Priority Setting Process Methods Packet SEPT 7 2011

Healthy Montgomery Review Packet
09/07/2011
Priority-Setting Process Packet

Enclosed are selected materials for review by the Healthy Montgomery Steering
Committee to become familiar with best practices and tested methods of carrying out a priority
setting process within the community health improvement process.
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.
Mecklenburg Needs Assessment: Priority-Setting Exercise

(http://www.charmeck.org/mecklenburg/county/HealthDepartment/HealthStatistics/Documents/2
010%20Community%20Health%20Assessment.pdf)
Well-documented community health improvement process that includes detailed implementation
of a priority-setting process that integrated groups discussion, expertise of participants with
individual scoring and data results to derive priority issues. Process also considered determinants
of health and disparities.
Examples of Criteria Used in Priority-Setting are provided in the chart on the next page for your
information.
Establishing Criteria for Priority-Setting Process

Conference call on September 21, 2011
8:00-9:00 a.m.
Phone: 240-773-8125, Passcode: 958625
Page1 9/6/11
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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
Page2 9/6/11
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For Additional Reading
Summaries of the various priority setting methods available are provided by CDC and NACCHO
below:
Prioritization section from NACCHOs APEXPH in Practice Workbook. Accessed

September 7, 2011 at: http://www.cdc.gov/nphpsp/documents/Prioritization.pdf
First Things First: Prioritizing Health Problems, National Association of County and City
Health Officials (NACCHO). Accessed September 7, 2011 at:
http://www.naccho.org/topics/infrastructure/accreditation/upload/Prioritization-
Summaries-and-Examples.pdf
Prioritization, National Public Health Performance Standards Program (NPHPSP)
Excerpt of NACCHOs APEXPH Prioritization Chapter, Centers for Disease Control and
Prevention (CDC). Accessed September 7, 2011 at:
http://cdc.gov/nphpsp/documents/Prioritization%20section%20from%20APEXPH%20in
%20Practice.pdf
Page3 9/6/11
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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:
What is prioritization? Prioritization is a process whereby an individual or group places a

number of items in rank order based on their perceived or measured importance or significance.
In conducting APEXPH, prioritization is generally a group process whereby organizational or
health issues are ordered by perceived significance or importance. Prioritizing issues is an
important process, in that it assists an organization in identifying the issues on which it should
focus its limited resources.
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.
Examples of Prioritization Techniques and How They May be Implemented

Several prioritization methods are described in the following pages. A step-by-step process for
implementing each is described, as well as ideas for customizing each method. They are
displayed in no certain order. A chart near the end of this section summarizes the strengths,
weaknesses, and optimal group size for each process.
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.
Step-by-Step for Simplex:
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:
1. This health issue affects:
a) very few people
b) less than half of the people
c) half the people
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.
3. Respondents then fill out the questionnaire.
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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).
Ideas for Customizing Simplex:

Groups may choose to place additional weights to certain questions if they are deemed
particularly important.
Nominal Group Planning

Nominal Group Planning was developed for situations where individual judgments must be
tapped and combined to arrive at decisions which cannot be determined by one person. This
strategy is best used for problem exploration, knowledge exploration, priority development,
program development, and program evaluation.
In the APEXPH process, nominal group planning can be used to:
determine what community issues are of greatest concern;

decide on a strategy for dealing with the identified issues; and
design improved community services or programs.
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.
Step-by-Step for Nominal Group Technique:

1. First, it is important to establish the group structure. Decide whether or not the group should
be broken down into subgroups. A more complicated problem is often better handled by
being broken down into components that can be addressed by smaller subgroups. The
minimum suggested size for the process is 6 to 10. This method often works well for larger
groups, and consensus can be reached with as many as 15 to 20 participants.
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.
Ideas for Customizing Nominal Group Technique:

Criteria used in the discussion of the issue ranking can be selected by the community.
Subgroups can be used to discuss issues (i.e., a subgroup can prioritize all of the
environmental health issues, to come up with the priority issue to be addressed).
Criteria Weighting Method

The criteria weighting method is a mathematical process whereby participants establish a
relevant set of criteria and assign a priority ranking to issues based on how they measure against
the criteria. The calculated values do not necessarily dictate the final policy decision, but offer a
means by which choices can be ordered. An example exercise which follows this section,
entitled Priority Setting Exercise, is a customized version of this method.
Step-by-Step for Criteria Weighting Method:

