Public health, which celebrates its 150th anniversary in Michigan this year, plays a crucial role in safeguarding the health and wellbeing of state residents. The Michigan Department of Health and Human Services and the state’s county and regional health departments not only provide vaccines to residents, but serve as hubs for multiple other programs such as emergency preparedness, environmental education, sanitation, and family planning. 

To better serve their communities, many health departments and hospitals undertake community health needs assessments (CHNA) by surveying the people they serve. The data gathered shapes their programs. The federal government requires all nonprofit hospitals to conduct a CHNA every three years. When hospitals and health departments work together, these assessments have an even greater impact on the communities served. 

Community health needs assessments are used to create a picture of the health of a community and its residents. Using data collected through surveys, interviews, and observations, the assessments portray the demographic and socioeconomic makeup of the community, the health status of its residents, and their utilization of health care. The surveys can also be used to monitor the effectiveness of the current and new health care programs.

Many health care systems throughout the state use assessments to shape and monitor the health of their communities. In 2021, University of Michigan Health collaborated with two hospitals within Washtenaw County to administer an assessment to meet new IRS requirements under the Patient Protection and Affordable Care Act. The survey data showed that climate change was an issue of increasing concern and action was needed to help mitigate the risks of its impact such as extreme heat. Every three years, Henry Ford Health conducts an assessment to find the most critical health needs of the communities it serves. The assessment of 2022 found more focus was needed on reducing infant mortality, chronic disease prevention and management, and behavioral health prevention and management. One of the resulting strategies was depression screening for everyone seeking psychiatric care.

A 2019 community health needs assessment for Bronson Healthcare inspired funding for a Kalamazoo single-family housing project.
MiThrive engages community to improve health

Emily Llore serves as community health planner at the Health Department of Northwest Michigan and director of MiThrive Community Health Assessment and Improvement for the Northern Michigan Community Health Innovation Region (NMCHIR). Nick Derusha is the director and health officerat Luce-Mackinac -Alger-Schoolcraft District Health Department (LMAS). Debra Lull is chief nursing officer for Mackinac Straits Health System (MSHS). All three have shaped community health assessments in conjunction with area hospitals to strengthen their ties with the community and to collect data for program creation and monitoring. 

Conducted every three years, the MiThrive community health needs assessment brings together residents and cross-sector partners from more than 31 counties in northern lower Michigan. The latest one kicked off in January 2024. In its mission to support Healthy People in Equitable Communities, MiThrive collaborates with seven public health departments that make up the Northern Michigan Public Health Alliance. The team partners with local hospitals along with multiple organizations. Their encompassing goal is community engagement, fostering strong local connections, and improving community health.
Emily Llore.
“Today, all five hospital systems across the region participate in MiThrive as well as many other community-based organizations, coalitions, collaboratives, businesses, academic institutions, elected officials as well as residents,” Llore states. “Many of these partners are required to conduct a community health assessment so partnership makes sense to maximize resources, leverage collective wisdom, and produce high-quality data that is comparable across our rural communities and work to align our shared priorities and strategies.”
 
As an evidence-based community-wide strategic plan, MiThrive uses the innovative MAPP 2.0, Mobilizing for Action through Planning and Partnerships, that includes multiple phases and types of assessments that roll up to form a 360-degree picture of community health using a combination of qualitative and quantitative data. 

“The goal of MAPP is to achieve health equity by identifying urgent health issues in communities and aligning community resources. The framework defines health equity as the assurance of the conditions for best health for all people,” says Llore. 

Challenges with implementation in rural communities exist, the largest being resource limitations including funding and staffing. To overcome these issues, partners have pooled their monetary resources and have shared employees. 

MiThrive has completed four community health needs assessments, talking to 4,305 residents and 1,101 service providers along with community partners. The assessment data has developed shared priorities that include access to health care, chronic disease, housing, economic security, and behavioral health including mental health and substance use. Local organizations and residents can access the information. MiThrive staff assist in making the data meaningful to the community. Residents and local leadership can learn more about the program via email and subscribing to its newsletter.

“Public feedback is immensely important to MiThrive. We believe MiThrive is community owned and inclusive,” Llore says. “Our staff work to empower local organizations and residents to access MiThrive data, assist in localized meaning making, and support their leadership in decision-making within their communities.”

Serving a large and sparsely populated area

At LMAS, Derusha was instrumental in the most recent community health assessment, the UP Wide Community Health Needs Assessment. Most Upper Peninsula hospitals participated. The assessment is a snapshot of the region’s health status, explains priorities for residents’ health improvement, and addresses such issues as access to care, transportation to care in a rural region, and substance abuse. The Western Upper Peninsula Health Department took the lead in 2022 with LMAS providing the support and resources it needed as the assessment covered a large, sparsely populated area.

“I believe collaborations are extremely important in creating a community health needs assessment,” says Derusha.

A 2022 Calhoun County community health needs assessment identified the need for more access to healthcare and inspired a mobile clinic.
Reaching out to the underserved and vulnerable

At MSHS, Lull, who oversees Mackinac Island Medical Center, also recognizes the importance of community health needs assessments. Her organization completed one in 2022 and conducted informational interviews with members of the community served by its overseeing organization, the Mackinac Straits Health System (MSHS). The interviewees included people who represent the medically underserved, vulnerable populations, and public health experts.

Leadership from MSHS and the public health departments implemented the assessment in the communities of Mackinac County and collected both objective and subjective data.
Debbie Lull.
“The committee used questions developed from a variety of nationally accepted health improvement models tailored to uncover the health needs that may exist within the MSHS community,”  Lull says. “Identification and prioritization of community health needs and services then followed. Finally, adoption of goals and implementation tactics to respond to prioritized needs in collaboration with community partners was completed.” 

Results from the assessment revealed a greater need for substance abuse and mental health services as well as a need for people to have better understanding of the health system’s programs and services. The assessment was not without challenges.

“In certain cases, there were limitations to MSHS' ability to assess all of the community's health needs based on a lack of existing health-related data collected at the county level,” Lull says.

However, the assessment use of public feedback was beneficial and connected community partners with a common goal of improving health care within the communities. One improvement that resulted was the implementation of telepsychiatry services for both Mackinac Island Medical Center and Saint Ignace Medical Clinic patients. Another was creating a greater awareness of current services by utilizing social media. A third was the development of the opioid advisory committee chaired by one of the county commissioners to expand substance abuse programs. 
 
Lull stresses the importance of local hospitals working with public health departments.

“The health department participated in the assessment and continues to be a great partner for our health system and our community.”

Leslie Cieplechowicz is a photographer who developed her craft by working the streets of Detroit as a paramedic and shooting old, historical buildings she found on her runs. Her love of creating unique imagery led her across the state, then the United States, then globally, where she currently finished shooting in the country of Cuba, documenting its lively culture, friendly people, and classic automobiles. She currently works as an instructor and her book "Detroit Revealed: A Different View of the Motor City" is on the shelves. 

Kalamazoo housing photo by Al Jones. Photos of Mackinac Straits Health System, Calhoun Wellness Wagon, Debbie Lull, and Emily Llore courtesy subjects. Masthead photo by Olia Danilevich via Pexels.com.

The Yours, Mine, and Ours — Public Health series highlights how our state's  public health agencies keep us healthy, safe, and informed about issues impacting physical and mental health in our communities, homes, workplaces, and schools. The series is made possible with funding from the Michigan Association for Local Public Health.