Section 10. Community-Level Indicators: Some Examples

Learn how to identify and choose community-level indicators to fit your needs and what kinds of indicators you might look for in a given field.

 

The Payneside Health-for-All Coalition wanted to better understand the effectiveness of its effort to make health services more accessible to everyone in the community. The Coalition selected some community-level indicators to help them understand if progress was being made. They got information about the percent of adults seen by a doctor in the past year for a routine checkup, the percent who did not have a medical home, number of community health clinic visits for people of various ages, and how many visits to the sliding-scale clinics were of patients who could afford to pay little or nothing. They also tracked the number of community residents who received free care at local hospitals, the number of seniors who received subsidized home care, and other statistics. As a result, Health-for-All learned that a larger number of citizens were, in fact, seeking regular health care, and that the Coalition’s work had borne fruit. Using community-level indicators had helped the Coalition provide community members with better access to services.

In the previous section, Gathering and Using Community-Level Indicators, we introduced community-level indicators, and briefly discussed why and when they can be used and how to gather them. The section included a number of examples of possible community-level indicators for different issues: substance use, teen pregnancy prevention, tobacco control, injury prevention, and violence prevention. In this section, we’ll explain further how to identify and choose community-level indicators to fit your needs, and give some guidance as to what kinds of indicators you might look for in a given field.

What are community-level indicators?

Community-level indicators are measures that refer to population groups rather than individuals. (They indicate what’s happening at the community level, rather than the individual level.) Community-level indicators offer objective measures of outcomes. An example would be monitoring smoking through the community-level indicator of sales of cigarettes in the community, rather than by polling people to find out how many cigarettes each person smoked daily.

There are many places to find information on community-level indicators. For health-related indicators, some excellent places to start are Health Indicators Warehouse (HIW), which provides a wide variety of health indicators with national, state, and community data; Community Health Status Indicators (CHSI), which provides local public health agencies access to county health status profiles; and County Health Rankings, which provides rankings of each county within each state according to its health outcomes and health determinants. And for demographic indicators, The U.S. Census Bureau is always a good place to start. There are many other helpful websites that can guide your choices of community-level indicators, listed in the Internet Resources section below.

Community-level indicators can range from the very specific and focused – the rate of nighttime, single-vehicle crashes as an indicator of alcohol and substance use – to the more subtle and indirect – the amount of shelf space devoted to alcoholic beverages in local supermarkets. All the community-level indicators you use, however, should have some things in common.

They should be:

• Relevant
• Available
• Usable in practice
• Statistically measurable
• Logically or scientifically defensible - You must be able to convince people that the link between your indicators and the issue they concern is real.
• Reliable
• Leading - “Leading indicators” tell you what’s coming. If they change, it usually means that the rest of that category will make the same changes soon. If you can identify leading community-level indicators, you can use them to predict trends relating to your issue.
• Policy-relevant

Some general considerations

• As we’ve already mentioned, good community-level indicators can take several forms. Sometimes, what seem to be the most obvious aren’t as useful as they seem. For instance, smoking is a major cause of lung cancer, so measuring lung cancer rates in a community ought to tell us about smoking rates. It does, but it tells us about smoking rates 20 or 30 years ago, because that’s how long it may take many cancers to develop. The same is true for heart attacks and cholesterol – the current condition of your heart reflects your eating and exercise habits of 20 years ago as much as your current ones. It’s important, therefore, to pick indicators that tell you about current conditions (unless what you want to know is how many people are currently affected, or what happened 20 years ago).

• A second consideration is that unusual connections may give you important information. An increase in the shelf space that supermarkets devote to healthy foods says something about people’s concerns about diet, for instance, and may reflect the adoption of healthier lifestyles.

How might you use community-level indicators?

Community assessment. Community-level indicators can be useful in community assessments for different purposes. An assessment to identify community issues and problems, for instance, might rely on such indicators as the incidence of a disease or medical condition either in the community at large, or in a particular social, ethnic, or geographic group. The number of children receiving free or reduced-price school lunches, or the number of schools instituting breakfast programs can speak volumes about the community’s economic problems, or about child hunger. 