1. The group first needs to start with criteria to consider about each issue. Criteria could
include the following:
Magnitude of the problem: How much of a burden is placed on the community, in
terms of financial losses, years of potential life lost, potential worsening of the
problem, etc.?
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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.
Ideas for Customizing Criteria Weighting:

Some groups may want to leave the issues in the order in which they are calculated
others may want to make the final prioritization decision based on discussion using
the results as a starting place.
Each community needs to determine their own criteria- this allows for consideration
of many factors in the community.
A "Quick and Colorful" Approach
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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.
Step-by-Step for a "Quick and Colorful" Approach:
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.
Ideas for Customizing a "Quick and Colorful" Approach:

The group can decide to place weights on particular problems if they are deemed more
important.
The number of colored tokens or stickers that each member receives can be controlled
(e.g., distribute only two red stickers).
Comparison of Prioritization Techniques

Given the many different techniques for prioritization, health planners may wonder how to
determine which method to use. Different techniques are suited to different types of decisions,
groups, and data. Perhaps most importantly, most of these methods permit individual tailoring
so that it can best meet the needs of a particular community. The chart below provides a
summary of the techniques described here and the strengths and weaknesses of each.
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SUMMARY OF PRIORITIZATION TECHNIQUES

Strengths Weaknesses Optimal size of group
Simplex Efficient and quick to use, once Requires the development of a Any size.
questionnaire is constructed. questionnaire.
Can be used with any size group. Relies heavily on how questions
Allows for weighting of problems. are asked.
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.
For Further Information Contact:
Carol Brown, MS, Director, Data and Community Assessment

Liza Centra, MPA, APEXPH Project Manager
NACCHO
440 First Street, NW, Suite 450
Washington, DC 20001
Phone: (202) 783-5550 Fax: (202) 783-1583
email: CBrown@naccho.org LCentra@naccho.org
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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Healthy People 2020 Focus Areas

COMMUNITY PRIORITY-SETTING Access to health services *
PROCESS AND RESULTS Adolescent health
One of the major features of each Charting the Course VI is the review Arthritis, osteoporosis, and chronic
back conditions
of health issues felt to be impacting the San Diego region. These health
Blood disorders and blood safety
issues are examined from local (San Diego County), state and national
Cancer *
perspectives. The starting point for the 2010 process was a review of
Chronic kidney disease
the 38 Healthy People 2020 focus areas (shown in the sidebar on this
Diabetes*
page). Because of the large number and the diversity of health issues, Disability and secondary conditions
the Charting the Course VI committee selected 17 of these health issues Early and middle childhood
for additional study and possible inclusion in this years Charting the Education and community-based
Course VI. (Health issues selected are indicated by an asterisk in the programs
sidebar.) They selected these issues based on an extensive review of the Environmental health
issues and a ranking of their perceived importance by the Charting the Family planning
Course VI committee. The 17 health issues were then divided into three Food safety
categories: Genomics
Global health
Overarching Issues (4 Issues) considered overarching because Health communication and health IT *
they potentially impact all of the other issues in this report. These Healthcare-associated infections
included: Hearing and other sensory or
communication disorders
o Access to health services
Heart disease and stroke *
o Health communications and health information technology
o Public health infrastructure HIV/AIDS
o Social determinants of health Immunization and infectious diseases*
Injury and violence prevention *
Health-Related Behaviors (6 Issues) behaviors that are important
Maternal, infant, and child health *
components in long-term health, such as:
Medical product safety
o Keeping immunizations current Mental health and mental disorders *
o Smoking cessation Nutrition and weight status *
o Increasing physical activity Occupational safety and health
o Achieving healthy weight status and improving nutrition Older adults
o Maintaining Oral health Oral health *
o Preventing violence and injury
Physical activity and fitness *
Health Outcomes (7 Issues) looks at the change in the health Public health infrastructure *
status of the population and various demographic groups over time Quality of life and well-being
related to:
Respiratory diseases *
o Cancer
Sexually transmitted diseases
o Diabetes
o Heart disease and stroke Social determinants of health *
o Infectious diseases Substance abuse *
o Maternal, infant and child health Tobacco use *
Vision
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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):
What is the size of the health issue in San Diego County?

