Introduction
Community health assessments help to identify the health needs of a given community. Through these evaluations, practitioners can address issues affecting the health outcomes of a population. A fundamental principle in evidence-based practice is that clinical practice should be centered on the best available proof (Demarco & Healey-Walsh, 2020). Without a community health assessment (CHA), populace-based interventions would be grounded on assumptions rather than evidence. Therefore, health practitioners must conduct a comprehensive evaluation of their communities before developing interventions to address the populace’s health needs. This paper aims to conduct a community health assessment to identify the community’s resources, strengths, challenges, and health issues.
Community of Focus
The community of focus in this paper is Gladstone City, located north of Oregon City. The community is well-established, with a population of approximately 12 324 people (“Gladstone, Oregon population,” n.d.). It stretches from the Willamette River up the hill in Clackamas town. Clackamas River acts as a boundary between Gladstone and other areas in the region. The community is bordered by Milwaukie, Portland, Clackamas, and Oregon City. I also noticed economic divisions between Gladstone and the neighboring towns. For example, Oregon City was a major supplier of goods and services which were not readily available in the community. Clackamas, a three-to-four-minute drive from the community, serves as a major town center for the community, although it has a different school system, parks, and festivals (“Gladston,” n.d.). Being an urban area, the community is susceptible to infectious diseases, injuries, and chronic diseases associated with crowded living conditions and industrial pollution. However, I think the primary health concern for this community is obesity. Recently, the prevalence of obesity in the community has gained a lot of traction, including in the media. However, there are no official reports on the extent of the problem in the community.
Windshield Survey
The community’s map was obtained from the planning department at Oregon County. Different areas of the community were divided into zones, with each zone being assigned a number. I created an “interest area list,” which consisted of the areas that needed to be visited in each zone. The interest areas included laundries, barber and beauty shops, community churches and centers, drugstores, healthcare centers, small businesses, housing projects, the library, and other buildings. I walked around the streets of the marked zones and noted down my observations. I used the windshield method, driving around the neighborhoods, to collect information on the community’s daily living.
The community has a unique cultural diversity; I saw individuals of different races in the community. However, I noticed that whites and Hispanics were the largest racial group, followed by African Americans. The community’s service centers include three schools, two chiropractors, two dentists, three hair salons, police, and the fire station department. There is only one grocery store in the community, three mini-markets, three bars, a 24-hour fitness center, and numerous retail outlets all located around the town center. I saw various offices that provide support services to community members such as the offices for medical benefits for the aged program (MBA), blind or disabled, modified adjusted gross income program (MAGI), supplemental nutrition assistance program, and Prescription Drug Assistance Program (PDA), and food assistance.
The residential buildings were mostly single-family homes, and the architectural designs varied by neighborhood. The community’s lower side mostly had two-storied buildings and 1950s designs, while the north side had modern designs. Most family homes had open fields, big lots, and were partially wooded. There was a considerable disparity in the cleanliness among the neighborhoods in the community. The yards in the single-family homes on the southside were unkempt and mucky, while the northside houses were well maintained. However, there were no unattended garbage piles in public areas. The primary employment industry included school districts, car dealerships, healthcare facilities, public service, rehabilitation, and specialty care center.
Community members have picnics, swim, and take walks at Clark park, which has well-maintained pedestrian pathways, bike paths, and trails. The community’s senior center is currently non-operational due to COVID-19. The community holds a festival that features a car show, games & movies at the park, food, drinks, and street dances every 1st week of summer. The common areas include the park, open spaces in public schools, and the library. They have T.V.s or screens that mostly run advertisements. WIFI connection in some public areas gives residents an upper hand in online communication. Bulletin boards are located along streets and pathways and feature public notices, advertisements, and announcements.
Although public transport, Trimet, is available, most people use private cars. Given that Trimet is a scheduled transportation system, coupled with the fact that most shopping outlets are considerably far from the neighborhoods, it is more convenient for community members to use private transportation than public transportation. A considerable number of streets have potholes and leaves piles. I saw religious buildings such as the Catholic Church, Baptist church, Marmon, Adventist church, and Luthern. There were no industries that did any apparent harm to the environment.
