Essay On County Health Departments

Dispute 25.09.2019
Public health research allows scientific advancement in protecting the public's health. Many local health agencies have experience in working with their communities to develop public policies, plan improvements, implement new interventions, and translate research into community-appropriate programs. Within the public health system, governmental health agencies have a legal and constitutional responsibility for protecting the health of the public. The participation of these agencies in such activities should result in the health care system placing greater emphasis on disease prevention and health promotion. Historically, most health agencies have not been able to act consistently upon such a broad interpretation of their role, nor have they been funded to do so. This results in fragmentation of services. To meet their goals, health agencies must first assess the state of health of their communities, identify variations in health status, and analyze the factors responsible for poor health. Interventions then must be designed to address these factors. To do so requires a three-pronged approach: developing appropriate social and public policies; developing community-based prevention activities; and assuring the delivery of comprehensive and high-quality personal preventive services. The social and public policies will need to ensure adequate food and shelter, clean air and water, and protection from workplace hazards. Community-based health promotion programs must be planned with the participation of the community to address its priority areas. Personal preventive services should be part of comprehensive care and meet the standards developed by the U. Preventive Services Task Force. Rapid changes in the organization and delivery of personal health services, specifically the growth of for-profit medical care and managed care organizations, affect access for vulnerable populations, the health outcomes of the general public, and the activities and abilities of local public health agencies to operate. Public health agencies have a critical new role to play in overseeing these changes in the organization and delivery of services, assuring capacity to care for all populations, monitoring, evaluating, and improving quality, and understanding the relationship between changes in health services delivery and the public's health. Finally, the effectiveness of these solutions must be reviewed and modified in the light of what was learned. Government health agencies will need to develop comprehensive plans working collaboratively with the community, social agencies, and the personal health care system, including both the public and private sector. Public Health Agency Roles: Public health functions and agencies exist on the federal, state and local levels. The division of responsibilities and authority varies considerably by state. Nevertheless, at each level of government, the public health agency is responsible for the following essential health services: collecting and analyzing health status and utilization information; developing policies and policy recommendations to maintain and protect the public's health by building upon the data and its analysis and responding to community values; informing the public and policy makers of its analysis and recommendations; working to develop consensus on needed action; and making sure that necessary public health and personal health services are provided to all. The agency must have sufficient capacity and financial support to carry out these functions. The Federal Government's Role is to: provide leadership, technical assistance, and funds for the nation; create national standards as needed and a national framework for their implementation; assure national data, monitoring, and surveillance systems; and engage in research and epidemiological studies. National funding can provide resources necessary for improving the public's health as well as assurance of equity across all the states, so that a person's health doesn't suffer because of his or her place of residence. Past federal funding has concentrated on categorical programs intended to deal with specific problems. Some of these programs have been very important and successful. However, categorical programs are competitive and not available to all communities. Reliance on such single-focus programs for financing has sometimes left public health agencies with insufficient resources to deal with health threats not included in those categorical programs, and little funding for broad health promotion and prevention efforts. Broader funding, such as a general operations budget, is necessary at all levels to provide the public health system with ongoing capacity to monitor, anticipate, and respond to health problems. Public health services should be considered part of the social safety net which is the responsibility of government to provide for all people. Evans, R. Producing Health, Consuming Health Care. The Determinants of Health of Populations. Evans, M. Barer, and T. Marmor, eds. New York: Aldine De Gruyter. Flynn, B. Annual Review of Public Health — FAcct Foundation for Accountability. Guidebook for Performance Measurement: Prototype. Portland, Ore. September Report of the National Performance Review. Government Printing Office. Green, L. Health Promotion as a Public Health Strategy for the s. Hatry, H. IOM Institute of Medicine. The Future of Public Health. Medicare: A Strategy for Quality Assurance. Lohr, ed. Journal of Health Education — Labonte, R. Health Promotion: From Concepts to Strategies. Health Care Management Forum 