What is the seriousness of the health issue in San Diego County?
What community resources are currently available to address the health issue?
How much data or information do we have to evaluate the health issues outcomes?
Participants in this priority-setting process were asked to review the information for each health
issue covered in the briefing document, provide their ratings from their perspective and weigh
each issue using the information provided along with their knowledge of the health issue.
Overall, 72 community leaders participated in the priority setting process. As part of this exercise,
participants were requested to indicate the geographic region of the county they represent.
(Participants were allowed to indicate more than one region.) As shown on the following table,
participants in the priority-setting process represented all regions of the county.
Priority Setting Responses by Geographic Region
Percent of total Percent of total
Region Count
count respondents
North Coastal 48 16.1 67.6
North Inland 46 15.4 64.8
North Central 49 16.4 69.0
Central 57 19.1 80.3
East 48 16.1 67.8
South 51 17.1 71.8
Many types of organizations participated in the priority-setting exercise, as shown on the following
table.
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Priority-Setting Responses by Type of Organization

Type of organization Count Percent
Hospital or health system 21 29.2
Community-based organization 18 25.0
County government/public health 9 12.5
Community clinic 5 6.8
Membership organization 4 5.6
Foundation 3 4.2
Social services agency 3 4.2
Consultant 2 2.8
Health plan 2 2.8
Physician 2 2.8
University/medical school 2 2.8
Other non-profit organization 1 1.3
Total 72 100
The following briefly presents results of the

community priority-setting process; results by
scoring criteria and ranking are shown in Figure
1 (page 18).
Overarching Health Issues

The scoring and ranking of importance of the
four overarching health issues produced
consistent results indicating participants felt
that health access and delivery and social
determinants of health were the top two issues
in this category.
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In terms of size and seriousness scoring these

two issues scored highest. In terms of outcomes,
where a lower score is more desirable,
participants indicated that current efforts
related to access and delivery and public health
infrastructure are more effective than for the
other two issues.
When ranked by importance, both health access
and delivery, and social determinants of health
were ranked as more important than the other
two overarching issues.
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 was clearly the behavior felt to

have more effective interventions than the Overall Ranking by Issue
other behaviors.
When ranked by importance, nutrition and
Nutrition & weight status
weight status clearly ranked as the most 1.7
important health-related behavior. Physical activity & fitness 3.1
Substance abuse & tobacco use 3.7
Injury & violence 3.8
Oral health 4.2
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
seven health outcomes produced rather 2,000

311 214 213 204
inconsistent results. Mental health received 442

374 325 330 214 207 214
1,500 316
the highest total score but was ranked third in 322 297
Total Score
1126 1136
importance. Much of the mental health score 1,000 1018 1160
914 884 858
was driven by the perceived lack of 500

477 505 460 488
community resources and the perceived lack 0
416 389 389
Mental health Diabetes Cancer Heart disease Respiratory Infectious Maternal,

of effective interventions (outcomes score). & stroke disease disease infant & child
health /
family
In terms of size and seriousness scoring, Size Seriousness Community resources Outcomes planning
diabetes, cancer, and heart disease and stroke

Note: The algorithm used for calculating total score uses the total rating points for size, seriousness,
scored highest. community resource and outcomes. Total score = size + (seriousness x 2) + community resources + outcomes
When ranked by importance, diabetes and

heart disease and stroke clearly ranked as the Overall Ranking by Issue
most important health outcomes, followed by Health Outcomes
mental health and cancer.
Diabetes 2.6
Heart disease & stroke 2.8
Mental health & mental disorders 3.6
Cancer 3.7
Maternal, infant & child health / Family
planning
4.6
Infectious diseases 5.3
Respiratory diseases 5.5
1 2 3 4 5 6 7
Most Mean Ranking Least
Important Important
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09/07/2011
(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.
PAGE 17 OF 61
09/07/2011
Selection of Health Issues
One of the key outcomes from the community

priority-setting process was identification of which
health issues to bring forward for discussion in the
community forums and expand upon in the
Charting the Course VI report. Key considerations
for the selection of the health issues were the
availability of data at the regional level and the
position of the issues on the spectrum of
prevention. To help with the latter consideration,
the committee members used the Spectrum of
Prevention Framework to help them visualize
which issues are most impacted by prevention
activities as opposed to treatment.
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:
Health access and delivery
Social determinants of health
A combination of nutrition, weight status, physical activity and fitness
Injury and violence
Mental health and mental disorders
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.
PAGE 18 OF 61
09/07/2011
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PAGE 32 OF 61
09/07/2011
A Profile of Health
Indicators and
Prevention Priorities
for Our Community
PAGE 33 OF 61
09/07/2011
Contents 2010 Mecklenburg County Community Assessment
CONTENTS
Executive Summary............................... 1
Overview................................................. 5
Priority Setting.......................................10
Assets and Challenges......................... 21
Demographics 32
Determinants of Health36
GIS Maps. 43
Community Health Indicators