Community-level indicators can also provide information about the effects of community projects and initiatives. A reduction in the number of single vehicle nighttime crashes might be evidence that a recent substance use prevention program is working; a reduction in the number of people who are unable to obtain or have to delay medical care due to costs might be evidence that the new clinic in the area is helping a previously underserved population.

Accountability. Community-level indicators, by providing evidence of progress, can help maintain accountability for those who are running initiatives and projects. A community initiative to provide more affordable housing might be measured, for instance, by the number of affordable housing units available, or the average per-room or per-square-foot rental cost for residential property in the community. Levels of economic prosperity can be measured by looking at the community’s unemployment rate, average wage for workers, etc.

Evaluation. You’re most likely to use community-level indicators to measure your progress toward the outcomes you’re aiming at. A substance-abuse initiative, for example, might look at admissions to treatment programs for signs of progress. Outcomes might be measured by such indicators as drug-and-alcohol-related arrests, emergency-room admissions related to substance use, underage drunk-driving incidents, or single vehicle, nighttime crashes.

Policy change. Community-level indicators can help determine where policy change is needed, and whether a change in policy is having the desired effect. Many states and communities, for example, have reformed property tax laws to help seniors and lower-income people stay in the homes they have owned for many years. These reforms came about because of (community-level) indications that these groups were being forced out of their homes by high taxes. Checking the records of home sales in the community two years before and two years after such reforms might tell you whether fewer seniors and lower-income residents are selling their homes, or at least whether the neighborhoods formerly most affected are becoming more stable.

How do you choose community-level indicators?

Decide on just what your goals are in using community-level indicators. What exactly is it you want to find out? For instance, if your initiative is working to increase health care access for those in your community, your goals might be to determine the number of uninsured people who have to delay getting medical care because of high costs, and then as your initiative progresses, determine whether your initiative has reduced this number.

Determine what kinds of information you’d need to achieve your goals. You’d want to assess the nature of the problem as it currently exists, which means looking at issues such as how many people in the community are uninsured, the percentage of uninsured people who are receiving annual checkups and recommended cancer screenings, etc.  The same issues could be examined later to find out how successful you were, and what else might need to be done.

Choose community-level indicators that reflect the information you want, and that can be measured, so that they can be compared, and give you real information to work with. Some community-level indicators you might choose in this case are the number people who have a primary care physician or stable source of ongoing care, the number of families using the emergency room as their primary care provider (as reported by emergency room intake data), and the number of people who have to delay receiving treatment or obtaining prescriptions because of the costs. All of these might be compared to measurements from previous years, and then analyzed again in the future to determine if there has been progress.

Measure the indicators and analyze the results. You might find that there are high numbers of uninsured people in the community, and they are not receiving the recommended annual checkups and cancer screenings. Then your efforts should focus on disseminating information about the importance of such screenings and information about the availability and affordability of those services.

By continuing to use the indicators you’ve chosen, and adding others that make sense, you can evaluate your efforts, and make changes where needed.

Examples of community-level indicators

Here we’ll examine a number of areas – health, human services and education, community development, public safety, the environment – and point out some general types of community-level indicators that could be used as starting points. You might use or adapt some of these indicators for your own work. Additionally, if you have community-level indicators that are not listed here and you would like to share them with us, please email us at toolbox@ku.edu.

Many of these indicators are most useful when compared to past figures or figures from other similar communities, when monitored over time, or when looked at as a percentage or proportion of the population. These figures are often stated as “per 100,000 (or 1,000) people”. Thus, if there are 20 cases of lung cancer in a community of 10,000, the number might be stated as “a rate of 200 cases per 100,000.” In that way, the figures can be reasonably compared with those of communities of any size.

Health

Health covers a range of areas – wellness promotion and health maintenance, disease and injury prevention, detecting and addressing medical issues unique to the community, and providing health services to all who need them.

