for the method.
2010 San Diego Needs Assessment: Community Priority-Setting Process and Results
(http://www.sdchip.org/media/4095/Community_Priority_Setting_Process.pdf)
The priority setting process and appendices A-C within Appendix 2 of the report
(http://www.sdchip.org/media/4089/2010_Health_Issue_Briefs.pdf) that collectively document
and describe the stepwise process followed in San Diego, including the criteria under which the
committee evaluated and established priorities, taking into consideration disparities, equity, and
social determinants.
Examples of Criteria Used in Priority-Setting are provided in the chart on the next page for your
information.
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ExamplesofCriteriaUsedinPrioritySetting
Univ.ofIllinoisChicago3
APEXPHNominalGroup
MecklenburgCounty2
APEXPHSimplex1
SanDiego4
PrioritySettingCriteriaUsedbyVariousOrganizations
Numberofpeopleaffectedbytheissue/Sizeoftheissue X X X X
Theamountofpain,discomfortand/inconveniencecausedbytheissue X X
Whatistheseriousnessofthehealthissueinthecounty? X X
Whatcommunityresourcesarecurrentlyavailabletoaddressthe
X
healthissue?
Howmuchdataorinformationdowehavetoevaluatethehealth
X
issuesoutcomes?
Estimatedeffectivenessofthesolution NOTAPPLICABLE5 X
PEARLfactors(propriety,economicfeasibility,acceptability,resource
X
availability,legality)
Doproveninterventionsexistthatarefeasiblefromapractical,
X
economicandpoliticalviewpoint?
Degreeofpublicconcernand/orawareness? X
Needforactionbasedondegreeandrateofgrowth(decline);Potential
foraffectingandamplifyingotherhealthorsocioeconomicissues; X
Timingforpublicawareness,collaboration,andfundingispresent.
Costand/orreturnoninvestment
Urgencyoftheproblem
1
Usesanonnumeric5pointscale(e.g. veryfewpeople;lessthanhalfofthepeople;halfthepeople;amajority;everybody)
2
Eachissueisratedfrom110foreachcriteria.
3
Usesnumericalweightingforeachofthecriteriatocomeupwithatotalscoreforeachissue.
4
DetailedprocessandtoolscompiledforneedsassessmentcanbefoundinAppendix2ofSanDiegoneedsAssessment
accessedonSeptember7,2011athttp://www.sdchip.org/media/4089/2010_Health_Issue_Briefs.pdf.
5
CriteriaarenotselectedinadvanceoftheAPEXPHnominalgroupprocess;criteriaareraised,consideredandincorporated
withproposedprioritiesduringthebrainstorming,scoringandsummarysteps.Formoredetails,visittheCDCAPEXPH
PrioritizationPaperaccessedonSeptember7,2011from
http://cdc.gov/nphpsp/documents/Prioritization%20section%20from%20APEXPH%20in%20Practice.pdf
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Summaries of the various priority setting methods available are provided by CDC and NACCHO
below:
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Prioritization
Introduction
A critical component of the Part I and Part II APEXPH processes occurs at the point where
identified issues are prioritized. Prioritizing issues allows the health department and community
to direct resources, time, and energy to those issues that are deemed most critical and practical to
address.
The APEXPH workbook mentions several different methods of prioritizing and many have
found those methods highly useful. The APEXPH workbook particularly describes how the
Hanlon method can be used in both Part I and Part II (pp. 23-24 and Appendix E). Techniques,
such as the Nominal Group Planning Method, the Simplex Method, and the Criteria Weighting
Method, are mentioned but not described in detail. This section is designed to describe these
methods in greater detail and also offers additional options.
Background
Before delving into the how to, we will address some basic issues concerning prioritization:
Who is doing the prioritizing? All participants usually have input into the prioritization process.
Members of the prioritizing group need to be mindful that their own perceptions may be
different from those around them. Often there is no clear right or wrong order to prioritizing,
thus creating more difficulty in the prioritization process. This is especially true when trying to
prioritize options that are unrelated or whose solutions are very different.
Which method should be used? This section describes prioritization methods and the strengths
and weaknesses of each. Some methods rely heavily on group participation, whereas other
methods are less participatory and are more focused on baseline data for the health issues. It is
important to remember that no one method is best all of the time. Moreover, each method can be
adapted to suit the particular needs of a given community or group.