Mortality 55
Maternal Child Health 60
Health Behaviors 75
Injury and Violence 83
i
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Contents 2010 Mecklenburg County Community Assessment
Table of Contents
Community Health Indicators, cont.
Environmental Health 92
Communicable Diseases . 98
Mental Health ..120
Substance Abuse126
Access to Care.131
Chronic Diseases147
Health Disparities156
Primary Data Research
2010 Community Health Survey..164
Mecklenburg Area Partnership

for Primary Research170
2010 Mecklenburg Community

Food Assessment...172
Communication Plan....175
ii
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Executive Summary 2010 Mecklenburg County Community Assessment
EXECUTIVE SUMMARY
Prepared by: Mecklenburg County Health Department (MCHD), Epidemiology Program 1
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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.
MECKLENBURG HIGHLIGHTS FROM THE COMMUNITY DATA OVERVIEW

Cancer and cardiovascular disease are the leading causes of death, but mortality rates from heart
disease, cancer, and stroke have been declining over the past five years.
Disparate outcomes in mortality for racial/ethnic groups persist. For example, from 2004-2008,
people of Other Races died from diabetes at 2.6 times the rate for Whites.
Alzheimers disease is the 4th leading cause of death; White women, the group with the longest life
expectancy, make up the majority of Alzheimers disease deaths.
Unintentional injury is the 6th leading cause of death for the total population, the leading cause of
death for those 1-44 years of age, and one of the leading causes of death for Hispanics.
Mecklenburg County was one of six counties reporting the highest rate of syphilis increase in North
Carolina. Between 2008 and 2009 the Primary/Secondary Syphilis case rate in the county
increased by 138%, from 5.5 cases per 100,000 to a rate of 13.1.
In 2009, approximately 35% of adults reported elevated cholesterol; 29% high blood pressure; 64%
overweight or obesity; 21% no physical exercise in the past month; 17% current smoking; and 78%
eating less than five servings of fruits and vegetables per day.
In 2009, 16.5% of Mecklenburg Residents are uninsured for a total of approximately 150,180
individuals without health insurance. 21.2% of the non-elderly adult population in our county is
uninsured, while 9.8% of children are uninsured.
In 2009, nearly 33% of teens reported having had at least one drink of alcohol in the past thirty
days, 38% of Mecklenburg teens reported using marijuana one or more times during their life and
more than 14% of teens have taken prescription drugs such as OxyContin, Percocet, Demerol,
Adoral, Ritalin, or Zanax without a doctors prescription.
From 1995-2008, the pregnancy rate for teens ages 15-19 decreased by 27%.
In 2008, one out of every five babies born was to an Hispanic mother.
The 2008 Infant Mortality rate for Mecklenburg is 6.6 infant deaths per 1,000 live births. However,
infants of Other Races are 2.3 times more likely to die than are White infants.
In 2009, 28% of teens surveyed reported feeling sad or hopeless almost every day for two weeks or
more in a row to the extent they stopped doing some usual activities; 14% of teens reported actually
attempting suicide one or more times.
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RANKING PRIORITY FOCUS AREAS

In 2010, the Steering Committee reviewed the eight priority focus areas from the 2006 CHA. Examination of
the community data overview suggested that these focus areas remained of current concern and interest.
However, the decision was made to divide the injury category into two separate categories: Injury Prevention
and Violence Prevention. In addition, the environmental health category was renamed Healthy Environment so
as to be more inclusive of aspects beyond air and water quality like active transportation opportunities.
On October 27, 2010, ninety-one individuals representing a variety of community agencies and groups
attended the CHA Priority Setting meeting. Participants were asked to review data specific to the nine priority
areas and rank them using the following five criteria: magnitude; severity; intervention effectiveness; public
concern; and urgency. Health disparities were to be considered a part of every topic rather than a separate
focus area. In addition, Mecklenburg County residents were encouraged to participate in an online/paper
survey to gauge community beliefs and attitudes towards health as well as prioritize the nine focus areas.
Combined rankings from these two groups were as follows:
1. Chronic Disease Prevention through Healthy Choices

2. Access to Care
3. Healthy Environment Healthy Places Supporting Healthy Choices
4. Substance Abuse Prevention
5. Violence Prevention
6. Injury Prevention
7. Mental Health
8. Responsible Sexual Behavior, and
9. Maternal Child Health.
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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Environmental Health Healthy Places Supporting Healthy Choices