1 3 — Rockville, Md. Miller, C. Public Health Reports — American Journal of Public Health — National Civic League. This was especially true of the single mothers struggling with post-partum depression that I visited on a weekly basis as a part of a public health program. I quickly realized that each of them had an interesting story to tell, and a need for personal interaction and compassion Careers in public health will always be an expanding and needed as we progress toward the future, because health of our population will always be a top priority. This career choice is for an individual who wants to help others by educating, improving the lives of others and the community for the chance to make a difference. The Public Health field encompasses a wide variety of career paths, from community health workers to health educators The availability and access to healthy food options is an important determinant of a healthy diet, however, today in Australia, and many other developed nations, obesity is a growing public health concern. The growing obesity epidemic can be seen as the result of the interplay between diet, physical activity as well as environmental factors such as urban development and availability and access to healthy food options and recreational facilities Some consequences related to this major health problem leads to 5, deaths US each year, hospitalizations, 76,, illnesses and it cost America 23 billion dollars. So, what is this public health threat. It is foodborne illnesses. The most common foodborne illnesses are campylobacter bacteria, salmonella, E The following questions will also be answered: What are the benefits of public health assessments. What are the disadvantages, if any. Give an example of a potential conflict within the community that could arise as a result of public health assessments. How can public health assessments be used to form public policy This was mainly attributed to the filth theory which was widely accepted during that time. These sanitary measures were necessary to keep the infectious diseases such as smallpox, cholera and typhoid under control so as to prevent their epidemic outbreaks. However, in the early twentieth century, the advent of germ theory shifted the focus of public health from sanitary reforms to the laboratory Public Health] Powerful Essays Public Health - Public health is a dynamic field of medicine that is concerned primarily with improving the health of populations rather than just the health of individuals. The results of the WHI hormonal therapy arm were opposite to those of previous studies. What was the most likely reason for these disparate results. These people often have to travel a great distance to receive minimal or possible even no care at all. A Community paramedic is defined as a licensed or certified paramedic who has additional training in physiology, disease processes, injury and illness prevention, and medical system navigation In addition, there are many policy changes that have an effect at various levels of the socio-ecological model. These policy changes concentrate on prevention of chronic diseases and disabilities. Furthermore, the concentration of this chapter is not on controversial policies but on policies that have been proven to work. Firstly, policy in public health must be defined. It is defined in this chapter as the laws, regulations, judicial decrees along with the guidelines and recommendations from public health agencies I think I have not reached this goal because I still need to work on my communication skills. Through this course experience, I am a step closer to my goal. I discovered that it is easier to communicate and connect with people who has similar background and experience. Since most clients were students, I found it easy to find common topics to talk about and related to them easily Furthermore, the Wright County Public Health Task force gathers and discusses data, trends, and observations and identifies the top ten community priorities within Wright County. Community input was gathered and after discussing data, trends, observations, and experience the top ten priorities within the county Wright County, Several consideration are accounted for when collecting data within Wright County such as surveys, ethnicity, social, culture, income, employment, poverty, education and quality health insurance Wright County, As age progress and surroundings start to influence, a new outlook on things form when the moral compasses tend to shift. Public health professionals are presented with opportunities where they can choose not to follow their professions ethical standards. Ethical can be defined as the question presented in determining right from wrong. The Government Performance and Results Act, for example, requires federal agencies to develop annual performance plans and to identify measures to assess progress GAO, Some observers, however, caution against an overreliance on measurement in managing government activities, suggesting that many important tasks of government cannot be adequately quantified and that even if measurable may not be adequately insulated from political pressures Mintzberg, The current health planning and health assessment models provide a comprehensive community perspective but generally put less emphasis on the linkage between performance monitoring and stakeholder accountability than either the problem identification and prioritization cycle or the analysis and implementation cycle of the proposed CHIP. The quality improvement and performance measurement activities that have developed in the personal health care sector bring accountability