Many factors influence health and well-being in a community, and many entities and individuals in the community have a role to play in responding to community health needs. The committee sees a requirement for a framework within which a community can take a comprehensive approach to maintaining and improving health: assessing its health needs, determining its resources and assets for promoting health, developing and implementing a strategy for action, and establishing where responsibility should lie for specific results. This chapter describes a community health improvement process that provides such a framework. Critical to this process are performance monitoring activities to ensure that appropriate steps are being taken by responsible parties and that those actions are having the intended impact on health in the community. The chapter also includes a discussion of the capacities needed to support performance monitoring and health improvement activities.
In developing a health improvement program, every community will have to consider its own particular circumstances, including factors such as health concerns, resources and capacities, social and political perspectives, and competing needs. The committee cannot prescribe what actions a community should take to address its health concerns or who should be responsible for what, but it does believe that communities need to address these issues and that a systematic approach to health improve-
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