Community health assessment - Minnesota Dept. of Health

Community health assessment

A community health assessment identifies and describes factors that affect the health of a community, and the factors that determine available resources to address those factors. A community health board, or another lead organization, collects, analyzes, and begins to use data to prioritize issues and make decisions.

Community health boards do not need to submit the community health assessment to MDH; it is not a deliverable for this assessment and planning cycle. To view priorities from the past community health assessment cycle, visit: 2010-2014 Assessment and Planning Cycle.

MDH assistance
1. Organize
2. Plan assessment in partnership
3. Hold facilitated planning session
4. Develop action plan
5. Monitor and revise with partners

Related national public health accreditation standards
Further resources



A community health assessment is foundational to improving and promoting the health of a community. During the assessment, the community health board (or another lead organization) identifies and describes the health of the community served, the factors that contribute to health challenges, and existing community assets and resources they can mobilize to improve the community’s health. The assessment helps ensure that local resources are directed toward where they can make the greatest and most timely impact.

All community health boards are encouraged to develop a community health assessment that meets national public health standards.

Minnesota community health boards have been required to engage in a community health improvement process—beginning with a community health assessment—since the Local Public Health Act was passed in 1976. In Minnesota, community health boards perform community health assessments for the jurisdictions they serve.

The 2015-2019 community health assessment is similar to previous years’ assessments, but emphasizes the role of community partners even more, especially as those partners access data, share their perspectives during analysis, help present data and findings, and commit to using data.

Upon completing the community health assessment, community health boards must identify up to 10 priority health issues.


MDH assistance

MDH has designed all assessment and planning guidance to help community health boards meet national public health standards developed by the Public Health Accreditation Board (PHAB).

Staff from the MDH Center for Public Health Practice and MDH Center for Health Statistics can help with parts of the community health assessment, including data collection, data analysis, and community engagement. MDH has designed guidance and technical assistance to help community health boards meet national public health standards. To contact MDH, visit: Help and Technical Assistance.


1. Organize

1a. Review previous process with key stakeholders

Assessment and planning is cyclical, and future work builds on past work, and the community health assessment is a great time to re-assess the foundation of your planning process. Because community health boards performed a community health assessment for the 2010-2014 Assessment and Planning cycle, they can build on their past successes and lessons learned when beginning their next community health assessment—including how effective the planning process and partnerships were during the last assessment.

Kick off this Assessment and Planning cycle by debriefing with key stakeholders about the previous cycle. You might use a focused conversation format for this discussion, to learn what went well and what to improve.

1b. Recruit or refresh a partnership team

A community-level partnership guides the community health assessment process. Before beginning the assessment, consider the makeup and structure of the existing teams that work on community health assessment and planning. Members should include participants with a broad range of perspectives; who represent a variety of groups, sectors, and activities in the community; and who have the enthusiasm and resources necessary for the process.

Your community health board can use tactics like community meetings and focus groups to ensure broad participation and that the community drives the assessment process. The community health board may lead the assessment, or may produce a joint assessment co-led with other key stakeholders. In some situations, other key stakeholders may lead the assessment process and development, with the community health board's input and support.

This team focuses on moving the planning process forward, and likely includes individuals providing staff support to the community health assessment process. If your planning team has a team charge, this is a good time to review and revise it with your team. Your planning group might include:

  • CHS administrator/director
  • CHS department directors
  • CHS supervisors
  • Key public health staff
  • Hospital or primary care partners
  • Community-based organizations
  • Schools
  • Other county agencies (e.g., social services, public safety, etc.)
  • Community members
  • Businesses
  • Foundations
  • Distinct populations (e.g., specific racial/ethnic groups or age groups, persons with disabilities, etc.)

Some community health boards use a single internal team and a single external stakeholder team to guide the assessment; others use multiple external groups to guide and enact different parts of the process. Think about how your teams work together or complement each other. If public health does not lead the assessment process, you may see the opportunity to highlight the role of public health in assessment.

This conversation will continue in Step 2, and you can revisit it at any time. Consider:

  • Who is missing from our planning table?
  • Who will lead the group?
  • Do members feel burnt out?
  • Does our partnership team include members of the community we are trying to impact?
  • How does our partnership team relate to other groups working on other parts of the community health assessment and planning process?
  • How does our group coordinate/work with other community collaboratives?

Download ► Stakeholder identification tool (DOC)

Resources: Recruit or refresh a partnership team

The following resources are specific to Minnesota:

The following national resources are also helpful:

1c. Choose, adapt, or design an assessment and planning model

Your partnership team (or community health board, depending on your partnership structure) should select, adapt, or design an assessment and planning model. As you think about which to use, you may want to consider how each model meets your key stakeholders’ needs; for example, if you are partnering with a nonprofit hospital on its community health needs assessment (CHNA), you’ll want to find a model that meets both of your needs.

The national public health accreditation standards notes two models in particular:

Resources: Choose, adapt, or design an assessment and planning model

1d. Set meetings

A meeting schedule should respect partners’ time commitments. You may need to hold some meetings in the evening or on weekends if community members are involved.