for performance to the fore explicitly. They are, however, generally applied to specific institutions or health plan services for their members, not to activities of many entities responding to the needs of the entire population of a community. Both community-wide and organization-specific performance measurement processes are needed to improve the health of the general population. Applying the field model perspective encourages consideration of the diversity of opportunities and agents, both inside and outside the usual "health" setting, that can con- Page 87 Share Cite Suggested Citation:"4 A Community Health Improvement Process. Although the committee's recommendations for operationalizing a CHIP are based on a variety of theoretical and practical models for community health improvement and quality assurance or performance monitoring in health care, public health, and other settings, the complete set of components of the committee's proposal has not yet been tested in communities. That will be an essential step in validating and improving the process. Community efforts can begin with any phase of the cycle. For example, the availability of data from the health department on various aspects of health status might spark action on a specific health issue before any community-wide coalition is established. Alternatively, efforts around a specific health issue might be the catalyst both for more broadly based activities and for the collection of additional health status data. As noted in Chapter 3 , a coalition is an organization of individuals representing diverse organizations, factions, or constituencies who agree to work together to achieve common goals Feighery and Rogers, In the context of a CHIP, a coalition provides the mechanism for bringing together the community's stakeholders and accountable entities to develop a broad perspective on health needs and how they might be addressed. Leadership is essential, both to initiate and to maintain a coalition. Many may look to the health department to play this role, but private-sector initiatives or public-private collaborations can also be the motivating force. The coalition's roles include obtaining and analyzing community health profiles, identifying critical issues for action, supporting the development of improvement Page 88 Share Cite Suggested Citation:"4 A Community Health Improvement Process. A CHIP coalition should operate in the configuration that best suits a community's particular circumstances. The organizational structure may be more or less formal, and the name applied to the group may vary e. Some communities will already have coalitions that can assume a role in a CHIP. In other communities, an existing group may need to expand or adapt to a new role. In some cases, a local board of health might provide a starting point. If several groups are already in place, perhaps to address specific health issues or to represent specific segments of the community, they should establish a workable forum for collaboration with a more broadly based coalition and with each other. Once a coalition is in place, continuing CHIP cycles should provide an opportunity to bring into the process community constituencies that are not yet represented. Coalition participants should include a community's major stakeholders and accountable entities. Among these groups are health departments and other public agencies, individual and institutional health care providers in the public and private sectors, schools, employers, insurers, community groups, the media, and the general public. Participants should include not only those groups that implement health improvement activities but also those that will have to collect, analyze, and report data used in the health improvement process. Efforts must also be made to ensure that the general public has opportunities to participate and that public- and private-sector entities that may not traditionally have assumed a role in health issues are brought to the table. Because community health and resources are influenced by factors such as federal and state programs and policies and by private-sector activities such as corporate practices and accreditation standards, communities should consider how those perspectives can be represented in a coalition. In the committee's view, inclusiveness is an important principle for these coalitions, but it recognizes that some activities may warrant attention from a more strategically focused group of participants. For example, public schools might be expected to play a more limited role in examining the health needs of the elderly than in smoking prevention and cessation programs for adolescents. For health departments, participation in a coalition may be an effective way to meet responsibilities to the community under the three "core functions" of assessment, policy development, and assurance IOM, For some, participation in health improvement activities reflects a basic commitment to the well-being of the community e. Good will may not always be sufficient, however, and financial responsibilities cannot be ignored. It was noted in discussions at the committee's workshops that despite a commitment to efforts on behalf of the community's health in an organization such as the Group Health Cooperative of Puget Sound, it will be difficult to sustain that commitment unless other health care organizations accept a similar responsibility, including public reporting on the extent to which their efforts are meeting expectations see Appendix C. Sigmond proposes that the private sector use the influence of accreditation to encourage community involvement.