Wellness promotion and health maintenance. Research shows that healthy eating, regular exercise, and stress reduction contribute to a longer and better-quality life. In addition, most people benefit from regular health maintenance and monitoring – visits to health professionals, care about exposure to dangerous conditions or substances, etc. Some community-level indicators include:

• Percentage of adults people with a Primary Care Provider
• Percentage of people who have had a Primary Care Provider checkup in the past 12 months
• Percentage of adults who receive regular dental checkups
• Percentage of adults receiving annual vision screenings
• Percentage of children receiving regular medical checkups
• Percentage of children who have regular dental visits
• Vision screening for children (percent)
• Average number of prenatal doctor visits for pregnant women
• Shelf space devoted to healthy and/or organic products and foods in supermarkets
• Shelf space in stores devoted to tobacco
• Number of liquor stores in the community
• The mileage of bike paths and hiking/running trails, compared to road miles in the community

Disease and injury prevention. Unlike most wellness and health maintenance activities, disease and injury prevention involves taking specific measures to prevent or minimize the effects of specific diseases and conditions. Some community level indicators include:

• The percentage of the over-65 population inoculated for flu
• The percentage of children registering for school with proof of all recommended inoculations
• The number of people receiving regular cancer screenings – mammograms, Pap smears, prostate antigen tests, colonoscopies, etc.
• Condom sales, especially among teens. These might be related to the incidence of sexually-transmitted infections (STI’s), including HIV, and might also relate to teen pregnancy rates
• The percentage of schools providing sex education
• The number of homeless people tested for TB and other infectious diseases
• Number of single vehicle, nighttime crashes

Detecting and addressing health issues unique to the community. Any community may have unique health needs, stemming from the prevalence of a particular disease or condition, or from a threat to the community’s health. The causes here may range from the environmental – pollution of drinking water, poor air quality, chemicals in the soil, etc. – to the genetic – a large population of an ethnic group that’s susceptible to a certain disease – to the cultural – a population at risk of heart attack because of a traditional diet high in saturated fat. Examining some community-level indicators can help you find and deal with these kinds of conditions.

• Results of screenings for blood pressure and cholesterol, HIV/AIDS, TB, various cancers, neurological conditions, diabetes, and other chronic conditions, both for the community as a whole and for specific populations
• The number of hospital admissions and/or deaths resulting from particular diseases or conditions – certain cancers, diabetes, HIV-related illnesses, etc
• The number of miscarriages, stillbirths, and birth defects, both for the community as a whole and for specific populations
• Infant mortality rate, low-birthweight babies, babies with fetal alcohol syndrome, etc.
• The incidence of obesity in children
• The frequency of emergency room visits for asthma attacks, particularly among children
• The average number of cavities per childhood dental visit
• Number of children’s visits to mental health facilities

Providing health services to all who need them. A community may have excellent health services, but if many people are unable to take advantage of them – because of cost, difficulty of access, or some other reason – then they do those people no good. Community-based indicators can tell you whether there’s a large segment of your community that’s denied proper health care.

• Number of practicing primary care providers
• Patient to primary care provider ratio
• Percentage of people who have a usual primary care provider
• Proportion of insured persons with coverage for clinical preventive services
• Proportion of persons who receive appropriate evidence-based clinical preventive services
• Percentage of uninsured families in the community. The number of free or sliding-fee-scale clinics, and their rate of use
• Percent of dental care providers who accept Medicaid
• The number of families using the emergency room as their primary care provider (as reported by emergency room intake data)
• Proportion of individuals who are unable to obtain or delay obtaining necessary medical care, dental care, or prescription medicines
• Proportion of hospital emergency department visits in which the wait time to see an emergency department clinician exceeds the recommended timeframe
• The number of elders receiving in-home health and care services
• Average waiting time to obtain non-emergency medical services – for regular checkups, follow-ups, chronic conditions, etc.
• Handicapped accessibility of health facilities – hospitals, clinics, medical buildings and practices, dentists’ offices, optometrists, etc.
• Availability of ambulance and emergency medical services, particularly in rural areas
• Availability of interpreters in various languages at health facilities

Human services and education

Human services includes things such as welfare; homeless and emergency aid services; job training and retraining; youth development; community-based mediation; counseling and other mental health services; violence prevention; services for seniors, and those with physical or developmental disabilities; providing support to new immigrants and language minorities; and safeguarding citizens’ civil and legal rights.