Strengths and Weaknesses
The key strength of the community is that bulletin boards are strategically positioned along the paths and streets. The strategic position of the bulletin boards can ease information dissemination. For example, I easily learned about community events and common host locations through the bulletin boards. Another key strength is that the pathways and trails at the park provide an excellent opportunity for hiking and exercising because they are well-maintained. Finally, the support programs I saw can be resourceful in supporting community interventions.
A major downside was that most streets were in bad condition, mainly due to potholes. Secondly, there is only one grocery store in the community, which, in my own perspective, is insufficient in serving the community’s needs. Given its population size, I think Gladstone needs more grocery stores, which might increase access to nutritious food. The third challenge is that the grocery stores, mini-markets, and retail stores are all located in the town center. I believe this is a challenge because distance can discourage people, especially the poor, from making healthy choices. When stores are located far from home, it might be expensive to travel to and from the stores. Therefore, one opts to buy whatever is easily available at their locality to save on time and money. I also gained a whole new perspective on the community members. Often, they would stop us and inquire about what we were doing and then give us additional insights into the challenges and strengths of day-to-day living in the community.
Key Informant Interview
I reviewed existing data about the community from public health sources. I collected data on the community’s strengths and weaknesses, its health concerns, and unaddressed needs. After identifying the type of data I needed, I brainstormed ideas on people that would be the most knowledgeable on the topics. I decided to interview a community member (R) and a nurse (J). I contacted my key informants and organized a face-to-face interview once they accepted my request. I used a set of interview questions to guide the interviews. I took notes on the informants’ responses for future reference and confirmation.
- Informant J’s Interview Summary (J. S, personal communication, November 27, 2020): J provided insightful information on the characteristics and culture of the community. According to J, the police and fire department were a significant strength within the region. J noticed that Gladstone residents are amicable. She also mentioned that the community had many long-term residents – people who lived in the community for generations. She raised concerns about food insecurity among senior residents and low-income earners. She said that the community needs affordable healthcare, especially mental health services. Obesity is a primary health concern and, nutrition, exercise, and diet improve the community’s health. This standpoint confirms my health concerns regarding the prevalence of obesity within the population. The unaddressed societal needs within this region include childcare services for working and assistance to senior residents living alone.
- Informant R’s Interview Summary (R. K, personal communication, November 27, 2020): R shared J’s views that the Gladstone residents are friendly. According to R, the community members are “helpful and have a neighborly attitude.” The community’s main challenge, according to R, was that it was backward and stuck in the past. When asked about the community’s major health concerns, R said that it was COVID-19 and the older generation. The unaddressed community needs included infrastructural maintenance, better regulations, and an active government. R felt that the community’s health needs were not being addressed because the local government was unresponsive.
From the interviews, I learned about important socio-cultural aspects of the community. First, the community is traditional, presumably because the residents have lived there for generations. Second, the older generation and senior residents are a population of interest in the region. J asserted that most experienced food insecurity and live alone, and need a robust social support system. R also shares the same views when he mentions that the older population is a significant health concern. Due to their age, the older population is susceptible to chronic conditions. According to Bell et al. (2016), 40 million older adults in the U.S. have at least one chronic condition. Therefore, I deduced that the older population in the Gladstone community is a high-risk population. The primary strength of the community is that they are friendly and homely. Their friendliness can facilitate the development of healthy and meaningful relationships with the health promoters.
Epidemiological Data
Social determinants of health (SDH) are conditions in the physical, sociocultural, and economic environment that may affect an individual’s health outcomes. The Chronic Disease Indicator (CDI) database was used to determine the community’s risk factors for chronic conditions. (See appendix).