1e. Develop communications

Good communication is essential to keep your assessment and planning process on track and your planning team and partnership engaged. Use a communications plan to help determine the needs of all those involved. Consider:

  • Who needs to know about your plan and planning process?
  • What information do they need?
  • How can you best communicate with them?
  • How often do you need to communicate with them?

Download ►Communications plan (DOC)

Delegate a party responsible for maintaining the communications plan, and how often they should report back to the team.


2. Plan assessment in partnership

2a. Find consensus: Leadership, decision-making process, vision

Leadership may consist of the same group leading planning efforts, or a separate partnership team. Members must also determine together how they will make decisions throughout the assessment and planning process.

Members should then identify their vision for the community’s health, which serves as a reference point during the assessment and as the partnership moves into the community health planning process.

Resources: Find consensus

2b. Review background documents together

Background documents may include:

  • Definition and purpose of a community health assessment (to establish common ground)
  • Accountability requirements or national public health standards for community health assessments
  • Healthy Minnesota: Statewide health assessment
  • Previous community health assessments
  • IRS requirements for hospitals and partners’ community health needs assessments
  • Primary transportation or comprehensive plans for your region
  • Other assessments or documents recommended by partners

2c. Create work plan and timeline

As you create your work plan, consider:

  • The level of data or information the partnership should review or discuss
  • A schedule of topics for review
  • The process for determining criteria in order to prioritize findings
  • A plan for documentation, communication, and sharing results with the community

Resources: Create work plan and timeline


3. Hold facilitated planning session

3a. Gather, compile data from a variety of sources

Community health assessment sources should be diverse and include qualitative and quantitative data.

The MDH Center for Health Statistics and MDH Center for Public Health Practice developed Minnesota county-level indicators for community health assessment, which lists 114 indicators across public health categories and from various data sources, and links to county and community health board data. The Center for Health Statistics also links you to additional MDH data sources useful for your assessment.

Community health boards might consider how the information collected through their Health Equity Data Assessment (required by the Statewide Health Improvement Partnership in 2016-2018) might align with and become part of their community health assessment.

Other data sources:

  • HEDA: Conducting a health equity data analysis, MDH Center for Health Statistics
  • Regional economic analysis
  • Focus groups or community conversation-type meetings
  • Hospital or health plan data
  • Other organizational assessments, such as Head Start
  • Community opinion or behavioral surveys
  • School district data

Partnership members can also suggest and/or supply community-level data.

Resources: Gather, compile data from a variety of sources

3b. Summarize and analyze data with partners

When examining data with your partners:

  • Identify trends and emerging concerns
  • Look for areas that have improved and areas that have worsened
  • Ask questions: What does this data mean? What does this trend imply? What are the health implications?
  • Consult with partners and staff to understand the data and add meaning and context

3c. Continue collecting and analyzing data as needed

You may gather data over several rounds, as questions arise and you need additional information.

3d. Identify priority issues with partners

Look for issues of particular concern that emerge as you gather and analyze data. Work with the partnership to clearly define and describe these critical issues. Use the decision-making process (from Step 2) to prioritize key community health issues.

Priority health issues

After completing the community health assessment, the community health improvement planning team prioritizes up to 10 health issues it (and other community partners) can address during the planning process.

Resources for 3b, 3c, 3d


4. Develop action plan

4a. Prepare print and/or online documentation of findings

Your written documents support the community health improvement plan process.

4b. Share findings with community

Share key findings with decision-makers and with the public by disseminating the report, infographics, or fact sheets. Give community presentations on the findings, or hold feedback sessions.


5. Monitor and revise with partners

The Public Health Accreditation Board recommends a partnership make a continuous effort to better understand a population’s health, by monitoring a community health assessment, refreshing it, adding data to it, and further analyzing the data found in it.


Related national public health accreditation standards

1.1.1(T/L). Tribal/local partnership that develops a comprehensive community health assessment of the population served by the health department.

Related documentation:

  • Participation of representatives from a variety of sectors of the tribal or local community
  • Regular meetings or communications with partners
  • The process used to identify health issues and assets

1.1.2(T/L). A tribal/local community health assessment.

Related documentation:

  • A tribal or local community health assessment that includes:
    • Data and information from various sources contributed to the community health assessment and how the data were obtained
    • Demographics of the population
    • Description of health issues and specific descriptions of population groups with particular health issues and inequities
    • Description of factors that contribute to specific populations’ health challenges
    • Description of existing tribal or community or assets or resources to address health issues
  • Opportunity for the tribal or local community at large to review and contribute to the assessment
  • The ongoing monitoring, refreshing, and adding of data and data analysis

1.1.3. Accessibility of community health assessment to agencies, organizations, and the general public.

Related documentation:

  • Information provided to partner organizations concerning the availability of the community health assessment
  • The availability of the community health assessment findings to the public


Further resources