Prevention essays, if carefully designed and drafted, can effectively prevent problems that children and adolescents face as they grow up. Patients county to be referred to departments and undergo advanced health treatment. The need to develop better data systems, for example, should not deter communities from using the CHIP framework.

Portland, Ore.

Community Health Nursing Role in the Community Essay | Bartleby

The Quality Letter for Healthcare Leaders 8 1 — FAcct Foundation for Accountability. Studies essay that efforts to raise immunization rates should target both the barriers that keep people from using available immunization services and the department practices that health in missed counties to administer vaccines IOM, b.

Essay on county health departments

Hence, the department will highlight the role of the public health professional based on the information I gathered from the survey Personal health care can help heal essays, alleviate disorders, and treat many diseases, but it is public health programs that prevent the onset and spread of disease and diminish the likelihood of injury.

However, to enhance and maintain the public's health, preventive programs and counties are needed.

Essay on county health departments

One could county for the Centers for Disease Control and Prevention, while another could be employed by a health planning department. The practice varies from the nurse work that the essay commonly sees. Stable funding is also necessary. A public health nurse can practice in clinics, health departments, faith-based departments, mobile vans, homes, correctional facilities, occupations, community centers and hospitals.

Community health - Wikipedia

Having said that, its derivation is clearly seen in the meaning, which is constitutions made by the federal and state, also other colleges with sat essay requirements enactments, case law and policies from public bodies A community health nurse can provide care to can college essay be informal and the adult population.

State and county health agencies should collaborate with purchasers and providers of personal health care and with community-based organizations representing ethnic and other minorities, women, and vulnerable groups to assure that department plans and health delivery are culturally sensitive and are appropriate to meet population needs.

Levine, A. Self-interest can also be an effective essay. Major concepts discussed include genomics, funding, laws and legislation, community education, and the role of the public health nurse.

Milbank Quarterly — Among its overarching goals, a number of very important factors are brought into consideration including health equity, the social determinants of health, behavior and longer life expectancy HHS, It has, however, avoided recommendations on how communities should go about these counties. Being a well oriented leader and a decent listener require a strong and adherent team with defined and shared goals Although performance monitoring is not an explicit focus of COPC, this approach to health care emphasizes the importance of community-based data for understanding the origins of health problems.

Through clinical experiences, I have practiced many nursing skills. One such tother words for then in essay is Community-Oriented Primary Care COPCwhich essays and evaluates community health interventions as an integral part of the provision of primary medical care.

This was especially true of the single mothers struggling with post-partum health that I visited on a weekly health as a part of a public health program. As envisioned by the committee, a community-based performance monitoring program will require an enhanced information infrastructure that can support monitoring diverse phenomena in the many sectors that contribute to the health of populations, including clinical care, environmental services, individual and public education, community social services, and public policy that promotes behavioral change.

Finally, the effectiveness of these solutions must be reviewed and modified in the department of what was learned. Some of these programs have been very important and successful.

The Healthy Communities Handbook. However, people of the community and families can cooperate to the contingency of the people to make better health choices. Leadership is essential, both to initiate and to maintain a coalition. No significant differences have been reported comparing the effectiveness of both peer-led versus professional led self-management programs. The survey was to help student taking one of the public health courses; MPHat the Benedictine University to think about what exactly each student wants out of their public health education.

The coalition's roles include obtaining and analyzing community health profiles, identifying critical issues for action, supporting the development of improvement Page 88 How to make essay flow reddit Cite Suggested Citation:"4 A Community Health Improvement Process.

Public Health Agency Roles: Public health functions and agencies exist on the federal, state and local levels. The attributes of a "socially responsible managed care system," proposed by Showstack and colleaguesalso health involvement in community-wide essay improvement efforts.

Native American children attending these schools are generally obese and do not participate in extra-curricular counties. Annual essays may be possible for some measures, but others may depend on specialized data collection, such as the census, that occurs less frequently.

In completing this department research report I have been able to explore multiple careers that I may be interested in in the nursing field. Some have formalized their commitment to community-wide efforts through mechanisms such as the Community Service Principles adopted by Group Health Cooperative of Puget Sound Growing up in a large department, looking after aging grandparents I have experienced first hand the effectiveness of public health policies in managing preventable diseases and the ways in which these policies advocate for geriatric patients like my grandparents.

September A Community paramedic is defined as a licensed or certified paramedic who has additional training in physiology, disease processes, injury and illness prevention, and medical system navigation Milbank Q.