Increase access to community gardens particularly in food deserts or use vacant lots with a focus on
living green
Host a community-wide awareness day to promote active transportation (biking, taking the bus,
carpooling etc.)
Synchronize CHA efforts with other strategic efforts in the city and county like sustainable community
initiatives, park & recreation, land use and development, education, historic sites, bus services and
environment focus area
Substance Abuse Prevention

Increase/maintain current funding for treatment
Increase funding for treatment during incarceration
Create a public awareness/educational campaign to stress that substance abuse is an equal-
opportunity disease and is a gateway to many risk-taking behaviors and chronic health problems
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Section Priority Setting 2010 Mecklenburg County Community Assessment
PRIORITY SETTING EXERCISE
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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LIST OF ATTENDEES, cont.

Last First Agency
Gardner Jennifer Carolinas HealthCare System
Garvey Suzy Community Member
Glenn Jacqueline Mecklenburg County Health Department (Clinical Services)
Gonzalez Karina Mecklenburg County Health Department (Hispanic Health)
Grindstaff Beverly Care Ring
Hartley Wendy Community Member
Henderson Lee Smart Start
Hernandez Brisa Elizabeth Family Practice
Houser Lorraine Mecklenburg County Health Department (Communicable Disease)
Hudson Nancy Charlotte Community Health Clinic
Huynh, MD Toan Carolinas HealthCare System
Jacobs, MD David Carolinas HealthCare System
Jackman Julie Mecklenburg County Health Department (Worksite Wellness)
Kaclik Deb Charlotte Mecklenburg Schools
Kehrer Rebecca Care Ring
Langenfeld Nancy Charlotte Mecklenburg Schools
Leon Emma Mecklenburg County Health Department (Hispanic Health)
Levin Jon Mecklenburg County Health Department (Health Promotion)
Lewis Judy Metrolina Provider Network
Lipman Helen Mecklenburg County Community Support Services
MacDonald JoAnn Mecklenburg Medical Alliance & Endowment
Marks Marilyn Society of St. Andrews
Martin Mark Novant Health/Presbyterian
Masakadza Lovemore Mecklenburg County Health Department (Tobacco)
Massad Lola Mecklenburg County Parks and Recreation
Mateo Wendy Bethesda Health Center
Matthews Christopher Anuvia
McGovern Mary Women's Impact Fund
McGruder Mona Mecklenburg County Health Department (School Health)
McNinch Barbara Mecklenburg County Health Department (Health Promotion)
Mead Antonia Johnson C. Smith University
Mele Connie Area Mental Health
Mignery Allison Mecklenburg County Health Department (Nutrition)
Mobley Wanda Community Health Ambassador, Greater Meyers Chapel Penecostal
Myer Jane Smart Start
Newsom Kay Ada Jenkins
Nguyen Van Nhi Boat People SOS
Owens Clayton Carolinas HealthCare System
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LIST OF ATTENDEES, cont.

First Last Agency
Palmer Trena Charlotte Mecklenburg Senior Centers
Perry Emily Office of Healthy Carolinians
Peterson-Vita Elizabeth Area Mental Health
Powers-Jones Shannon Student, University of Alabama
Pruess Heidi Mecklenburg County Land Use & Environmental Services Agency
Readous Sherena Student, Walden University
Reese Maria Mecklenburg County Health Department (Community Services)
Reeves Kelly Mecklenburg County Health Department (School Health)
Ross Malisha Another Level Services
Royster Susan NC MedAssist
Safrit Libby Teen Health Connection
Sailer Kaaren Care Ring
Schafermeyer, MD Bob Carolinas Center for Injury Prevention
Schambach Anita Community Care Partners of Greater Mecklenburg
Scharf Joan Mecklenburg Medical Alliance & Endowment
Scruggs Carolyn Mecklenburg Medical Society
Seekings Michelle Community Alternatives of North Carolina
Simon Karen Mecklenburg County Sheriff's Office
Singleton Cheri Mecklenburg County Health Department (Maternity Care)
Singleton Reggie Mecklenburg County Health Department (The Males' Place)
Sowyak Michael Shelter Health
Starr Teresa Matthews Free Medical Clinic
Sullivan Linda Mecklenburg County Health Department (School Health)
Tapp Hazel Elizabeth Family Practice
Terrell Deborah Johnson C. Smith University
Thompson Michael UNC Charlotte (Public Health)
Vaca Patrick CMC Randolph (Behavioral Health)
Vandiver Shannon Junior League of Charlotte
Wall John Community Member
Ward Ashley Student, UNC Charlotte
Warren Deborah Carolina RAIN
Williams Janice Carolinas Center for Injury Prevention
Winters Dick Mecklenburg County Health Department (Built Environment)
Withers-Thompson Tamara Charlotte Community Health Clinic
Wolfe Nicole Hospice & Palliative Care Charlotte Region
Woody Gayla Centralina Area Agency on Aging
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09/07/2011
PRIORITY RANKING RESULTS