Simplex Method
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With the Simplex Method, group perceptions are obtained by the use of questionnaires. The
method assists a decision-making group to analyze problems more efficiently. The answers to
the questionnaires are scored and ranked and the issues with the highest scores are given the
highest priority.
An added feature of the Simplex method is that particular problems can be given more weight,
thus raising its priority level. However, this method relies heavily on the way in which the
questionnaire presents the problems and questions. A customized exercise using the Simplex
method follows this section.
1. Develop a simplex questionnaire. The questionnaire should have a series of questions about
each particular option being prioritized. Closed-ended questions should be used rather than
open-ended, due to the ease in comparing responses to closed-ended questions. The answer
to each question should have a corresponding score with the higher scores reflecting a higher
priority. While the questionnaire can ask as many questions as desired, fewer questions
permit quicker responses and diminish the chance that questions overlap each other or cause
other distortions. For example, questions such as the following could be asked for each
health issues being prioritized:
d) a majority
e) everybody
2. The pain, discomfort, and/or inconvenience caused by this health issue is:
a) none
b) little
c) appreciable
d) serious
e) very serious
Each issue being prioritized needs its own set of questions, and in order to compare the
responses and place the answers in rank order, the questions need to be comparable for each
health issue. At a minimum, each problem needs to have the same number of possible
answers.
2. Before the questionnaire is distributed, respondents need to understand the issues being
presented, its impact, other information and data related to the problem, and potential
interventions.
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4. Answers to the questions relating to each issue are averaged. The issues are then ranked in
order, from most important to least important.
5. The issues, having been placed in rank order, can be selected in one of two ways: priority
issues can be all those above a cutoff point (e.g., those with scores 60); or a specified
number of the top issues can be selected (e.g., the top six issues).
The model is used in basically the same way for each application. This method involves little
math and is based more on group discussion and information exchange.
Group members generate a list of ideas or concerns surrounding the topic being discussed. This
list becomes decision-making criteria and the prioritization is the ultimate result of consensus
and a vote to rank order the criteria.
2. The group should then determine the leader or facilitator. The leader explains the process
and question being considered.
3. Before initiating discussion, the participants should silently write down all of their ideas and
recommendations. There is no discussion at this stage. This stage should take approximately
four to eight minutes.
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4. The group leader works with the group to list items from each group member in a round-
robin fashion. Each member is asked to briefly state one item on his or her list until all ideas
have been presented. The group leader records these items, using the members own words,
on a flip chart in full view of the group. Members should state their items in a phrase or brief
sentence. This step may be lengthy, especially in large groups, but may be shortened by
limiting each member to a specific number of items.
5. Once a list has been compiled, the group then reviews, organizes, clarifies, and simplifies the
material. Some items may be combined or grouped logically. Each item is read aloud in
sequence. No discussion, except for clarification, is allowed at this point. This stage should
generally take approximately two minutes per item, but may be shortened by allowing less
time per item.
6. Each member of the group then individually places all the options at hand in rank order from
one to ten on a notecard (a community may choose to alter this number from ten). The
group members rankings are collected and tallied.
7. By tallying the rankings, each item is given a total score. The results are posted on a flip-
chart or through some other means whereby the group can see the results. The group leader
then works with the group to discuss the preliminary results. At this point, criteria for
evaluation, such as equity, proportion of the community affected, and cost of intervention,
can be discussed for each item.
8. After the discussion, the group may re-rank their choices. The process is then re-done and
the new ranking is the final product.
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Seriousness of the consequences of the problem: What benefits would accrue from
correcting the problem? Would other problems be reduced in magnitude if the
problem were corrected?
Feasibility of correcting the problem: Can the problem be addressed with existing
technology, knowledge, and resources? How resource-intensive are the
interventions?
Other criteria might include whether the problem is perceived as serious by the community
and whether incentives exist to intervene. The criteria can be derived through a variety of
means, but the nominal group technique (described above) is particularly suited to help in
this process.
2. The group then has the task of determining the relative significance of each criteria. This is
done through these steps:
a) The criteria are discussed to assure that the group understands each criteria and its
appropriateness and validity.
b) Each group member places a value on each criteria, such as 1 to 5.
c) These values are averaged and these averages become the weights that will be used in
the final ranking process.
