CENTERS FOR DISEASE CONTROL AND PREVENTION
Volume 16 • Number 1 • Winter 2003

Return to index of articles

Measuring the Health of Communities

As medical and public health advances have led to longer life spans for U.S. residents, the growing number of people living with chronic health conditions has led public health researchers to concentrate on quality as well as quantity of life. 

Communities that use CDC’s health-related quality of life (HRQOL) measures in their local surveys will be better able to partner with state and local health groups that use community health assessments as a tool to understand and improve the health of area residents. 

One example of such assessments is the Community Health Status Indicator (CHSI) Project, a collaborative effort of the Public Health Foundation, the Association of State and Territorial Health Officials, and the National Association of County and City Health Officials. Funded by the Health Services and Resources Administration, this project has identified a number of demographic, socioeconomic, and health-status indicators of community health: 

• Age distribution (percentage young and old). 
• Population size. 
• Population density. 
• Percentage of population living below the poverty line. 
• Percentage of population older than 24 without a high school diploma. 
• Unemployment rate. 
• Percentage of births to mothers under age 18. 
• Severe work disability rate. 
• All-cause death rate. 

In the late 1990s, CDC researchers conducted a study that examined the relationship between many of these socioeconomic and health status indicators and the mean number of days that people over age 17 reported poor health. Using data from the Behavioral Risk Factor Surveillance System, researchers found that HRQOL differs among U.S. counties according to county population size. The most unhealthy days were reported by people living in the most populous counties (those with more than 1 million residents), and the fewest unhealthy days were reported by people living in counties with populations between 500,000 and 1 million residents. 

They also found that other indicators also might affect county-level HRQOL differences. For each CHSI indicator used, the counties that reported the lowest rates of poverty, noncompletion of high school, unemployment, severe work disability, mortality, and proportion of births to adolescents had the lowest mean number of unhealthy days overall and for almost all county sizes. The authors concluded that county health departments should include local HRQOL data and associated community indicators along with other measures they use (such as access to health care and preventive services, environmental factors, and others) to identify health issues and guide their community health improvement processes. 

Communities use many different approaches to improve the health of their populations. In Improving Health in the Community: A Role for Performance Monitoring, the Institute of Medicine’s (IOM) Division of Health Promotion and Disease Prevention describes lessons learned from a variety of community health improvement processes and how performance monitoring can help guide such processes. CDC’s Healthy Days measures are included among the IOM’s suggested community performance measures. The guide also provides tools to help communities develop their own performance indicators. 

Communities are finding that measuring quality of life provides useful health assessment information. Officials in Boone County, Missouri, have used the Healthy Days measures since 1993 to help identify health problems of vulnerable groups and to justify additional funding for addressing these disparities. Health planners in Hamilton, Ontario, find the HQROL measures valuable in population health assessment, and King County, Washington, uses them as important community health indicators. 

Because such measures address health at the population level, they can help health officials determine whether community needs are being met. For this reason, even more communities are expected to adopt the Healthy Days measures. 

Suggested Reading 
Measuring Healthy Days—Population Assessment of Health-Related Quality of Life (CDC, November 2000). Available at www.cdc.gov/hrqol/index.htm. 

Morbidity and Mortality Weekly Report, Vol. 49, No. 13;281–5. April 7, 2000. Community Indicators of Health-Related Quality of Life—United States, 1993–1997. 

Improving Health in the Community. (IOM, 1997) Available at http://bob.nap.edu/books/0309055342/html/.*

Return to index of articles

Privacy Policy | Accessibility

Home | Contact Us

CDC Home | Search | Health Topics A-Z

This page last reviewed August 17, 2004

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion