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In 1854, an unknown killer was stalking a northern London neighborhood,
inflicting its victims with violent, deadly episodes of vomiting and diarrhea. Many
physicians attributed the malady to "bad air" emanating from decaying organic
matter. By the time English physician John Snow came on the scene, the
unknown killer had a name-cholera.
Snow did not believe "bad air" caused this epidemic. Instead, he believed it was
the result of people drinking water contaminated by fecal waste. After careful
analysis of the area of the outbreak, he discovered those inflicted clustered
around the Broad Street water pump. He shared his findings with local officials.
The handle to the pump was removed, and the incidence of disease subsided.
Snow and his systematic approach to a neighborhood search for a cause began
with a community health analysis and is known today as modern epidemiology.
Since that time, the methodology he devised has evolved into a major tool for
assessing a community's health and related needs.
As a natural outgrowth of Snow's work, modern community health assessments
have grown to include demographic information, lifestyle choices, environmental
factors, mortality/morbidity data, and perceptions of community needs by its
members. The focus is to develop an integrated data system to plan for a
population base represented by a community or neighborhood.
Passing the Torch
Until recently the medical profession primarily left community health assessment
in the hands of epidemiologists and other health care officials because of the
health care delivery system's emphasis on traditional feefor-service tertiary care
rather than community-oriented primary care.
Now, however, physicians and allied health care professionals are finding
themselves contractually responsible for planning and managing the needs of
large populations as defined by geography or enrollees within the constraints of
resources, time, and outcomes. With the growing influence of managed care,
populationbased primary care and its emphasis on community health
assessment is increasingly seen as critical for success in medical practice.
The ability to provide needed services to the community is fundamental to the
solvency of any health care organization. In the past, however, many
organizations have taken the "ready, fire, aim" philosophy, as evidenced in the
way they have implemented and developed programs with the idealistic notion
that "if we build it, they will come."

But who are they? What are their health care needs? What lifestyle choices are
they making and how are those choices influencing their health status? How are
environmental factors affecting their health status? What do community members
have to say about the factors affecting the health needs of their community?
If these questions sound familiar to marketers, it is for a good reason. They are
basic marketing issues. After all, marketing is based on the fundamental
assumption that an organization will attain its objectives (profit or otherwise)
more effectively when it identifies and fulfills the needs of its market(s).
Exchanges are maximized if-and only if-the product (or service) of the
organization coincides with the needs, wants, and desires of its customers.
Therefore, marketing specialists in the health care field should be skilled leaders
in promoting and using community health assessments as a part of their job.
Health care marketers who fail to integrate these assessments into their
strategies are following a production or sales orientation rather than a true
marketing orientation. The former might be successful in the short run, but, in an
environment of changing competitive markets, such strategies cannot ensure
survival, let alone long-term success. As in any other field, health care
organizations that do not adequately meet the needs of their target market and
other relevant stakeholders will soon fall prey to a competitor who can serve
those needs better.
Applying Marketing Strategies
Currently, decisions about health status assessment and prevention strategies
are based on vital records data, the U.S. Census, service-use rates, infectious
disease reporting, and state-level surveys of lifestyle behaviors, and health
knowledge. These data sources, however, are limited in their ability to address
the planning of effective prevention services at the local level.
Gross measures of geographic risk (state and county) or race/ethnicity risk are
inadequate to describe the health status of local populations. What is lacking is a
segmentation of county populations into more complex groups that constitute the
"market" for public health services and prevention messages.
It is time for health care organizations to use larger scale desk-top data systems
to serve their communities. These resources identify populations' lifestyles and
define communities by specific geographic, demographic, and psychographic
patterns. Using this database for identifying subpopulations that cluster by
lifestyle and socioeconomic experience in addition to basic demographics,
marketers can improve the practice of many health care organizations' functions
and activities.

The databases can be used to target in-need populations more effectively,

identify population and communitylevel risk factors, develop health marketing
media strategies, select sites for new community/public health clinics, and
determine the appropriate mix of health programs for communities characterized
by particular demographics (e.g., concentration of elderly, children, infants, and
women).
Multiple Benefits
The motivation to complete a community health assessment begins with a
fundamental principle of marketing-finding a need and filling it. But the potential
benefits of participating in the completion of a community health assessment go
far beyond meeting unmet needs. Those completing community health
assessments stand to benefit from the development of stronger ties with allied
organizations during the assessment process.
Furthermore, the list of important community needs generated from the
assessment will help to validate the need for the health care organization's
existence in the community. Additionally, a completed community health
assessment may also serve as an effective tool to market the community to
prospective physicians. Finally, health care organizations can use the information
generated from a community needs assessment to gain a competitive edge in
the marketplace while improving their corporate image.
Ultimately, a health care organization must decide what directions it will pursue
and how it will meet the challenges of a new era. If the institution sees itself only
as the supplier of acute care medical services (marketing myopia), it will severely
limit itself and its ability to understand, meet, and plan for the future needs of the
community it serves.
Consequently, those in health care marketing positions should be called upon to
see community health assessment not only as a means of providing better
services to their community but also as a vehicle to secure the growth and
stability of their organization.
Clearly, the torch lit by Snow in 1854 needs to be passed along in today's health
care organizations. Times have changed since he made his lifesaving discovery,
but the need to develop comprehensive community health assessments has not.
If anything, the role of this valuable tool should be expanded within medical
practice.
Marketing data can be used for local health planning, especially as it relates to
identifying and reaching high-risk populations. Health care organizations have
limited resources that must be managed carefully to serve high-risk and in-need
communities optimally. A community health assessment, using target marketing,

can focus and direct appropriate interventions and resources to specific

populations.
Consequently, local health care policy based on marketing segmentation can
maximize local health care resources, improve health care practice and better
serve those in need.
In the final analysis, both the health care provider and consumer stand to gain
from the completion of a community health assessment. Marketing professionals
recognize the need to look beyond personnel and bottomline issues and become
the visionaries for their organizations.