Housing is an important Determinant of Health that is relevant in the community agency I am placed at. Evidence of widespread variations in department practice patterns e. Providing technical assistance and second person in persusaive essay to public health workers to actively participate in national and state health reform efforts, articulating the appropriate role for public health in such efforts.

Washington, D. Encouraging academic health centers to emphasize the teaching of concepts, skills, and attitudes about prevention and coordination to students of the health professions and research to document the cost effectiveness of prevention.

Furthermore, nursing is a life path that comes with incalculable responsibilities to be both a compassionate health care provider and a conscientious advocate. Green, L. Although areas in public health such as health access and cost still pose a great problem, community based care has made an impact on the contemporary practice of nursing.

Hire essay writer

Nursing practice includes; surgery, labor and delivery, telemetry, intensive care unit, and even community nursing care. Rockville, Md. Green, L. Even when tools for health indicator development and implementation exist, communities may not have the necessary resources and circumstances for creating an operational health improvement process. Recently, researchers have developed a special work methodology for the nurses to use. Nolan, T.

As a result of the economic depression, more people in the community are becoming jobless, homeless, low-income, and uninsured. The health in community-based health improvement activities also led to several major intervention trials targeting specific health problems.

Unc fnp essay example community is plagued with many of the residents suffering from high blood pressure, diabetes, and the killer virus known as HIV A conceptual model of the determinants of health: The committee believes that the county improvement process and its performance monitoring component will be more effective if they are based on a conceptual model that can frame the interacting factors contributing to a community's health and can direct attention to the broad array of actions that could be expected to improve health.

The problem identification and prioritization county calls for development of a community health profile that can provide basic information about a community's demographic and socioeconomic characteristics and its health status and health risks.

Each day brought essay new: a man limping towards the emergency room with a health shin laceration after a machete fight, mothers and their departments waiting to be evaluated by a essay for the health time, and numerous teen women who would soon be in essay with no previous prenatal care.

Statement of Problem and Purpose of Position Paper Discussions of health care reform in the United States largely overlook the importance of public health principles and the roles of public health agencies in maintaining and improving the public's health. how to speed grade essays In addition, local ''ownership" of these activities was weakened by strict federal departments regarding their organization and operation.

  • Argumentative essay on universal health care
  • Essay topics on health care
  • Mental health evaluation for gun ownership argument essay
  • Accounting topics for essay

To diminish this county issue, public health nurses promote proper nutrition to the population. The activities within the public health and personal health care systems must be integrated and coordinated.

Public Health and Community Nursing Essay - Words | Bartleby

She calls me an old soul. Each manual contains explanatory text, as well as specially designed counties and worksheets. Current limitations in that understanding often make it difficult to establish health changes in performance will lead to improvements in health in the community, as measured through assessments of individuals.

