SETTING HEALTH PRIORITIES,This Application Assignment asks you to consider the kinds of data you would use, and how you would obtain the data, for a community health assessment.

This Application Assignment asks you to consider the kinds of data you would use, and how you would obtain the data, for a community health assessment.

Read through the case exercise on Community Health Assessment, linked below, and complete all the questions. All the information you will need to complete this assessment exercise is provided in the Appendix at the end of the document. Save this Word document to your computer before you begin to fill out the form.

Community Health Assessment Exercise

Note: Assessment is a very involved process, and you could easily spend many hours exploring this case exercise alone. However, for the purposes of this assignment, you should limit yourself to spending no more than two hours to complete this Application.

Your name:

Week 4 Application: Community Health Assessment for Pitt County, North Carolina[*]
Community health assessment is key to understanding the health problems and priorities of a population. This Application Assignment outlines a process by which you can complete a health assessment of a community using indicator-based methods. You will construct a set of health indicators from a variety of domains, evaluate problems, and report on the health priorities for a community.


Sections A–C ask questions about assessment in general. Section D involves assessment of a particular county in North Carolina, information on which is provided in that section and in the Appendix.

 Instructions: Save this document to your computer and complete all questions in Sections A–D below. Submit by the end of Week 4 following the submission instructions in the Week 4 Application section.

Section A: Community Health Assessment

The goal of public health is to improve the health of a population. Public health interventions such as safe water sources, immunization programs, and improved motor vehicle safety regulations account for the majority of years of life expectancy gained in the United States over the last 100 years.


A community health assessment involves obtaining and interpreting information to determine the health status of a specific community. Once community health needs are identified, public health interventions can be developed and their effectiveness evaluated using a similar approach.  Information necessary for performing a community health assessment, for example data on mortality rates or behavioral risk factors such as smoking, is available from various sources.



  1. How do you define community?
  2. What stakeholders (groups/organizations) would you want to consult with for a community assessment?
  3. What types and sources of data would you use for a community assessment?


Section B: Healthy People 2010


The Healthy People 2020 initiative is a national approach that identifies high priority health issues and establishes objectives to reduce the impact of these public health threats. To understand the significance of data on your own community, you have to be able to compare it to another standard. The questions in this section ask you about other standards that can be used.


  1. How are Healthy People 2020 standards used? What are advantages and disadvantages to applying them at a local community level? (Note: you may use the Healthy People 2010 standards if the 2020 standards are not reported.)


  1. What other standards (national, state, or local) can be used?

Section C: Health Indicators


For this exercise, you will use an indicator approach to develop a community health assessment. A community health assessment involves three-step feedback loop.


The first step in such an assessment involves identifying important health indicators. The second step involves matching those indicators with available data. In the third step, standards such as those explored in Section B are applied to the data gathered in the first two steps to transform it into useful information about health needs of the population.


Health indicators are measurable health outcomes, such as death rate, insurance coverage measures, immunization rates, or other data items that are relevant to the health of a community. Indicators are thoughtfully selected data points that provide useful information about the health of a community.


Note that each indicator should be:

  1. An important health problem.
  2. Prevalent or common in the community of interest.
  3. Measurable on a community or population basis. There should be population data on a local level that is easily available—this cannot be collected from health facilities or providers because these data sources do not apply to the entire community.
  4. Ideally, because we want to use a limited number of indicators, the indicator should not be redundant—not measure the same thing—as another chosen indicator.


To organize indicators, it is helpful to identify major areas of focus. For this case, we will refer to these broad categories of public health concerns as domains. Please refer to Table 1 below for examples of domains. For each domain, an example of an indicator is provided.

Table 1: List of Domains to Assist Developing a Community Health Assessment


Domain: Example of an Indicator:
Communicable Diseases(including Sexually Transmitted Diseases) Incidence of Gonorrhea
Chronic Diseases (including Cancer) Incidence of Diabetes
Injury and Violence Homicide rate
Maternal and Child Health Childhood immunization rate
Environmental Health Rates of Lead Poisoning
Access to Health Care Rates of Uninsured




  1. How you would obtain data for these indicators. What sources might you use? Select 2 of the indicators above and provide specific sources of information on them (including URLs) for your own community or state.

 Section D: Performing a Community Health Assessment


As a consultant to Pitt County Health Department, you are asked to perform a community health assessment for the county. Below is information about the county:


Pitt County is located in eastern North Carolina and has a population of 138,690 residents (2005 Census).  Pitt County has been classified as urban for the first time in 2006. It and the surrounding counties are largely rural with a history of dependence on tobacco farming. Caucasians make up about 62.8% of the population, African Americans 33.6%, Hispanics 3.2%, Asians 1.1% and American Indians 0.3%. There are an estimated 6,606 migrant and seasonal workers or 5.4% of the population. About 18% or 26,000 adults in Pitt County adults have household incomes below the federal poverty level with a median per capita income of $18,243 (2000). The child poverty rate is estimated to be 21.8%. Approximately 20% of adult lack health insurance.