3. Next, members of the group individually rank each issue according to the criteria. A scoring
system of -10 to +10 permits a more acute measure of individual issues. For example, if an
issue is nearly impossible to address with current resources, it could be assigned a -8 in
feasibility of correcting the problem, but may receive a score of +8 in magnitude of the
problem. Once each member scores the issues, the scores are then averaged.
4. Then, determine the significance levels of the criteria by multiplying each issue rating by the
criteria weight. The product of this is the significance level.
5. The significance level scores for each issue are then summed and divided by the number of
criteria. The totals are then placed in rank order with the issues with the highest number
being of the highest priority.
6. Once the issues are then ranked, the group can then make final decisions about prioritization.
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Some health departments and communities may want to adopt a quick, easy, and perhaps more
entertaining approach to prioritizing. The technique uses a means whereby individual group
members vote to prioritize each health problem. A secret ballot method or open method can be
used.
1. Determine if the vote should be open or by secret ballot. If it is by secret ballot, set up
labeled ballot boxes for each problem to be prioritized. The boxes should be constructed so
that voters cannot see the ballot placed by the previous voter. If it is open, place flip charts
around the room with the health issues written on them.
2. All members of the group should be provided with tokens with which to vote. These can be
colored poker chips or pieces of cardboard, numbered pieces of paper, or a similar item that
indicates a relative rank (i.e., red indicates top rating, yellow-medium, green- low). If the
process is by open voting, colored stickers can be used. The number of ranks can be chosen
by the group, but five or fewer simplifies the process.
3. Group members are given an overview of each of the health issues, and are instructed to
consider all of the issues and to prioritize these by voting their relative rank.
4. Members place one token in each box, if by secret ballot, or place a colored sticker next to
the written health issue on the flip chart, if by open voting.
5. Votes are tallied for each health issue and the overall scores are then rank ordered.
6. At this point, the group can accept the prioritizing that resulted from the rank order or choose
to discuss the order and re-rank the health issues. Before the process begins, it is often a
good idea to decide what will be done after the result of the first vote and if it is decided to
vote again following a discussion, it is a good idea to decide how many times this will be
done.
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Nominal Group Motivates and gets all participants Vocal and persuasive group 10-15 (larger groups
Planning involved. members can affect others. can be broken down
Can be used to identify areas for A biased or strong-minded into subgroups.) Not
further discussion and can be used facilitator can affect the process. <6.
as part of other techniques (e.g., to Can be difficult with larger groups
help develop a Simplex (more than 20-25)
questionnaire.)
May be overlap of ideas due to
Allows for many ideas in a short unclear wording or inadequate
period of time discussion.
Stimulates creative thinking and
dialogue.
Uses a democratic process.
Criteria Weighting Offers numerical criteria with Can become complicated. Any size.
which to prioritize. Requires predetermining criteria.
Mathematical process (this is a
weakness for some.)
Objective; may be best in situations
where this is competition among
the issues.
Allows group to weight criteria
differently.
Hanlon (described PEARL component can be useful The process offers the lowest Any size.
in the APEXPH feature. priorities for those issues where
Workbook, pp 23- Offers relatively quantitative solution requires additional
24 and Appendix answers that are appealing for resources or legal changes which
E) many. may be problematic.
Baseline data for issues can be used Very complicated.
for parts; this can be appealing due
to the objectivity of the data.
A "Quick and Simple. Less sophisticated (may be a Any size.
Colorful" Well-suited to customizing. benefit for some groups).
Approach Blinded responses prevent Doesnt offer the ability to
individuals influencing others. eliminate options that may be
Less time intensive. difficult to address given current
laws and resources.
If open voting is used, participants
may be influenced by others votes.
Conclusion
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There are many different techniques which local health departments, community health
committees, and others can use to identify and prioritize issues. By using formalized techniques,
such as those described here, groups have a structured mechanism that can facilitate an orderly
process. Such a process also offers a common starting point that groups can alter to suit their
own specific needs. Whatever technique is used, it is important to keep in mind that the reason
prioritization is undertaken is to include input from all interest groups. Therefore, it is vitally
important to include the community when defining criteria.
