By Autumn Shelton, WV Press Association, for “When All Are Counted”
CHARLESTON, W.Va. – For the past few weeks, the W.Va. Department of Health and Human Resources (DHHR), Bureau for Public Health, has been asking the state’s residents to fill out an anonymous online survey about their overall health and well-being.
The “State Health Assessment–Community Health Survey,” which launched on Sept. 18, will remain open to all West Virginia residents until Tues. Oct. 17, after an extension of the prior Oct. 9 deadline, according to Dr. Matthew Christiansen, state health officer and commissioner of the DHHR’s Bureau for Public Health.
In a recent interview, Christiansen explained how data collected from the assessment will be used to develop a five-year Statewide Health Improvement Plan, and how the bureau is working to ensure that data from all West Virginians is included, especially those in marginalized populations who have historically been described as “statistically insignificant.”
“It’s going well,” Christiansen said of the responses that have been collected so far. “We feel optimistic we are going to have an increase in numbers and that we are getting the data that we need to make an informed assessment as to what the priorities of West Virginia’s citizens are with regards to their health.”
Christiansen explained that the 19 questions included in the survey are based on national models but were “tailored for a West Virginia audience.”
“Our team here at the Bureau for Public Health worked to customize these for the state’s audience and narrative,” Christiansen stated, adding that prevention groups within the bureau worked to refine some of the questions to include health concerns for marginalized populations.
Although Christiansen said that he couldn’t speak to the demographics of those who worked on the questions, he stated that the questions, and the survey, are just “one piece of the analysis.”
“As we go through the process, we will pull information in through stakeholder questionnaires,” he said.
Yet, one concern with public health assessments surrounds the meaning of the term “community.”
For decades, those in public health have been working to determine what “community” means to marginalized populations. For some, community can mean a geographic location, for others, an experience or sexual orientation and gender identity.
In Dec. 2001, the National Library of Medicine published a research-based article, “What Is Community? An Evidence-Based Definition for Participatory Public Health,” which discusses how the term “community” is experienced by those with diverse backgrounds.
According to the report, a common definition of community emerged as a “group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings. The participants differed in the emphasis they placed on elements of the definition. Community was defined similarly but experienced differently by people with diverse backgrounds.”
Christiansen said the definition of community in the state’s health assessment is broad.
“It can certainly be geographic, but it can also be based on the identity of the individual filling it out. I don’t know that we, internally, have our own definition of community, but we can certainly give that as broad of a definition as possible to ensure we are capturing what the individual means by that.”
One survey question asks respondents to rate statements, from strongly agree to strongly disagree, about the health and quality of life in their community. The statement, “I feel safe in my community,” will require a lot more information from respondents in order to achieve accurate data for those in marginalized populations.
The National Intimate Partner and Sexual Violence Survey published on the Centers for Disease Control and Prevention’s (CDC) website, and last reviewed in 2014, states “sexual violence, stalking, and intimate partner violence are major public health problems in the United States. Many survivors of these forms of violence can experience physical injury, mental health consequences such as depression, anxiety, low self-esteem, and suicide attempts, and other health consequences such as gastrointestinal disorders, substance abuse, sexually transmitted diseases, and gynecological or pregnancy complications. These consequences can lead to hospitalization, disability, or death. Our understanding of these forms of violence has grown substantially over the years. However, timely, ongoing, and comparable national and state-level data are lacking.”
Christiansen explained that, in order to combat this lack of specific data, the state assessment has been distributed to numerous interest groups that “represent a diversity of West Virginians across the state.”
“We are trying to get this out as broadly as possible,” Christiansen stated. “We know that oftentimes when we do these surveys that we are not the right messenger, as the Bureau for Public Health, as a representative of the state of West Virginia. We really need local entities to help us get that representation of those they represent.”
Christiansen also noted that racism, which can be prevalent in many definitions of community, has also been discussed within the bureau as a possible contributor to poor health.
“We know that racism can drive health disparities and can contribute to inequities in health and health outcomes,” he noted. “So, it’s certainly something that we have had internal discussions about. We are looking at this through a health equity lens as defined by the CDC and their guidance and documentation. We certainly take this issue very seriously and want to give that its due consideration in the process.”
In addition to the survey, Christiansen explained that a series of eight community listening sessions, facilitated by DHHR staff, will take place throughout the state in October and November. For those who wish to remain anonymous, the online survey is also available.
Once the initial community assessment is complete, the next step will be to put together the State Health Improvement Plan, Christiansen said. This plan will include policy objectives and funding priorities.
“This isn’t a plan that will just sit on a shelf,” he said. “We will be redirecting our efforts, our time, and our resources toward addressing critical health issues. We are looking at a five-year cycle to see results over time. It will take on a multitude of different dissemination formats and products, depending on the issue. Some of the issues might involve pulling together task forces or advisory committees–whether in disadvantaged or poor populations with health disparities, or areas of specific subject matter expertise. If substance abuse and mental health issues rise to the top, then we will certainly need many of those experts at the table to be sure we are making the right recommendations and implementing an appropriate plan to meet the health objectives we have.”
However, as Christiansen noted, the first step is to have as many West Virginians as possible complete the online survey.
“We are depending on the survey to get started,” Christiansen stated. “We want to make sure that we are representing the needs of all West Virginians, regardless of socioeconomic status or historic disadvantage. This is something that we feel will help us do that.”
“I would love to have a survey where every West Virginian responded. I know we’re not gonna get there, but we do hope to get as many as reasonably possible,” Christiansen concluded. “It’s an incredibly important effort and we are hopeful about the roadmap that this will lead us toward.”
The Community Health Survey can be accessed at https://www.surveymonkey.com/r/32ZRWPC.
About “When All Are Counted”
—The “When All Are Counted” project, directed by the Charleston-based nonprofit advocacy group Think Kids and funded by a grant from the Robert Wood Johnson Foundation, has two goals — to advocate for those who have historically been considered “statistically insignificant,” especially in the Black, Disability and LGBTQIA+ populations, and to create a statewide healthcare data surveillance system that includes everyone, not just those in the majority white population.
To make a change, and ensure that all are counted, residents throughout West Virginia are encouraged to participate and provide insight for this project. Those who wish to help may visit the “When All Are Counted” project website to register for updates, read informative articles written by the communications team, and discover upcoming dates for in-person and virtual focus groups.