DEMOGRAPHIC PROFILE OF ATTENDEES
A total of 91 residents attended the Oct 27th Priority Setting Exercise Participant Background/Role
Priority Setting Meeting. Of those attendees, (N= 68, Percentages)
68 participants completed demographic and
evaluation forms. The following data describes
the demographic profile of participants. 3.00% 4.50% Business
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.
PRIORITY RANKING PROCESS

Participants of the Oct 27th Priority Setting meeting were randomly assigned into 16 groups to prioritize the
nine focus areas. Random assignments allowed members to share their diverse knowledge, experience and
challenges in addressing each priority area. Prior to the ranking process, the Epidemiology Program Manager
provided a PowerPoint presentation to briefly summarize data from each focus area. Participants were also
provided with copies of the 2009 State of the County Health Report as well as data summary sheets for each
priority area to facilitate group discussion. After discussion, each group member ranked priority areas with a
score of one to ten for the following five criteria:
1. Magnitude: Proportion of the population affected or vulnerable.
2. Severity: Impact on mortality, morbidity, disability and quality of life
3. Intervention Effectiveness: Proven interventions exist that are feasible from a practical, economic and
political viewpoint
4. Public Concern: Degree of public concern and/or awareness
5. Urgency: Need for action based on degree and rate of growth (decline); Potential for affecting and
amplifying other health or socioeconomic issues; Timing for public awareness, collaboration, and
funding is present.
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SAMPLE SCORING SHEET
PAGE 45 OF 61
09/07/2011
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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09/07/2011
COMBINED RANKINGS: CHA Survey and Priority Setting Exercise

During the month of September 2010, Mecklenburg County residents were encouraged to participate in a
survey to gauge community beliefs and attitudes towards health and the challenges in maintaining healthy
lifestyles. Survey participants were also asked to prioritize issues affecting the public health of the community,
utilizing the nine priority focus areas. Additional data on the 2010 CHA Survey can be found in the
previous section.
With the exception of the top two priority areas, Survey Rankings were different from Priority Setting Rankings.
Survey participants provided higher rankings for Violence Prevention and Injury Prevention in comparison to
participants from the Priority Setting Exercise. Conversely, Substance Abuse Prevention and Mental Health
were given lower rankings among survey participants.
2010 Priority 2010 CHA
Setting Exercise Online/Paper
Rankings Survey Rankings
Chronic Disease Prevention 1 1
Access to Care 2 2
Substance Abuse Prevention 3 6
Environmental Health 4 3
Mental Health 5 9
Violence Prevention 6 4
Injury Prevention 7 5
Responsible Sexual Behavior 8 7
Maternal and Child Health 9 8
METHODOLOGY: COMBINING THE RANKINGS

Survey participants were asked to rank the nine priority areas in comparison with each other without scoring for
the five criteria utilized in the Priority Setting Exercise. Due to this fact, overall scores among survey
participants were lower for each focus area in comparison to scores generated during the Priority Setting
Exercise. As the Survey Rankings were made without the education and discussion provided by the Priority
Setting Exercise, the decision was made to weight the data giving higher weight to Priority Setting Rankings.
Ranking results for both groups were converted into percentages and Priority Setting Rankings were given a
weight 3 times that of Survey Rankings.
Applying the appropriate weights for each group yielded the following results:
1. Chronic Disease & Disability Prevention
2. Access to Care
3. Environmental Health
4. Substance Abuse Prevention
5. Violence Prevention
6. Injury Prevention
7. Mental Health
8. Responsible Sexual Behavior
9. Maternal and Child Health
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09/07/2011
Mecklenburg Healthy Carolinians will develop action plans for at least the top four priority areas. Plans will be
completed by June 2011.
COMBINED RANKINGS: CHA Survey and Priority Setting Exercise