Attached are two prioritization exercises which the Thurston County Community Health Task
Force used during their APEXPH process. The first is an adaptation of the criteria weighting
method, the second is a varied form of the simplex method.
Other Resources:
Basic Health Planning Methods, by Allen D. Spiegel and Herbert Harvey Hyman, Germantown,
MD: Aspen Systems Corp., 1978.
Group Techniques for Program Planning: A Guide to Nominal Group and Delphi Processes, by
Andre L. Delbecq, Andrew H. Van de Ven, and David H. Gustafson. Glenview, IL: Scott,
Foresman, and Company, 1975.
Group Techniques for Idea Building, by Carl M. Moore. Applied Social Research Methods
Series, Volume 9. Beverly Hills, CA: Sage Publications, 1987.
Program Management: A Guide for Establishing Public Health Priorities. Centers for Disease
Control and Prevention, Public Health Practice Program Office, Atlanta, GA, 1988.
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o Mental health
o Respiratory diseases
The next step in the process was to narrow the number of health issues to five or six for an in-depth
evaluation. To achieve this task, a brief written report was prepared for each of the 17 health issues,
presenting background information about the issue from local (San Diego County), state and national
perspectives. The health issues briefs were distributed to 379 community leaders from throughout San
Diego County along with a priority-setting worksheet, which allowed participants to rate each issue
based on the following four criteria (For additional information about the evaluation process, please
refer to Appendix 2 Health Issue Priority Setting Exercise in the 2010 Health Issues Briefs in the
appendix of this document):
Many types of organizations participated in the priority-setting exercise, as shown on the following
table.
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Foundation 3 4.2
Consultant 2 2.8
Physician 2 2.8
Total 72 100
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Health-Related Behaviors
Health-Related Behaviors
Total Score
The scoring and ranking of importance of the six
3,000
health-related behaviors produced consistent
2,500 250
results for the top three behaviors, indicating that 409 238 211
2,000 223 246
participants felt nutrition and weight status, 361 338
443 189
385
Total Score
1,500 259
physical activity and fitness, and substance abuse 1232
1090
1,000 1100 900
and tobacco use were the top three issues in this 972 878
500
category. 646 581 527 538 406 431
0
In terms of size and seriousness scoring, nutrition Nutrition & Physical activity
weight status & fitness
Substance
abuse &
Oral health Injury &
violence
Immunization
tobacco use
and weight status, physical activity and fitness Size Seriousness Community resources Outcomes
scored highest. Note: The algorithm used for calculating total score uses the total rating points for size, seriousness,
community resource and outcomes. Total score = size + (seriousness x 2) + community resources + outcomes
Immunization 4.5
1 2 3 4 5 6
Most Mean Ranking Least
Important Important
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Health Outcomes
Health Outcomes
Total Score
The scoring and ranking of importance of the 2,500
Total Score
1126 1136
importance. Much of the mental health score 1,000 1018 1160
914 884 858
Cancer 3.7
Maternal, infant & child health / Family
planning
4.6
1 2 3 4 5 6 7
Most Mean Ranking Least
Important Important
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(Figure 1)
Community Priority-Setting Process Results
By Scoring Criteria and Overall Ranking
*Items within a particular category denote similar scores or ties in scores. No statistical analysis was
applied to this tool, it was designed as a rating tool to assist in the decision making process.
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Based on a review of the priority-setting results and utilizing the Spectrum of Prevention Framework to
associate select behaviors with potential health outcomes issues, the Charting the Course VI committee
designated the following health issues to be the focus of the in-depth report:
These issues were felt to have excellent data availability at the sub-regional level (with the exception of
mental health data) and they provide a broad enough focus for use by a wide range of potential
community organizations.
The committee designated nutrition and weight status, injury and violence, and mental health as topics
to be brought forward for discussion in the community forums.
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Healthy Montgomery Review Packet
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A Profile of Health
Indicators and
Prevention Priorities
for Our Community
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CONTENTS
Executive Summary............................... 1
Overview................................................. 5
Priority Setting.......................................10
Demographics 32
Determinants of Health36
GIS Maps. 43
Health Behaviors 75
i
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Table of Contents
Community Health Indicators, cont.
Environmental Health 92
Communicable Diseases . 98
Substance Abuse126
Access to Care.131
Chronic Diseases147
Health Disparities156
Communication Plan....175
ii
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EXECUTIVE SUMMARY
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INTRODUCTION
In the practice of public health, the community is the patient and the health of the community is monitored and
evaluated on a regular basis by examining key indicators such as infant mortality, communicable disease
rates, and STD infections. Every four years, Mecklenburg Healthy Carolinians and the Mecklenburg County
Health Department conduct a more extensive examination of the community through a state developed
process known as community health assessment (CHA). In addition to providing a picture of the communitys
health, CHA meets requirements for state accreditation of local health departments, the state consolidated
contract with local health departments, and certification by the Governors Task Force on Healthy Carolinians.
Findings from the CHA are used by the Health Department for strategic planning and by Healthy Carolinians to
develop or endorse collaborative community action addressing identified priority issues.
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RECOMMENDATIONS
Participants of the October 27th Priority Setting meeting made recommendations for the top four health issues,
Chronic Disease Prevention, Access to Care, Substance Abuse Prevention, and Healthy Environment.
Example recommendations are included below. For a complete list of recommendation, see the Priority
Setting Exercise chapter.
Chronic Disease Prevention through Healthy Choices
Create and encourage partnerships among community organizations to strengthen stake holders
commitment and to share resources
Increase education programs focusing on prevention of chronic disease
Access to Care
Increase number of Federally Qualified Health Centers (FQHC)
Foster partnerships with health department
Create medical homes for people with no insurance
Educate people about types of services available
Increase number of free clinics to reduce ER use and locate them across the county
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List of Attendees
Priority Ranking Results
Combined Priority Ranking Results
Priority Setting Exercise
2010 CHA Survey
Recommendations
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OVERVIEW
The Priority Setting exercise took place on October 27, 2010 at Trinity Presbyterian Church on Providence
Road in Charlotte. Invitations to participate in the priority setting process went out to nearly 400 individuals
representing a variety of community agencies, neighborhood associations, faith community leaders, colleges
and universities and local elected officials from the county as well as from the seven municipalities within
Mecklenburg County. A total of 91 people participated in the exercise; a detailed list of participants as well as
demographic information can be found below.
The process of the priority setting exercise was as follows: a brief presentation was given on the first of the
nine health focus areas selected by the CHA steering committee, this was followed by table discussions and
finally, each individual scored the topic with regard to various criteria. This process was repeated for each of
the nine health topics. Scoring sheets (see sample below) were collected throughout the exercise and scores
were entered into Epi Info. By the end of the session, participants were presented with the prioritized list of the
nine health topics based on their combined scores.
The final step in the priority setting process was to make recommendations for the top four health issues,
Chronic Disease Prevention, Access to Care, Substance Abuse Prevention and Healthy Environment.
Participants assigned themselves to one of those topic areas and generated a list of recommended actions
which are to be used in the action planning process. Before adjourning each participant was asked to fill out a
demographic form and an evaluation form.
To watch a short video clip of the Priority Ranking Exercise, click on the following link
http://www.youtube.com/profile?user=meckgov#p/u/4/BLtnUQz6kvs
LIST OF ATTENDEES
Last First Agency
Allison Carolyn Youfirst Healthcare Solutions
Barkley Roxie Community Health Ambassador, Faith CME
Beatty Ashley Florence Crittenton Services
Beatty Tony Area Mental Health (Substance Abuse)
Black Gary Mecklenburg County Public Service and Information
Boudreau Janine United Way
Clark Laura Council for Children's Rights
Cody Bill Queens University School of Nursing
Cook April Lake Norman Free Clinic
Crook Janet Hospice & Palliative Care Charlotte Region
Cruz Luis Mecklenburg County Health Department (HIV)
Cullen Kate Student, Winthrop University
Darden Chloe BCY HealthCare
Desliva Barb Carolinas HealthCare System
Fair Andy Mecklenburg County Public Service and Information
Flanagan Linda Mecklenburg County Health Department (STDs)
Furtney Susan Care Ring
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Research/Academia
The majority of the population was female 14.90%
(82%). Other
10.40%
31% were between the ages of 25 44 yrs, Communitymember
63% were 45 64 years. Persons less than 10.40% 6.00%
24 years and persons 65 years and older Education
each accounted for 3% of the population. 4.50%
FaithCommunity
72% were White, 22% were Black, 4% were 4.50%
Government
Asian and 1% were of Other Races.