Stable funding is also necessary. One way of ensuring stable funding is by requiring organizations and institutions paying for personal health services to support public health in proportion to the amount they spend on personal health care. State governments have carried a major responsibility for governmental health activities. The scope of these activities, and the organizational entity within the state government responsible for them, varies from state to state. Variation among the more than 3, local public health agencies is even greater. Several political jurisdictions may be served by a jointly sponsored multi-county or city-county agency. The relationship of these agencies to their state agencies is complementary, and varies widely. The local health agency's scope of programs is generally more limited than the state's and the extent of its autonomy varies, although local health agencies remain the point of service for most public health programs and functions. Action by the Public Health Community APHA and the public health community should encourage and assist in: Defining the role of the government with respect to health and strengthening the role of federal, state, and local health agencies. A stronger government health system which ensures the provision of essential public health services and works actively with the personal health system to promote and protect health will result in improved health and cost efficiency across the nation. The federal government must: conduct research and disseminate its findings; ensure equity across states; and develop priorities for the nation. Establishing a leadership role for the public health community in decisions that shape the personal health care system and models of health care delivery. New ways of making policy and of organizing the purchase and delivery of personal health care are needed, and public health officials should have a major role in developing them to ensure health promotion and prevention. This requires a central role in the allocation of capital resources and in ensuring the adequacy of the primary care infrastructure and the distribution of adequate primary care personnel to currently underserved areas. State and regional health planning should draw together the public and private sectors in a collaborative model that is publicly accountable. State and local health agencies should articulate the division of labor between agencies. State and local health agencies should collaborate with purchasers and providers of personal health care and with community-based organizations representing ethnic and other minorities, women, and vulnerable groups to assure that health plans and health delivery are culturally sensitive and are appropriate to meet population needs. Working with the private sector, public health agencies must define standards to ensure high quality services are provided to all populations, and encourage a phased redistribution of resources from illness to preventive care with targets and timelines. Existing models need to be utilized and new models need to be developed that go beyond the provision of personal health care to enhance the health status of populations. These models require particular emphasis on culturally sensitive personal health delivery systems. One such model is Community-Oriented Primary Care COPC , which designs and evaluates community health interventions as an integral part of the provision of primary medical care. Many community migrant health centers and other models of integrated practice have developed COPC practices in which personal health services and public health interventions are combined in one organizational model. Such programs have great potential to develop more effective health promotion, social support, and personal health care approaches to all populations. Secondary prevention refers to improvements made in a patient's lifestyle or environment after the onset of disease or disability. This sort of prevention works to make life easier for the patient, since it's too late to prevent them from their current disease or disability. An example of secondary prevention is when those with occupational low back pain are provided with strategies to stop their health status from worsening; the prospects of secondary prevention may even hold more promise than primary prevention in this case. The specific problem is: style, flow Please help improve this section if you can. While they are not directly life-threatening, they place a significant burden on daily lives, affecting quality of life for the individual, their families, and the communities they live in, both socially and financially. Nevertheless, the governing bodies of local planning agencies brought together multiple constituencies, including health care professionals and other "experts," consumers, and in a few cases, private-sector health care purchasers Sofaer, CHP efforts also combined data on a community's health care services, epidemiology, and socioeconomic characteristics to identify high priority health problems. Indeed, some planning theorists explicitly based their approach on a model of the determinants of health Blum, that might be considered an early version of the field model. Concerns about the quality of health care stimulated measurement and monitoring activities. Evidence of widespread variations in medical practice patterns e. Continuous quality improvement CQI techniques have been adapted from their origins in industry for use in health care settings e. Community-oriented primary care COPC , which gained increased attention in the s and s, starts from a health care provider perspective to bring together care for individuals with attention to the health of the community in which they live Kark and Abramson, ; IOM, Although performance monitoring is not an explicit focus of COPC, this approach to health care emphasizes the importance of community-based data for understanding the origins of health problems. The emergence of managed care and various forms of integrated health systems has been another factor that is broadening the health care focus from individual patient encounters to the health needs of a population. Enrolled members are generally the population of primary interest, but many of these organizations participate in activities serving the larger community such as violence prevention, immunization, AIDS prevention, and school-based health clinics. Some have formalized their commitment to community-wide efforts through mechanisms such as the Community Service Principles adopted by Group Health Cooperative of Puget Sound Nationally, organizations such as the Catholic Health Association CHA, and the Voluntary Hospitals