Evolving Priorities in Community Health

Hospitals play a vital role in serving their communities' health needs, but the role constantly evolves as community health needs change.

To help healthcare providers stay attuned to those evolving needs, the federal government requires non-profit hospitals to conduct community health needs assessments (CHNAs) every three years. The mandate took effect as part of the Patient Protection and Affordable Care Act (ACA), enacted into law in 2010. 

Syntellis (formerly Stratasan) has worked with non-profit hospitals since the start to develop nearly 100 CHNAs — helping organizations assess their communities’ needs and develop effective strategies to address them. In that time, we have developed unique insights and expertise on CHNAs.

This is the first of two blog posts highlighting some of those insights, including how community health priorities have changed over time and best practices learned in 11 years of developing CHNAs. This blog post focuses on shifting health priorities, including changes in the way healthcare leaders talk about and approach different community health challenges. 

Refining community health priorities 

For each CHNA, hospital leaders collaborate with community members to identify their communities' top health priorities. Narrowing down a wide range of priorities across diverse communities can be challenging, but organizations have become more adept over the past several years. 

In the early years of non-profit hospital CHNAs, leaders were ambitious in seeking to conquer a higher number of health issues within their communities. Over the past several years, hospital leaders have learned to better refine their lists and consolidate related priorities, such as obesity, healthy eating, and active living.

Our analysis shows that the average number of health priorities identified in CHNAs increased from about eight to 10 from 2012 to 2014, then decreased to about five or six beginning in 2016. 

Changes in how we talk about health issues 

Since the ACA was enacted, healthcare leaders have become increasingly aware of how their words can impact how people feel, and help or hinder community health improvement efforts. Two examples of this include: 

Substance misuse. Many communities nationwide struggle with misuse of legal and illegal substances. Throughout the time our team has worked on CHNAs, this has remained the most-mentioned health issue in hospital CHNAs, but the way people talk and think about addiction has evolved.  

A decade ago, CHNAs often identified “drug abuse” as a primary health priority to be tackled. Now, the terms “substance misuse” or “substance use disorder” are more commonly used to better frame the issue as the result of a medical disease, and not simply individuals making poor health choices. 

Healthcare access. While ensuring access to care has long been a priority for communities nationwide, how organizations think about access has changed significantly. For hospitals, improving access to care no longer means just “adding more providers.” Similarly, the affordability of healthcare services and health insurance was once a category unto itself. Today, healthcare leaders recognize that these factors are intrinsically linked, and that improving access to care requires offering services and health insurance coverage people can afford. 

Changes in how we think about personal responsibility 

Another evolution we have witnessed in 11 years of CHNAs centers on personal responsibility. While personal responsibility will always be important in health improvement, hospitals and communities are increasingly focused on building systems and processes that help people elevate their health. 

Rather than being frustrated waiting for people to change their behaviors on their own, communities have shifted to creating a vision of health for the future. For individuals, a common approach is to guide people at first, focusing on things they can do today to improve their health, one step at a time. 

One example of this change in perspective was reflected in our analysis by a 31% decrease in the use of the term “obesity” as a health priority in 2017-2022 versus 2012-2016. Meanwhile, there was a corresponding 38% increase in focus on initiatives promoting good nutrition/healthy eating, exercise, active living, and healthy weight over the same period. 

The rise of new priorities 

In some cases, long-standing health issues have risen in terms of focus and priority for communities. Priorities involving child health and wellness increased 691.5% between the years 2012-2016 versus 2017-2022. Two other notable examples include: 

Mental health. While mental health issues have always existed, they have risen significantly as a major health priority for communities over the past decade. From the early years of 2012 to 2016, compared to 2017 to 2022, occurrences of mental and behavioral health access as a health priority in CHNAs increased by more than 58%. 

The increase coincided with the COVID-19 pandemic, which had widespread impacts on mental health as individuals worked to adapt to the stresses of living during that time, including getting sick, concerns of losing loved ones to the virus, and sudden, complete lifestyle changes like the switch to distance learning and remote work.  

Social determinants of health (SDOH). Communities also have increased their focus on SDOHs over the past decade. SDOH are defined as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” 

Regarding CHNAs, the first mention of SDOH didn’t come until after 2016. Related factors such as homelessness and housing (277% increase) and food insecurity (239% increase) also rose in priority lists over the study period.  

Conclusion 

In 11 years of conducting CHNAs, we have witnessed our nation's hospitals' hard work and dedication as they continuously evolve to meet the dynamic health needs of their communities.  

Below is an analysis of all priorities over the 11 years expressed as a percentage of total health needs from the study periods of 2012-2016 and 2017-2022. The list is ranked based on the 2017-2022 percent of total of all priorities. Items in bold are discussed in this blog post as being a noteworthy shift. 

Read our next blog to learn CHNA best practices garnered from our many years of experience helping healthcare leaders develop these assessments. 

Contact Lee Ann Lambdin (llambdin@syntellis.com) for more information about the Syntellis CHNA process.