Pitt County contains Greenville, the largest city in eastern North Carolina with a population of 67,525 (2005). Greenville is considered the hub of eastern North Carolina. The major employers are Pitt County Memorial Hospital (PCMH), Brody School of Medicine and East Carolina University. If a state was created of all the land in North Carolina east of Interstate 95, it would be the poorest of all 50 states. In addition, it would rate 48th in terms of premature mortality. Consider these factors when evaluating populations at risk and targeting resources for public health activities.


You now embark on the steps needed to perform your assessment.






As noted earlier, the first step in a community health assessment is identifying health indicators.   Develop a list of 18-20 indicators you would want to use in your assessment, identifying 3-4 indicators per domain.


Complete the column on the right in this table:



Domain: Indicator: (provide 3-4 per domain
Communicable Diseases

(including Sexually Transmitted Diseases)

Chronic Diseases (including Cancer)
Injury and Violence
Maternal and Child Health
Environmental Health
Access to Health Care





Now that you have chosen indicators to use for a community health assessment, use the information provided in the tables below (Appendix) to match available data to your chosen indicators. In this example, residents of Pitt County constitute the community. If the Appendix does not give you the data for your indicator, you should choose another indicator (alternatively, you may seek out the data elsewhere that you need for your proposed indicator).




  1. Have you matched each of your indicators to the data available in the Appendix? If not, explain how and where you got the data needed for your proposed indicator.



Using the information gathered in the first two steps, please answer the following questions.

Note: Keep in mind that in order to plan an effective intervention program in real life, you must communicate with other constituents and stakeholders and see what they perceive to be priority health issues. Collaboration with community stakeholders in program design is critical to the success of an intervention plan. For this purposes of this assignment, however, you are reviewing the data on your own, without the input from other stakeholders.



  1. Looking at this data only, what would you conclude are three priority health issues for this population? (Can be picked by how the indicator compares)


  1. Choose three of your indicators. Compare them to the Healthy People 2020 Standards (or 2010 if appropriate) and provide URL(s) for the relevant Web page from Healthy People to the specific indicator.


  1. How do you explain the health disparities of these indicators? (i.e., as shown by this comparison with HP?]


You have completed this Application on assessment. Submit this completed form in the Dropbox following the submission instructions in the Week 5 Application area.



Community Health Assessment Indicators Pitt County (NC),

North Carolina, and the United States




Domain: Maternal and Child Health (2004) 
Indicator Pitt County North Carolina United States
Infant mortality rate per 1,000 live births(2004)   7.1     8.8     6.9
      Black infant mortality per 1,000 live births   8.1  15.6   14.1
      White infant mortality per 1,000 live births   7.0    6.2   5.8
Neonatal infant mortality rate per 1,000 live births(<28 days of age) (2000-2004) 5.7 6.0 4.6
      Black neonatal infant mortality rate   8.9 11.2   7.3
      White neonatal infant mortality rate   3.3   4.1   3.8
Low birth weight (<2,500 g) per 100 births(2004) 11.6     9.1   7.9
      Minority births <2500 g 15.9 13.4  13.0
      White births <2500 g   8.3   7.4   6.5
Very low birth weight (<1500 g) per 100 births(2000-2004) 2.8 1.9 1.4
      Minority births <1500 g   3.3   3.6   3.0
      White births <1500 g   2.4   1.0
Teen pregnancy rate per 1,000 teens(ages 15-19)(2000-2004) 39.8 64.1(11.9%)  83.6
      Minority pregnancies 54.5 87.3 153.3
      White pregnancies 27.0 53.6  71.4
Smoked during pregnancy   8.9  12.5  11.4
Postneonatal infant mortality per 1,000 live births (>28 days <1 year) (2000-2004) 1.4 2.8 2.3
      Black postneonatal rate   1.1   4.5   4.8
      White postneonatal rate   1.7   2.1   1.9
Immunization status at 2 years of age NA 82%
Immunization status at school entry NA 99%


BRFSS for 2004Age adjusted rates Pitt County North Carolina
Adult disability   28.3   25.0
Current asthma    7.1     6.4
Smoking: women of childbearing age    30.4   24.4
Smoking everyday: men    32.9   37.6
Obesity    26.1   22.7
Binge drinking (childbearing age)      9.5    6.8
Binge Drinking (all)    12.0    8.4
       Men    19.8
       Women      3.1
No leisure time physical activity    26.4   26.3
Are any firearms kept in your home    39.6   40.9