(With Weighted Data)
Weighted Rankings (Priority Setting Ranking X3)
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
Access to Care 73.5% 57% 55.2% 14.3% 69.4% 2 2
Environmental Health 72.1% 48% 54.0% 12.0% 66.0% 4 3
Substance Abuse Prevention 73.4% 42% 55.0% 10.5% 65.5% 3 4
Violence Prevention 70.0% 47% 52.5% 11.8% 64.2% 6 5
Injury Prevention 66.4% 44% 49.8% 11.0% 60.8% 7 6
Mental Health 71.5% 13% 53.6% 3.3% 56.9% 5 7
Responsible Sexual Behavior 64.0% 34% 48.0% 8.5% 56.5% 8 8
Maternal and Child Health 61.2% 27% 45.9% 6.8% 52.7% 9 9
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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
to specific populations and cultures 5
Educate lay people in community to help their 4
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
Educate people about types of services available 6 5.3 5.5

Increase number of free clinics to reduce ER use and 5
locate them across the county 4
Satellite hospitals increase referrals to sliding scale

3
2
clinics 1
Improve communication between specialty services 0
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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3. SUBSTANCE ABUSE PREVENTION

Average Scoring for Substance Abuse Prevention
Increase/maintain current funding for treatment (By Criteria)
Increase funding for treatment during incarceration
Create a public awareness/educational campaign 9
8.3
to stress that substance abuse is an equal- 8
7.8 7.9
opportunity disease and is a gateway to many 7 6.3 6.5
risk-taking behaviors and chronic health problems 6
Increase prevention services 5
Increase and promote more self-help groups 4
within local communities (using resources already 3
there i.e. churches, community police efforts etc) 2
to reach out to those in identified substance abuse 1
programs using a weight watcher type format to 0
support, provide counseling training, job help, etc Intervention Magnitude Public Severity Urgency
and maintain abstinence Concern
4. ENVIRONMENTAL HEALTH HEALTHY PLACES SUPPORTING HEALTHY CHOICES
Increase community gardens particularly in food

deserts or use vacant lots with a focus on living Average Scoring for Healthy Environment
green (By Criteria)
Host a community-wide awareness day to
promote active transportation like biking, taking 10
8.9
the bus, carpooling or walking to work and school 9
7.8 7.7
Synchronize CHA efforts with other strategic 8
6.5
7
efforts in the city and county like sustainable
community initiatives, park & recreation, land use 6
5.2
5
and development, education, historic sites, bus
4
services and environment focus area
3
Advertise existing environmental focused 2
programs through PSAs, billboards and other 1
educational efforts using recognizable logos, etc 0
to promote healthy lifestyle changes and to make Intervention Magnitude Public Severity Urgency
the community aware of available federal, state, Concern
local programs that already exist within the
community
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Section Assets and Challenges 2010 Mecklenburg County Community Assessment
ASSETS AND CHALLENGES
PAGE 51 OF 61
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COMMUNITY ASSETS FOR INFLUENCING HEALTH

While Mecklenburg County encounters numerous health challenges from a diverse and rapidly growing
population, it also possesses a wealth of assets that offer assistance in addressing them.
A survey of community assets includes but is not limited to the following:
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
PAGE 52 OF 61
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POSITIVE HEALTH TRENDS AND INDICATORS

When comparing community health indicators with North Carolina and the United States, for the most part
Mecklenburg County fairs as well as if not better. Exceptions are conditions associated with urban areas such
as HIV disease, tuberculosis and homicide. However, some health indicators like overweight and obesity are
negative across the county so a similar or better comparison does not necessarily indicate a favorable status.
In addition, when examining Mecklenburg health indicators by race and ethnicity, it is obvious that not all
populations are equally enjoying good health.
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
CHALLENGES: AREAS REQUIRING ADDITIONAL ATTENTION

The information presented below reflects a quick summary of the priority health concerns and information from
throughout this report including community recommendations. Some concerns or areas for attention may be
reflected in several categories. For a more extensive presentation of data and recommendations by priority
health concern, see the Priority Ranking Exercise Section.
HEALTH DISPARITIES
Are evident in all priority concerns
Special attention is needed to diabetes, infant mortality, STDs and HIV disease
PAGE 53 OF 61
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PREVENTING CHRONIC DISEASE & DISABILITY THROUGH HEALTHY CHOICES

Promoting healthy behavior choices in physical activity, nutrition and tobacco use
Overweight and obesity
Appropriate nutrition and physical activity for children and teens for building healthy bones to prevent
osteoporosis in the future as well as preventing overweight and obesity
Promoting preventive screenings for skin, breast, prostate and colon cancer
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
ENVIRONMENTAL HEALTH HEALTHY PLACES SUPPORTING HEALTHY CHOICES

