A written transcript of presentations must be submitted to the conference secretariat by 05 September 2017. Unless presenters have requested a time extension, transcripts received after this date will not be included. The transcript should be a full written version of your speech. A full reference paper in not, necessarily, required.
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Title: THE HEALTHY COMMUNITY ASSESSMENT TOOL
Authors: Dr Elizabeth McDonald, Menzies School of Health Research, NT
A long and healthy life for many but not for all
In the 20th century in Australia, improvements in sanitation, drinking water quality, food safety, disease control and housing conditions were central to improving the quality of life and longevity of most of the population. A long, healthy life is now an achievable goal for most Australians. However, Australians living in regional and remote areas still experience poorer living conditions and health than people living in major cities. People in remote and regional Australia have higher levels of death, disease and higher levels of the health risk factors that lead to chronic disease than those who live in major metropolitan areas. They have less access to educational and employment opportunities, income, most goods and services, and in some areas, to necessities such as adequate shelter, clean water and fresh food.
A picture of poor health in rural and remote communities
In 2002–04, death rates in regional and remote areas were between 10–70% higher than in major cities. These rates reflect the high prevalence of chronic diseases such as diabetes, heart and kidney diseases that place a great burden on individuals, communities and the health system. These diseases are mostly the consequences of the social and economic circumstances experienced throughout life and the physical environment in which people live. The longer people live in stressful economic and social circumstances, the greater the physiological wear and tear they suffer and the less likely they are to age in a healthy manner.
To promote good health and prevent chronic disease
Fundamental interventions necessary to promote good health and prevent diseases in rural towns and remote Indigenous communities include the provision of clean water, sanitation and waste management; housing to reduce overcrowding; and a safe and nutritious food supply. The known risk factors leading to chronic disease (obesity, physical inactivity and smoking) can be reduced from before birth and throughout all of life, even into old age. To promote long lasting good health it is necessary to change or modify the living environment in rural towns and remote communities to support community members choosing healthy lifestyle options.
The Healthy Community Assessment Tool (HCAT)
What is the healthy community assessment tool?
It is a tool that has been developed to help assess if a community has the infrastructure and programs considered important to promote good health and prevent chronic diseases. It is suitable to use for small rural towns and remote Aboriginal communities.
The Healthy Community Assessment Tool (HCAT) aims to cover a broad range of important issues relevant to a community environment that supports achieving and maintaining good health (Table 1). It has been designed for easy use by people from diverse backgrounds in a wide variety of rural and remote communities. In some communities there may be many complexities to some of the specific issues covered by the Tool. These social, technical and other issues may need to be addressed in more depth if they are seen to be priority issues for a community.
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Fig.1 Infrastructure and programs considered important to promote good health and prevent chronic disease: key domains and indicator categories
Who can use the Tool?
The Tool can be used by community members, community leaders, environmental health officers, health promotion workers and government officers at all levels to:
gain a comprehensive picture of how well the community environment supports healthy living
assist with prioritising community needs
assist decision making about allocating resources
assess, document and advocate for community public health needs
compare the needs of communities in order to prioritise resource allocation
implement a community environmental health continuous quality improvement program.
Features of the Tool
The Tool was developed to offer a number of features. Each item (or domain) is broken down into a number of components, for example, a ‘Water Supply’ system includes the hardware that forms the delivery system, water quality, and water pressure and customer satisfaction issues.
The Tool is intended to be educative and provide information to promote an understanding of how infrastructure and the community environment can support efforts to improve health. Information provided in the tool links issues about the need for appropriate programs to maximise any health and wellbeing benefits to be gained from infrastructure. It highlights the need to have programs to accompany infrastructure to maximise health and wellbeing benefits, for example – there is little benefit from a community centre that is not utilised by community members.
The scoring system allows for small improvements to be measured as only small incremental improvements can be expected in some communities (Figure 2). This allows for ongoing monitoring and evaluation and use in a continuous quality improvement process.
The Tool also incorporates consideration of age and gender issues and inequities which may be present in communities.
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Table 1: Healthy Community Assessment Tool Scoring Scale
Completing the Healthy Community Assessment Tool
It is best if a minimum of 3 people with a wide range of information about the community do the assessment. This helps ensure that a balanced view of the state of community infrastructure is reported.
If the tool is being used for quality improvement or planning purposes the group completing the Tool should include staff responsible for services and community representatives. The Tool is useful to gain a shared understanding of the problem issues facing the community and the potential solutions to these problems.
To obtain accurate information or verify a situation it may be necessary to do a community tour or identify other people to obtain additional information.
Only the sections relevant to the situation in your town or remote community need to be completed. The assessment can be completed in stages if necessary.
Using the healthy community assessment tool
The Tool’s guide contains tables which consist of components and indicators that together make-up an item (or domain) that needs to be assessed.
Each indicator is rated using a scoring scale. The score is written in the box with the description that you think generally applies in your community. Qualifying comments should be entered under the score (Table 2). This is because the tool provides a generic description of indicators and these will not necessarily provide a perfect fit for each and every community or town.
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Table 2: Example completed component for the domain – Food Supply
A separate scoring form accompanies the HCAT Tool so scores for each item or domain can be summarised. In the scoring form the score for each indicator is noted and then, after considering these scores, an overall score can be decided on. It is not good to ‘average’ the component scores for an item to come to the overall score as some components are more significant than others. See the example below (Table 3). What overall score you rate will depend on what is happening in your community. It is important that the score for each component is shown as well as the overall score.
Score Overall Score: 4
10.1 Food outlet infrastructure 3 Reason for overall score: There is a lot of room for improvement in our food supply system. The store infrastructure is very old and limits what improvements we can make. We need a new store. We also need to try and ensure that healthy food is always available and community members can afford to buy healthy food.
10.2 Access to healthy food 5
10.3 Availability of healthy food 4
10.4 Affordability of healthy food 3
10.5 Food safety 8
10.6 Promoting eating a healthy diet 10
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Table 3: Example scoring Table – Food Supply
There are few tools or mechanisms available that takes a population health approach and will help assess, monitor and evaluate the appropriateness or effectiveness of government policies and services in addressing the social determinants of health in small rural and remote communities.
The HCAT Tool offers a mechanism to help achieve better coordination between agencies and services and work towards more appropriate, effective and efficient service delivery. This is consistent with the ‘whole-of-government’ approach to planning and service delivery in remote Aboriginal communities that is spoken about in Australian and NT Government policy documents.
The HCAT Tool is a prototype that offers many potential uses and benefits for community leaders, government officers and others seeking to address inequities in the social determinants of health in remote communities. Maximum benefits in using the Tool will be gained when there is community and across sector involvement and assessments is part of a CQI program. The HCAT Tool should help to achieve the critical requirement that the social determinants of health that underlie poor child health and prevent adults making healthy lifestyle choices in remote Aboriginal communities are addressed in a way that empowers community leaders.
There is insufficient time today to speak at length about the Tool. We have trialled the Tool and believe the HCAT Tool can be used with confidence to help those involved in planning, service provision and more generally promoting improvements in community social determinants of health and reduce inequities in health between Indigenous and non-Indigenous Australians.
FOR MORE INFORMATION [Enter the details of the person who can be contacted about the presentation]
Dr Elizabeth McDonald
Menzies School of Health Research
PO Box 41096
Parap, NT 0804
Ph: 08 8943 5035 Email: firstname.lastname@example.org
HCAT – Healthy Community Assessment Tool