Assessing community well-being in your next CHNA

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We've helped large and small health systems and community organizations better understand the causes, conditions and solutions to population health issues.

Is your community thriving? That is a complicated question, seemingly without any easy answers. However, it is also one of the most important questions faced by community leaders, health systems and local governments. As the amount of data available to decisions makers has increased, it seems that the facets of this challenge become ever greater.

Luckily, there are a number of efforts underway to help answer this question, primarily through the frame of 'well-being'.  What is well-being, you might ask? Generally, well-being is the overall state of a person or community. If a person has high well-being, then they will be resilient, happy and healthy. If well-being is low, then they will face many challenges, including poor health, economic insecurity and inequality.

National Committee on Vital and Health Statistics

NCVHS is a federally established advisory committee, created to inform HHS about data and information policy.  Recently, NCVHS has tackled the question of well-being by convening a subcommittee to focus specifically on development of a new quantifiable framework for measuring health and well-being in populations.

Through their report 'NCVHS Measurement Framework forCommunity Health and Well-Being', NCVHS recommended a broad-based framework of domains and indicators that compose a holistic view of well-being, including:

  • Community Vitality
  • Economy
  • Environment
  • Education
  • Food and Agriculture
  • Health
  • Housing
  • Public Safety
  • Transportation

Though not as specific as some of the following frameworks, NCVHS provided a rigorous, stakeholder led process to identifying and categorizing evidence-based indicators.

Seven Vital Conditions

The Seven Vital Conditions for Health and Well-being (VCs) is a framework and measurement approach developed by Bobby Milstein and ReThink Health.  Like the NCVHS framework above, the Vital Conditions is a broad-based framework designed to capture both assets and deficits faced by communities.  One general difference is that the VCs don't have an explicit individual health component, instead looking at the social determinants of health rather than specific disease or other health outcomes.

The seven vital conditions are:

  • Basic needs for health and safety
  • Lifelong Learning
  • Meaningful Work & Wealth
  • Humane Housing
  • Healthy Environment
  • Belonging and Civic Muscle

You can read our case study of applying the Seven Vital Conditions in New York as part of New York City Health + Hospitals latest CHNA.

Well-being in the Nation (WIN) Measures

Most recently, the Well-being in the Nation (WIN) Measures were launched by 100 Million Healthier Lives supported by the Robert Wood Johnson Foundation.  The WIN Measures build on the work of NCVHS to add more context around community vitality.  Specifically, the WIN Measures include an explicit domain for 'Well-being of People' designed to be informed by direct survey responses or something like the Well-being Adjusted Life Year (WALY).  

The WIN Measure categories are:

  • Community vitality
  • Economy
  • Education
  • Environment & infrastructure
  • Equity
  • Food & agriculture
  • Health
  • Housing
  • Public Safety
  • Transportation
  • Well-being of people
  • Demographics

Which is right for me?

If you are interested in measuring well-being as a part of your next CHNA, each of these frameworks can provide a strong foundation upon which to build, and they each have their strengths.

When you need a validated, relatively simply view of your community, NCVHS is evidence based and pragmatic. Most organizations already collect data used in the framework, so it can be easy to apply to existing assessments.

If you want a more broad-based, community focused perspective, The Seven Vital Conditions is rigorous and informative. The downside is that for health-systems in particular, it doesn't include individual measures of health outcomes.

The WIN Measures are the newest effort to quantify well-being. The framework is based on common data, and uniquely includes new direct measures of well-being based on survey responses.  For some, that may be limiting, but for larger systems this can be a great opportunity to engage with the community to do additional data collection.