SOCIAL ASSESSMENT IN HEALTH PROMOTION PLANNING

Within the context of health promotion, social assessment refers to a process in which objective and subjective information are used to identify high-priority problems, or assets, that affect the common good. Ideally, this process will use a variety of social, economic, and quality-of-life indicators, including the perceptions and concerns of representatives from the area or community being assessed.

There are strong connections between major health problems (e.g., violence, chronic disease, teen pregnancy) and their social determinants (e.g., cultural differences, variability in levels of income, social support, housing, and education). While these factors tend to cluster within neighborhoods or communities, they vary considerably between communities. Any social assessment should be designed to take these realities into account. Armed with the information generated from a social assessment, planners will be in a better position to tailor interventions to meet the unique needs of a given community.

MULTIPLE INDICATORS

There are different ways of knowing, and different interpretations of reality. An epidemiologist, an anthropologist, a health educator, and a layperson are all likely to view a given problem through different lenses. More importantly, each is quite likely to detect a glimpse of reality that the others may miss. The social assessment process will be productive to the extent that: (1) it serves as a first step in a planning process, (2) it reflects a spirit of inclusion, (3) time is dedicated to allow all stakeholders to discuss and interpret information gained in the process, and (4) those discussions are carried out in an atmosphere of mutual respect and trust.

The literature describing methods and instruments to assess quality-of-life and social indicators is extensive and growing. Included among the objective and subjective indicators that may be used as a part of social assessment include perceptions of quality of life; sense of community; perceived functional capacity; employment rates; differences in levels of income; access to transportation and transportation services; alcohol-related auto crashes; housing density; crime; trust or distrust in government; air and water quality; access to health, mental health, and social services; and education.

A wide range of methods have been used to collect data for social assessments. These include, but are not limited to, interviewing those who have a stake in the outcomes of a relevant program or project, community town meetings, focus groups, community polls and surveys, archival research, reviews of income, housing status, access to health services and other relevant social indicators, and synthetic estimates from national data interpolated to the local level. As a means to save limited resources, some planners retrieve existing information whenever possible, rather than generate new data. Federal, state, and local offices of housing and urban planning keep reasonably up-to-date summary records. Most of these data are in the public domain and are easily accessible, though a meaningful social assessment will inevitably require the allocation of resources to gather new information perceived as relevant to the population being studied.

ASSETS

As implied in the definition, a social assessment in health promotion should involve an accounting of community and individual assets as well as identification of problems or concerns. John McKnight and John Kretzmann describe a process of community asset mapping, wherein relevant skills and capacities of individuals, as well as other assets that may exist in a given community, are documented. These assets are classified into three tiers of primary, secondary, and potential building blocks. Primary building blocks are those that exist and are controlled within a given community (e.g., a local health agency, or a local teacher); they are also the assets that are most accessible. Secondary building blocks are those that exist within a community but are controlled from outside the community (e.g., a health clinic which is a satellite of a regional or corporate medical system). Potential building blocks are those located and controlled outside of the community (e.g., federal grant programs or national campaigns). An analysis of this kind will help planners keep a realistic perspective on the comparative difficulty of accessing the assets they have identified.

Another example of using positive indicators is found in Peter Benson's work on the developmental assets that influence children and adolescents. Benson describes forty developmental assets, which are classified equally into two categories:(1) internal assets related to the personal qualities of children (e.g., self esteem, achievement motivation) and (2) external assets (e.g., family and adult support, safety, programs and services). Analysis of developmental assets reveals a consistent pattern where, among youth, developmental assets are inversely related to high-risk health behaviors— the more developmental assets children have, the less likely they are to engage in behavior that puts them at health risk. High levels of developmental assets are associated with success in school and valuing diversity.

RESPECT

Lawrence Green and others have made the point that health is an instrumental value, that is, a value that facilitates the striving for, or attainment of, higher order, or ultimate values. For example, a company may value a commitment to physical fitness and nutrition to the extent that it influences employee performance and satisfaction. The implication is that health has value to the extent that it either supports or enables higher order values, which may include social benefits, overall quality of life, the capacity to function, or even an organization's bottom line. This point is relevant to social assessment because information gleaned from the process can be used to illustrate how the effective application of health-promotion programs contributes to the improvement of social benefits beyond improvements in health.

In a study designed to improve the immunization rates among children 0 to 2 years of age and born to low-income mothers in an urban setting, researchers found that marked increases in immunization coverage were attributable to tailored messages created from assessments that took into account the family characteristics, social and environmental conditions, and selected cultural factors unique to the participants. Irrespective of the methods, indicators, or instruments used in the social assessment process, a commitment to engaging the people of a community in identifying and assessing their own perceived problems and aspirations is essential. Not only does such a commitment assure that a critical view of reality will not be left out of the health-promotion program planning process, it signals a tangible sign of respect toward the members of a community.

Marshall Kreuter

Brick Lancaster

(see also: Assessment of Health Status; Community Health; Community Organization; Health Promotion and Education; Healthy Communities; Mobilizing for Action through Planning; Sociology in Public Health )

Bibliography

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