3.00% Healthcare
12% were Hispanic/Latino. 38.80%
MentalHealth
The majority of attendees reported living in
Mecklenburg County for more than 10 years PublicHealth
(56%). 7% of attendees reported living in
the county for less than 3 years.
Participants were from various backgrounds, including Health Care, Mental Health, Public Health,
Community Members/Leaders, Education and Faith Communities.
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Ranking results from participants were entered into an Epi-Info database by Mecklenburg Epidemiology staff
members during priority setting exercise and final scorings were presented to attendees at the close of the
prioritization exercise. Several attendees arrived after the start of the priority setting exercise. While priority
rankings were included for all participants, due to time constraints, data from this group was entered and
analyzed after the Priority Setting Meeting. Inclusion of these scores provided one slight shift in priority
rankings, Access to Care dropped from the first priority to the second.
The rankings for the nine focus areas, based upon the priority setting exercise (including data from late
attendees) were:
1. Chronic Disease Prevention 6. Violence Prevention
2. Access to Care 7. Injury Prevention
3. Substance Abuse Prevention 8. Responsible Sexual Behavior
4. Healthy Environment 9. Maternal and Child Health
5. Mental Health
2010 CHA Priority Setting Exercise: Average Score Ranking of Priority Focus Areas
Based upon Oct 27th Priority Setting Meeting and including data from late attendees
9
Chronic
Disease
8.5 Prev.
8.08 Substance
8 Access Abuse Healthy
to Care Mental
Prev. Env.
Health Violence
7.5 7.35 7.33 Prev.
7.23 7.15 Injury
6.99 Prev. Sexual
7
Behavior
6.63
6.40 MCH
6.5
6.12
6
5.5
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Mecklenburg Healthy Carolinians will develop action plans for at least the top four priority areas. Plans will be
completed by June 2011.
Priority Online/Paper
Setting Survey Priority Online/Paper Priority Setting FINAL RANK
Average Average Setting Survey Exercise Ranking (with weighted
Score Score Weight (75%) Weight (25%) Final Score ALONE data)
Chronic Disease Prevention 81.7% 57% 61.3% 14.3% 75.5% 1 1
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RECOMMENDATIONS
1. CHRONIC DISEASE PREVENTION- THROUGH HEALTHY CHOICES
Create and encourage partnerships among Average Scoring for Chronic Disease Prevention
community organizations to strengthen stake (By Criteria)
holders commitment and to share resources
Increase tobacco tax 10
9.1 9.2
8.6
Increase education programs focusing on
9
8 7.2
prevention of chronic disease 7
6.7
Focus efforts based on demographics and tailor 6
neighborhood 3
2
Help people see the connection between 1
change in behavior and better health outcomes 0
Increase focus on small groups, neighborhoods Intervention Magnitude Public Severity Urgency
Indentify and focus on barriers to changing behavior Concern
Reorganize SNAP (food stamp program) to reward healthier choices (fruits, vegetables) and discourage
less healthy choices
Provide financial incentives for those who give up tobacco or who are in process of withdrawal from tobacco
products
Recruit and use those indigenous to communities to educate and provide outreach to lay health persons
identified to carry banners within their communities such as local faith community groups
2. ACCESS TO CARE
Average Scoring for Access to Care
(By Criteria)
Increase number of Federally Qualified Health
Centers (FQHC) 10
8.7 8.7 8.6
Foster partnerships with health department 9
8
Create medical homes for people with no insurance 7
2
clinics 1
and primary care physicians or FQHCs Intervention Magnitude Public Severity Urgency
Improve medication access and coverage Concern
Facilitate access for populations in need by working with existing and making referrals
Involve health department in identifying areas of need for future clinics
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support, provide counseling training, job help, etc Intervention Magnitude Public Severity Urgency
and maintain abstinence Concern
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Two hospital systems: Carolinas Poverty rate lower and median income
HealthCare System and Novant higher than the state
Health/Presbyterian Healthcare
Consolidated School Health Committee
Safety Net System of Care within Charlotte Mecklenburg Schools
o One federally qualified community Numerous community collaborations
health center: CW Williams affecting health
o Seven free clinics o Childrens Alliance
Charlotte Community Health Clinic o Charlotte Mecklenburg Drug Free
Charlotte Volunteers in Medicine Coalition
Clinic o Community Child Fatality Prevention
