“Applicants Will Propose Criteria to Select 4-8 Communities in Which to Focus Prevention Efforts”: State Approaches to Prioritizing Communities for Public Health Action

BACKGROUND: Public health funders are increasingly asking states to select specific communities or geographic areas in which to focus prevention activities.  Choosing these communities requires a simultaneous evaluation of at times competing criteria, such as disease burden and population size.  Determining the “best” methodology for prioritizing communities for these interventions can be difficult. This session will present community prioritization methods from three states (Idaho, South Carolina, and Utah), describing each state’s approach, including problems encountered, solutions, and reception of the prioritization process by programs/administration.        

METHODS: While all followed a similar process of selecting indicators and developing a weighting and scoring system for the indicators, each state’s model varied. In this presentation, each state will describe the rationale supporting its weighting and scoring system, with a goal towards identifying key considerations in applying weights and scores. Idaho recently developed a new prioritization process in response to a grant application. The methodology emphasizes a participatory process which can be implemented quickly. The model is also capable of incorporating qualitative measures such as a community’s perceived ‘capacity’ to implement public health activities. In Utah, all local health departments (LHDs) were invited to demonstrate their interest in and capacity for implementing strategies under a chronic disease prevention grant. To assess burden among the local health districts, Utah selected over 25 chronic disease and demographic indicators and weighted and scored them. The LHD evidence demonstrating interest and capacity was combined with the burden data to make selection decisions. South Carolina used a composite index of 36 indicators to prioritize its efforts in lowering the burden of chronic conditions and their common risk factors by geography. Indicators included mortality and morbidity rates of heart disease, stroke, diabetes and their common risk factors over the most recent available three years period by race. The age-adjusted rates were used to compose an overall county level burden index for prioritization.  

RESULTS: Each presenting state was able to implement a prioritization process.  Speakers discuss varying levels of satisfaction with their respective methodologies and acceptance (by the various parties involved) to incorporate each methodology as a standard decision-making practice.   

CONCLUSIONS: There is no single “best” approach to prioritization for states and communities to follow.  Examples from the three presenting states, however, identify features common to a prioritization approach being readily accepted and utilized by public health.  These common features include a process that is: flexible, yet standardized; objective; and transparent.