Item B: Lane County Community Health Assessment Plan

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Socioeconomic Factors: The community health assessment and community health improvement team was encouraged by the level of community interest expressed in efforts that focus on the "social determinants of health ". Work in this area would fall into the bottom and most impactful level of the pyramid above — Socioeconomic Factors. Work in this area — e.g. poverty reduction, ensuring access to affordable housing, increasing formal educational attainment at the community level — has generally been outside the purview of public health interventions. The community health assessment and community health improvement plan leadership team looks forward to supporting and coordinating community efforts to engage in work in this area. Our top priority - advancing and improving health equity - an element in this work plan still at a very early stage of development, will be a place to focus work in this area. Work in each of the four.other priority areas will also be prioritized to focus community energy on efforts with the greatest potential to improve health equity. Changing the Context to Make Individuals' Default Decisions Healthy: The majority of the strategies in this plan focus on efforts to encourage public and organizational policy adoption and implementation here in Lane County. As depicted in the visual above developed by Dr. Thomas Frieden, MD, MPH, the Director of the U.S. Centers for Disease Control and Prevention (CDC), it is at the lower levels of the pyramid where we can expect the greatest impact for the effort exerted. This is true both in terms of the resources necessary to lead the intervention and on the impacted community members. According to CDC Director Dr. Thomas Frieden: "Public action and interventions represented by the base of the pyramid require less individual effort and have the greatest population impact .... . ... Interventions at the top tiers are designed to help individuals rather than entire populations, but they could theoretically have a large population impact if universally and effectively applied. In practice, however, even the best programs at the pyramid's higher levels achieve limited public health impact, largely because of their dependence on long -term individual behavior change "(A Framework for Public Health Action: The Health Impact Pyramid, American Journal of Public Health, April 2010, Vol 100, No 4, pages 590 -595). [A complete PDF of this article is available online free of charge. Because public health is inherently political, unless we build community understanding and support for work at the lower levels of the pyramid, we cannot expect to gain the level of support necessary to encourage the policy changes needed to get ahead of health problems of this