The epidemiological data expounded on my knowledge of the health issues affecting the community. First, CDI data confirms my initial stance that obesity is a significant public health issue for Gladstone’s population. According to CDI data, the percentage of overweight or obese adults in the community is 61.6%, while those of healthy weight are 34.4% (CDC, 2020). This data means that more than half of the community members are either overweight (at risk of being obese) or are already obese. Through the CDI data, we can see the extent to which obesity affects the community. To improve the Gladstone community’s health, community obesity rates should be reduced from 61.6% to 33.9% since the healthy People initiative aims to reduce obesity rates in the country to 33.9%. The Healthy People is an initiative that sets objectives for an efficient and robust healthcare system, promotes healthy departments, and advocates for the improved life quality and health of families and communities (Fielding et al., 2012). Unfortunately, CDI did not provide data on the health insurance status among older adults. Therefore, the concerns of informant J could not be ascertained. Considering that older adults are vulnerable, understanding their insurance coverage states can inform patient-centered interventions.
Analysis and Discussion
My perspective on the health status of the community has not changed. Epidemiological data of the community confirmed my stance that obesity is a major health concern in the community. According to the data, 61.6% of the community is either at risk of being obese or is already obese (CDC, 2020). Considering that obesity is a risk factor for chronic conditions, this data suggests that 61.6% of the adult community in Gladstone is at risk of developing a chronic condition. Therefore, obesity is a health priority of the community and, therefore, needs to be addressed. I also learned of new challenges encountered by individuals within this area; they include affordability of healthcare, insurance coverage, poor infrastructure (roads), and the aging populace’s wellbeing. The most impactful data derived from this assessment is that overweight or obese individuals are almost double the number of individuals with a healthy weight. Obesity prevalence increases the population’s risk of developing chronic conditions such as diabetes, cardiovascular diseases, and cancer.
Community Weaknesses
The identified weaknesses included poor infrastructure and the number and location of grocery stores in the community. Key informants identified food insecurity, unhealthy diets, obesity, and insufficient social support services for children and older adults as the community’s main challenges. The causes of obesity need to be prioritized because the pandemic has been identified as the community’s primary health concern. In this regard, I think that the number and location (positioning) of the grocery stores are the main weakness that needs to be prioritized.
A study conducted by Burgoine (2017) revealed that the absence or presence of a food source (supermarket or grocery store) in a given geographical area is a strong predictor of diet quality and body weight. At Gladstone, there are only three mini-markets and one grocery store that serve over 12 324 people. Additionally, these mini-markets are all located in the town center, which is far from residential homes. Going by Burgoine’s (2017) findings, it can be surmised that the positioning and number of grocery stores at Gladstone are the main contributors to the obesity pandemic.
The second health concern of the community is the health and well-being of older adults. Demographic shifts play an instrumental role in influencing a community’s health status (Eisenhauer et al., 2016). From the key informant’s interviews, it is evident that the older population is a population of interest in the community. Informant J raised the issue of isolation among senior citizens living alone, food insecurity, and the affordability of healthcare services such as mental healthcare. Informant J asserted that older adults experience food insecurity, live alone, and need a robust social support system. Informant R also shares the same views when he mentions that the older population is a significant health concern. The informants’ concerns are similar to Seematter-Bagnoudand, and Büla’s (2018) study outcomes that highlighted mental illness, malnutrition, unsanitary living conditions, and poverty as the common health concerns among older adults. Older adults are usually retired and, therefore, lack a stable source of income. Low-income levels are associated with adverse health outcomes, including inadequate healthcare access (inability to pay for healthcare services). Although there was no data to ascertain whether the community’s older population could afford healthcare, population-health interventions should still seek to increase access to affordable health services.
Community Strengths
The medical benefits program provides access to low-cost healthcare services for individuals aged 65 and over. Considering that older adults’ income and insurance status in the community is problematic, the program will be resourceful in reducing the problem. The supplemental nutrition assistance program provides food assistance by covering grocery costs in approved stores. The program can be useful in promoting healthy nutrition and dietary choices among homeless and low-income families.
The second resource is free communication channels that can be used to promote a healthy-living message. For example, I noticed that the news bulletin boards were strategically positioned near footpaths and public spaces from my windshield survey. Through these bulletin boards, we can post advertisements to increase the public’s awareness of obesity prevalence in the community. The community’s friendliness may foster the relationship between the community and health promoters.