Domain: Access to Care
Indicator Pitt County North Carolina United States
% No medical insurance   20.8   17.5   16.5
% Children with no health insurance   14.3   12.5     9.8
% Children enrolled in  Medicaid   36.7   32.6   26.0
% Children enrolled in NC Health Choice     5.2     5.9   NA
Primary Care Physicians/100,000 population  149   83.5
Dentists/100,000 population   37.8   40.5   58.4
Kindergarten Tooth Decay Rates   27.7%    22%   26% whites36% A-A

43% Hispanic

BRFSS 2001 Eastern NC North Carolina
Cost as barrier to health insurance   16.5   11.5
No usual place of care   24.0   22.1
No dental insurance   52.7   45.3
Domain: Communicable Diseases
Indicator Pitt County North Carolina United States
TB rate per 100,000 population (2004)  5.0  4.5  4.9
Hepatitis A rate per 100,000 population2004: 17 cases 12.1(2004)  3.65(2003)  2.6(2003)
Hepatitis B rate per 100,000 population2004: 11 cases   7.0(2004)  1.9  2.6
Hepatitis C rate per 100,000 population2004: 4 cases  2.9  0.2  0.4


Domain:Sexually Transmitted Diseases
Indicator Pitt County  North Carolina United States
Gonorrhea rate per 100,000 population   347.8 181.3   113.5
      Black rate   848.3 673.8   629.6
      White rate     52.6   38.4     33.3
Chlamydia rate per 100,000 population   645.9 313.3   319.6
      Black rate 1206.4 929.7 1209.4
      White rate   216.2 116.3   143.6
Syphilis rate per 100,000 population       3.2    8.9       2.7
      Black rate       8.0  15.3       9.0
      White rate       1.3    1.1       1.6
HIV rate per 100,000 population     18.0  25.2      20.7
      Black  rate     38.8  76.6      76.3
      White rate       7.2    9.6        9.0


Domain: Cancer (2000)
Indicator Pitt County North Carolina United States
Lung Cancer
      Mortality rate per 100,000 population   68.7   61.6    54.2
      Incidence rate per 100,000   78.8   69.7    67.5
Breast Cancer (Female)
      Mortality rate per 100,000 females   27.7   26.5   14.4
      Female incidence per 100,000 females 167.5 149.5  132.2
Colon/Rectum Cancer
       Mortality rate per 100,000 population   22.7   20.0   19.1
        Incidence rate per 100,000 males   64.7   48.4   52.0
Prostate Cancer
      Mortality rate per 100,000 males   36.7   36.9    31.5
      Incidence rate per 100,000 males  154.5 152.5  166.7
Incidence All Cancer  494.3 445.3


Domain: Chronic Diseases
Indicator Pitt County N.C.(1999-2002) United States(2003)
Heart disease
      Mortality rate per 100,000 population 248.5  246.6 235.4
      Mortality rate per 100,000 population   82.1   72.0  54.3
      Mortality rate per 100,000 population   34.3   27.4  25.4
      Mortality rate per 100,000 population   38.4   46.5  43.4
Youth death rates (Ages 0-17)/100,000  100.6   79.9


Domain: Environmental Health
Indicator Pitt County North Carolina United States
Lead (2004)     2.8 1.3 >1100 infants56% tested
Have you had an illness in the past 12 months that you think was caused by outdoor air pollutants?     9.1      12.0
Have you had an illness in the past 12 months that you think was caused by poor indoor air quality?    15.0      16.4
Domain: Injury and Violence
Indicator Pitt County North Carolina1999–2002 United States2003
Motor vehicle accidents
      Mortality rate per 100,000 population  19.6  19.2  15.2
      Homicide rate per 100,000 population  11.2   7.6   5.9
      Suicide rate per 100,000 population(10-24 yr) 10.82 11.36  10.5
Violent Crime rate per 100,000 population (2004) 617.2 446.9
Accidents Unintentional injuries
      Mortality rate per 100,000 population   40.0  42.7  36.3
Child Maltreatment substantiated   18.1  14.5 12.3
Admissions to Juvenile Justice  38.6  34.1


Domain: Economic and Education
Indicator Pitt County North Carolina United States
Premature mortality rate per 100,000 populationunder 75 956 years 903 years 799 years
Percent below poverty level   17.5    15.2    12.4
Percent of children below poverty level   21.8    21.9    16.9
Unemployment rate     5.2      5.0      4.7
Percent children receiving food stamps   24.9    18.2 10.6 million(14%)
Percent children receiving free or reduced lunch   48.4    44.3    41.9
Public school dropout rate (9-12thgrade)2004-5      6.95        4.86    10.3%
High School completion (%)    56      86.1    85%
Percent >25 years of age with <9th grade education      7.6      7.8     7.5
Median Household income $ 33,734 46,335 50,046
Median per capita income $ 18,243 26,882 32,937
Migrant and seasonal workers number 6,606 (5.4%) 155,888(2.1%) 13 million(4.4%)

APPENDIX 2: Healthy People 2020

What Is Healthy People?

Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans.. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:

  • Encourage collaborations across communities and sectors.
  • Empower individuals toward making informed health decisions.
  • Measure the impact of prevention activities

It can be used by many different people, states, communities, professional organizations, and others to help them develop programs to improve health.

Healthy People 2020 continues in this tradition with the launch on December 2, 2010 of its ambitious, yet achievable, 10-year agenda for improving the Nation’s health. Healthy People 2020 is the result of a multiyear process that reflects input from a diverse group of individuals and organizations.

What Are the Leading Health Indicators?

Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans. Healthy People 2020 contains 42 topic areas with nearly 600 objectives (with others still evolving), which encompass 1,200 measures. A smaller set of Healthy People 2020 objectives, called Leading Health Indicators, has been selected to communicate high-priority health issues and actions that can be taken to address them

. The Leading Health Indicators are composed of 26 indicators organized under 12 topics. The Healthy People 2020 Leading Health Indicators are:

  1. Access to Health Services                                  7.  Nutrition, Physical Activity, and Obesity


  1. Clinical Preventive Services                                  8.  Oral Health



  1. Environmental Quality                                           9.  Reproductive and Sexual Health


  1. Injury and Violence                                                10.  Social Determinants


  1. Maternal, Infant, and Child Health                       11. Substance Abuse


  1. Mental Health                                             .      12. Tobacco


 Pitt County Municipalities Data:


Municipality Child<5 yrs Pop. Persons/square mile WhiteNon-Hispanic% African-America% Amer.Indian% Hispanic (#) % Asian%
Ayden   282   4,622   1992 47.6 49.5 0.2   (102)  2.2 0.2
Bethel   116   1,681   1618 40.2 58.1 0.0    (13)   0.8 0.1
Falkland     11      112  <112 68.8 30.4 0.0    (11)   9.8 0.0
Farmville   252   4,302   1431 47.4 50.1 0.1    (91)   2.1 0.2
Fountain     38     533     515 49.0 50.5 0.2      (3)   0.6 0.0
Greenville 3,361 60,476   2298 61.4 34.1 (181) 0.3 (1,244) 2.1 (1,098)1.8
Grifton   122   2,073   1188 63.2 33.2 0.0     (98)  4.7 0.2
Grimesland     19      440     850 62 29.1 0.0    (39)  8.9 0.2
Simpson     32      464   1125 56 42.5 0.0    (13)  2.8 0.0
Winterville    399   4,791   1877 58.7 38.4 0.5     (49) 1.0 0.1
Total 4,603  75,624 (1573)
Pitt County 8,653 133,798     216 62.1 33.6 (357)0.3 (4,216) 3.2 (1,443)1.1
North Carolina 72.1 21.6 1.2   4.7 1.4
U.S. 75.1 12.3 0.9 12.5 3.6


MunicipalitiesCounty/State MedianFamily


% < HSEducation Families below poverty In labor force>16 years of age Median travel to work(min) %  nowmarried

(>15 yrs of age)

Ayden 34,808 30% 21% 53.1% X 45%
Bethel 35,278 40% 18.5% 49.2% 25 42.5%
Falkland 43,750 40%  5.0 57.4% 18 36%
Farmville 38,918 27.4% 14.6 57.5% 18.7 44.6%
Fountain 26,042 41% 35.6 51.6% 20.4 48%
Greenville 44,491 14%  9.0 66.3% 17.9 35.9%
Grifton 40,875 27% 12.2 55.9% 23.4 58.3%
Grimesland 36,250 40% 12.3 58.3% 22.9 53.5%
Simpson 47,500 23.6% 14.2 63.6% 17 56.6%
Winterville 47,167 16.6% 10.3 71.2% 25.5 56.7%
Pitt County 43,971 20% 13.5 65.8% X 47%
North Carolina 46,335 22%  9.0 65.7% X 56.3
U.S. 50,046 19.6%  9.2 63.9% 25.5 54.4     


Disclaimer regarding interpretation of data in this Community Assessment:


Various sources of data have been used in the development of this teaching case  including but not limited to vital statistics, the 2004 BRFSS survey, N.C. Communicable Disease Control Branch reports, N.C. County Health Data Book, U.S. Census  American Fact Finder, N.C. Child Advocacy Institute, N.C. Child Fatality Task Force.

The data in this report is not to be relied on for actual assessment activities because of various limitations including: different time periods for data collections and a small number of events during the reported time period. These factors subject the results to chance variation. Longer time periods of data collection are required before inferences can be made. For a full discussion of the issues and up-to-date data, refer to the report of the North Carolina State Center of Health Statistics,