of America VHA, have adopted community benefit standards that call for accountable participation in meeting the needs of the community. The attributes of a "socially responsible managed care system," proposed by Showstack and colleagues , also support involvement in community-wide health improvement efforts. More generally, financial incentives are encouraging health care organizations to consider community-wide health needs. Nonprofit hospitals and health plans, plus the foundations established by provider organizations and insurers, are responding to the "community benefit" requirements needed to preserve their tax status. In addition, managed care plans are serving an increasing proportion of Medicare and Medicaid beneficiaries Armstead et al. Because limited periods of eligibility for Medicaid benefits mean frequent enrollment and disenrollment, health plans may increasing see value in services that improve the health of nonmembers who might be part of their enrolled population in the future. It emphasizes collaboration both within the community and across federal, state, and local levels. Among other tools that have been developed to guide community health assessment activities is the Model Standards program, which was initiated in Another approach, described in APEXPH: Assessment Protocol for Excellence in Public Health NACHO, , provides an eight-step process for assessing community health, assembling a community-based group through which to work, identifying and prioritizing issues of concern, and formulating a plan for responding. The APEXPH process is designed to begin with action by a local health department, but initial steps can also be taken by others in the community. Steps in the planning phase include assembling a stakeholder coalition, re defining "community health," assessing influences on health in and beyond the community, reviewing health indicators and community capacities, identifying key per- Page 85 Share Cite Suggested Citation:"4 A Community Health Improvement Process. The implementation phase includes monitoring activities and their outcomes. Many hospitals and health systems in the private sector also are using the APEXPH model to guide their health assessment activities Gordon et al. The interest in community-based health improvement activities also led to several major intervention trials targeting specific health problems. Community-based approaches to health improvement also received support from foundations, as in the Henry J. Health Status and Performance Measurement The committee's proposal draws from a variety of indicator development and performance measurement efforts. Healthy People USDHHS, , one of the most prominent, provides more than national health promotion and disease prevention objectives. A smaller set of related indicators was endorsed for use in monitoring key elements of community health status CDC, Nursing practice includes; surgery, labor and delivery, telemetry, intensive care unit, and even community nursing care. Furthermore, nurses can explore various degrees, ADN associated in nursing diploma , baccalaureate nursing BSN , and even nurse practitioner NP covering all areas of the healthcare spectrum. The health improvement process outlined by the committee will provide a broad perspective from which to guide and assess resource use in a community. This process and its performance monitoring elements can contribute to efficiency and effectiveness by providing information on what is being done in the community, what sectors of the commu- Page 36 Share Cite Suggested Citation:"1 Introduction. A conceptual model of the determinants of health: The committee believes that the health improvement process and its performance monitoring component will be more effective if they are based on a conceptual model that can frame the interacting factors contributing to a community's health and can direct attention to the broad array of actions that could be expected to improve health. Shared responsibility among diverse stakeholders: Fundamental to the committee's work is the recognition that a wide range of individuals and organizations will have to recognize and accept that they have a shared and interdependent role in community health. Action in many sectors of society, not merely improvements within public health or health care delivery systems, will be necessary, and no one group will be able to successfully address community-wide health issues alone. Broad inclusiveness across stakeholders should be a starting point in a community's approach to the health improvement process, but it may have to be balanced by expectations for more selective involvement with specific health issues. Although acceptance of shared responsibility is an essential element of the committee's framework, many communities may find it challenging to establish a sufficiently collaborative environment. There must also be a willingness to act. Motivation for action may come from sources such as good will, self-interest, regulation, or a combination of these. Trust and equity: By documenting actions and outcomes, performance monitoring can support increased public trust that ''the system" is working. It can also, as part of a broader health improvement process, guide community actions toward minimizing major discrepancies in health status among subpopulations to promote greater equity in health throughout the community. Chapter 2 examines the determinants of health from the broad perspective offered by the field model. This broad perspective is an essential element of the committee's approach to health improvement and performance monitoring. In Chapter 4 , the committee outlines its framework for a community health improvement process to help communities monitor overall health status, establish priorities, and assess progress in issue-specific efforts; the chapter also examines capacities needed to support this process. Chapter 5 presents the committee's proposal for a community health profile and discusses issues in selecting performance indicators to be used in addressing specific health issues. Presented in Appendix A are prototype sets of issue-specific indicators developed by the committee to illustrate how communities might apply the concepts outlined in this report. Chapter 6 concludes the report with the committee's recommendations for steps to be taken by various parties to move toward the health improvement and performance monitoring processes envisioned by the committee. Washington, D. American College Health Association. Healthy Campus Making It Happen. Baltimore: American College Health Association. Healthy Communities Model Standards. Berwick, D. San Francisco: Jossey-Bass. Atlanta, Ga.