Conclusion
The Gladstone community’s major strengths include the community friendliness, availability of strategically positioned communication channels, and supportive health services from Oregon County. The fundamental weaknesses include poor infrastructure, poorly-lit streets, inadequate grocery stores, and their location. There are only one grocery store and three mini-markets that serve the need of the community. The positioning of the food sources affects the weight outcomes and nutritional choices of the community. The health concerns include obesity, the well-being of older adults, and the affordability of healthcare services. However, obesity is a health priority since it affects more than half of the community’s population. Given that obesity is associated with adverse health outcomes, including worsening chronic conditions, it should be promptly addressed.
References
Bell, S. P., Patel, N., Patel, N., Sonani, R., Badheka, A., & Forman, D. E. (2016). Care of older adults. Journal of Geriatric Cardiology, 13(1), 1–7. Web.
CDC (2020). Sources for data on social determinants of health. Centers for Disease Control and Prevention.
Burgoine, T., Mackenbach, J.D., Lakerveld, J., Forouhi, N.G., Griffin, S.J., Brage, S., Wareham, N.J., & Monsivais, P. (2017). Interplay of socioeconomic status and supermarket distance is associated with excess obesity risk: A U.K cross-sectional study. International Journal of Environmental Research and Public Health, 14, 1–13.
Demarco, R., & Healey-Walsh, J. (2020). Community and public health nursing: Evidence for practice (3rd ed.). Wolters Kluwer Health.
Eisenhauer, C. M., Pullen, C., Nelson, T., Kumm, S. A., & Hunter, J. L. (2016). Partnering with rural farm women for community-based participatory action and ethnography. Online Journal of Rural Nursing and Healthcare, 16(1), 195–216.
Fielding J., Teustch, S., & Koh, H. (2012). Health reform and healthy people initiative. American Journal of Public Health, 102(1), 30–33.
Gladstone. (n.d.). Portland creative realtors.
Gladstone, Oregon population 2020 (n.d.) World population review.
Seematter-Bagnoudand, L., & Büla, C. (2018). Brief assessments and screening for geriatric conditions in older primary care patients: A pragmatic approach. Public Health Reviews, 39(1), 1–13.
Appendix
Community Report Card
This community report card presents a guide for local agencies and governments to develop or create responses to the identified health disparities within Gladstone City. These organizations must focus on critical issues identified in the report to maximize the attainment of productive outcomes. The Chronic Disease Indicator (CDI) database was used to determine the community’s risk factors for chronic conditions. The CDI database provides evidence-based data on chronic diseases’ risk factors, including social determinants of health of a given state or metropolitan area. Collecting information on SDH can determine the extent or significance of the raised health concerns on the population.
First, I searched the database for Oregon State. I later narrowed down my search by using the keywords “weight status,” “physical activity,” and “nutrition” to get specific data for the three indicators. I chose physical activity and nutrition indicators because they are directly linked to obesity. Information on the weight status of the community would either confirm or reject my assumption that the primary health concern of the community is obesity. Since informant J raised concerns on affordable healthcare, I also collected data on overarching conditions to determine if the older population can afford healthcare services. The following data has been retrieved from the CDI database (“Sources of data on social determinants of health,” 2020):
Nutrition, Physical Activity, and Weight Status
Adults are individuals aged 18 years and over
- The percentage of obese adults – 29.7%
- The percentage of overweight or obese adults – 61.6%
- The percentage of healthy weight among adults – 34.4%
There was no data for physical activity/nutritional choices.
Overarching Conditions
- Current lack of health insurance amid adults between the age of 18 and 64 years old – 12%
- Current health care coverage amid women 18-44 years old – 87.5%
There was no data on health insurance of the older population
The Healthy People 2020 objectives underscore the need to attain health equity, high life quality, eradicate disparities, develop physical and social surroundings that promote health for all, and minimize the incidence of preventable disorders. Regarding obesity, this initiative aims to reduce obesity rates in the country to 33.9%. Therefore, to improve the Gladstone community’s health, community obesity rates should be reduced from 61.6% to 33.9%. Recommended approaches to remedy the issue include supporting families within this region, providing health education, and promoting healthy lifestyles by increasing the number of grocery stores within the region. Positioning these stores near low-income neighborhoods will trigger a significant surge in access to healthy foods.