Air quality
Built environment
Worksite wellness
Food availability and security
SUBSTANCE ABUSE PREVENTION

Underage drinking
Binge drinking
DUI
Perception that some alcohol use among minors is acceptable and that drinking at home is safer than
away from home; lack of understanding of the affect of alcohol on the still developing adolescent brain
Hispanic alcohol use
Prescription drug abuse
Illegal drug use
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,
PAGE 54 OF 61
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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
RESPONSIBLE SEXUAL BEHAVIOR

Rising rates of HIV disease and syphilis
Disproportionate burden of HIV disease and syphilis in the African American community
12% of births occur with an interpregnancy interval of less than or equal to six months
Even though meeting the HP2010 goal, the number of pregnancies in girls 15-17 is still of concern as is
the number in girls 10-14; certain areas of the community are not seeing the drop in adolescent
pregnancy experienced by the county as a whole
MATERNAL CHILD HEALTH

Large gap between white and African American rates of infant mortality
Safe sleeping arrangements affect infant mortality by decreasing the likelihood of SIDS and suffocation
Declining rates of entry into prenatal care during the first trimester
12% of births occurs with an interpregnancy interval of less than or equal to six months
Even though meeting the HP2010 goal, the number of pregnancies in girls 15-17 is still of concern as is
the number in girls 10-14.
OVERVIEW OF SELECTED COMMUNITY HEALTH INDICATORS

The following three documents provide a quick overview of the positives and negatives by comparing selected
health indicators with peer counties, North Carolina, the US and Healthy People 2010 goals.
2010 Community Health Assessment Summary of Selected Health Indicators
2009 SOTCH Summary of Selected Health Indicators
FY10 Mecklenburg County Health Index (a part of the Mecklenburg County Balanced Scorecard)
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Healthy Montgomery Review Packet

Priority-Setting Process Packet

Mecklenburg Needs Assessment: Priority-Setting Exercise

Establishing Criteria for Priority-Setting Process

For Additional Reading

Prioritization section from NACCHOs APEXPH in Practice Workbook. Accessed

What is prioritization? Prioritization is a process whereby an individual or group places a

Examples of Prioritization Techniques and How They May be Implemented

Step-by-Step for Simplex:

1. This health issue affects:

a) very few people

b) less than half of the people

c) half the people

3. Respondents then fill out the questionnaire.

Ideas for Customizing Simplex:

Nominal Group Planning

In the APEXPH process, nominal group planning can be used to:

determine what community issues are of greatest concern;

Step-by-Step for Nominal Group Technique:

Ideas for Customizing Nominal Group Technique:

Criteria Weighting Method

Step-by-Step for Criteria Weighting Method:

Ideas for Customizing Criteria Weighting:

A "Quick and Colorful" Approach

Step-by-Step for a "Quick and Colorful" Approach:

Ideas for Customizing a "Quick and Colorful" Approach:

Comparison of Prioritization Techniques

SUMMARY OF PRIORITIZATION TECHNIQUES

For Further Information Contact:

Carol Brown, MS, Director, Data and Community Assessment

Healthy People 2020 Focus Areas

What is the size of the health issue in San Diego County?

North Coastal 48 16.1 67.6

North Inland 46 15.4 64.8

North Central 49 16.4 69.0

Central 57 19.1 80.3

East 48 16.1 67.8

South 51 17.1 71.8

Priority-Setting Responses by Type of Organization

Hospital or health system 21 29.2

Community-based organization 18 25.0

County government/public health 9 12.5

Community clinic 5 6.8

Membership organization 4 5.6

Social services agency 3 4.2

Health plan 2 2.8

University/medical school 2 2.8

Other non-profit organization 1 1.3

The following briefly presents results of the

Overarching Health Issues

In terms of size and seriousness scoring these

Immunization was clearly the behavior felt to

important health-related behavior. Physical activity & fitness 3.1

Substance abuse & tobacco use 3.7

Injury & violence 3.8

Oral health 4.2

seven health outcomes produced rather 2,000

inconsistent results. Mental health received 442

was driven by the perceived lack of 500

Mental health Diabetes Cancer Heart disease Respiratory Infectious Maternal,

diabetes, cancer, and heart disease and stroke

When ranked by importance, diabetes and

Heart disease & stroke 2.8

Mental health & mental disorders 3.6

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