Care Ring and Protection Team
Free Clinics of Our Town (Davidson) o Fit City for Fit Families and Worksite
Matthews Volunteers in Medicine Wellness programs
Clinic
o HIV Community Task Force
Lake Norman Free Clinic
o Homeless Services Network
Shelter Health Services
Bethesda Health Center o Mecklenburg Food Policy Council
o Carolinas Medical Center o Mecklenburg Fruit & Vegetable Coalition
Ambulatory/Community Care Clinics o Mecklenburg Safe Kids Coalition
CMC Biddle Point o Mecklenburg Safe Routes to School
CMC Elizabeth Family Practice
o MedLink of Mecklenburg
CMC Meyers Park
o Partnership for Childrens Dental Health
CMC North Park
o Syphilis Elimination Project
o Volunteer physician care for the low-
income uninsured program: Physicians A strong and diverse faith community with
Reach Out (administered by Care Ring) over 1000 places of worship
o A Community Pharmacy: MedAssist Multiple Institutions of Higher Education
o Mecklenburg County Health Department o Central Piedmont Community College
Board of County Commissioners that o Johnson C. Smith University
strongly supports the Health Department
o Pfeiffer University
Strong and numerous Health and Human o Queens University
Services Agencies and Organizations
o University of North Carolina at Charlotte
Flourishing greenway system
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Listed below are examples of indicators that are strongly positive for the county. However, it is important to
remember that positive progress has been achieved through attention and resources. To no longer address
these issues because they are trending well would be to risk a reversal of positive direction.
Falling total mortality rates for all race and gender groups
Decreasing mortality rates for cardiovascular disease, cancer, diabetes and influenza and pneumonia
Falling adolescent pregnancy rates, a 22.5% decrease between 2000 and 2009 for girls 15 -19. The
2009 rate for 15 -17 old girls of 30.6 pregnancies per 1000 girls 15 -17 meets and exceeds the Healthy
People 2010 goal of 43.0.
Low rates of vaccine preventable communicable disease
Declining smoking rates, although at 17% in 2009 unlikely to meet the Healthy People 2010 adult goal
of 12%.
Declining reports of smoking and alcohol use during pregnancy
Smoke free school system and hospital systems as well as restaurants and bars
High level of seatbelt use with 88.9% in 2008 approaching the Healthy People 2010 goal of 92%
Almost 75% of women over 40 reported a mammogram within the past two years in 2008 exceeding
the Healthy People 2010 goal of 70%.
Carbon monoxide detector ordinance
HEALTH DISPARITIES
Are evident in all priority concerns
Special attention is needed to diabetes, infant mortality, STDs and HIV disease
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ACCESS TO CARE
Lack of dental care for low-income adults
Medical care for the low-income who do not qualify for assistance programs and the underinsured who
earn too much to be considered low income but work for employers who do not offer health insurance
or who cannot afford premiums; low-income males and the undocumented are at particular risk for not
receiving care; healthcare reform may address many of these issues but the problems of the
undocumented will not be affected.
Need for culturally appropriate health and mental health information and education as well as providers
who can provide culturally appropriate services.
Health literacy
MENTAL HEALTH
Child/Teen mental health issues and providers to address them
Stigma attached to treatment for mental illness
Services for the uninsured and LEP populations
As population ages, adequate resources to care for growing numbers of Alzheimers disease cases,
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VIOLENCE PREVENTION
Homicide is the 2nd leading cause of death for adolescents and young adults (some years, the first) and
one of the leading causes of deaths for Hispanics
Domestic violence
Child abuse
INJURY PREVENTION
Unintentional Injury is the 5th leading cause of death for the total population and the leading cause of
death for those one to 44 years of age as well as Hispanics. National data suggest that trauma and
associated costs resulting from injury exceed those for heart disease. However, public interest in injury
prevention as indicated by survey and prioritization is very low as is funding. Changing the perception
that injuries are accidents that are unavoidable to injuries are preventable is a challenge that will
require considerable creativity and effort.
Falls in the elderly
Safe sleeping arrangements affect infant mortality by decreasing the likelihood of SIDS and suffocation
Driving under the influence
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