Education encompasses not only public education (including special education for those with learning disabilities, or with physical, developmental, or psychological handicaps), and state-sponsored and -funded post-secondary systems, but also adult literacy and adult education (including language classes for immigrants), pre-school, after-school programs, alternative schools, and, to an increasing extent, distance learning (Internet, TV, or video-based instruction).

Human services aimed at children and youth. There are several areas to focus on: kids’ economic conditions, their school achievement, employment, family status, use of services, etc. Some types of indicators to consider:

• Number of families that are below the poverty line; within 150% of poverty; 200% of poverty; number of children eligible for free school lunches, subsidized child care, and other programs dependent on income

The U.S. federal poverty guidelines are updated annually. They are meant to define poverty, but don’t really represent the level at which a family is able to get by on its income alone. Although it sets separate guidelines for Alaska and Hawaii, which are known, because of their isolation, to be more expensive, the government doesn’t make allowances for people living in an expensive urban area, or for the need for transportation in rural areas, for instance. The guidelines are usually low, and a great number of families that must struggle to pay for both food and shelter are far above them. As a result, eligibility for many federal and state services is set at 150% or 200% of poverty.

• Family status: percentages of children living with two parents, one parent, other family members, in state custody (foster homes and institutions)
• Number of children under 18 involved with the juvenile court system: complaints, arrests, involvement in violent crimes, delinquency petitions, court referrals because of uncontrollable behavior.

This last goes by different names in different states, but boils down to parents or guardians referring children – usually young teens – to the court system because the kids are beyond their parents’ control, and are doing things likely to harm themselves or others.

• Family status: percentages of children living with two parents, one parent, other family members, in state custody (foster homes and institutions)
• Number of children under 18 involved with the juvenile court system: complaints, arrests, involvement in violent crimes, delinquency petitions, court referrals because of uncontrollable behavior
• Number of children under 18 in residential or lock-up programs
• Frequency of child abuse and neglect – physical and sexual assault, abandonment, negligent parenting, etc. – (available from emergency room reports, police files, state child welfare departments, and relevant human service agencies)
• Number of families with children seen by various agencies – emergency services, food bank, free health clinics, mental health services, rehabilitation, fuel assistance, child care, families-at-risk, pregnant and parenting teens, etc.
• Employment rate of youth 16 to 18
• Number of 16-and-under youth seeking family planning services
• Number of under-21 referrals to drug and alcohol treatment programs
• Availability of outreach and services for homeless youth, and numbers served

Emergency and similar services. Emergency services are essentially those services necessary to sustain health and/or life for people without the resources to continue to do so for themselves. Community-level indicators can measure both the extent of the need for these services and their effectiveness.

• The extent of homelessness in the community  (determined by admissions to shelters, winter counts of sleepers in the open, soup-kitchen meals served)
• Number of people on welfare or disability income
• Patronage of food banks and other food-distribution centers, surplus food eligibility, number of people receiving food stamps, number of people fed at the Salvation Army
• Number of families on fuel assistance
• Length of waiting lists for various types of subsidized housing, availability of affordable housing in the community, average percentage of income paid for shelter by people on public assistance
• Admissions to shelters and other services – counseling, placement in a new area, job training – for victims of domestic violence
• Number of people seen by emergency mental health services

“Second-level” human services. These are services that involve quality of life, rather than immediate physical survival or health, but, as a result, often address the underlying causes of problems, where emergency services, of necessity, may only address the symptoms.

• The percentage of people in the community who are unemployed
• The number of adults enrolled in or on a waiting list for adult literacy, basic education, or majority-language-learning programs
• The percentage of adults in the community lacking high school diplomas
• Number of child care slots available for low-income families
• Availability of public transportation
• Availability of independent or assisted living facilities or services, or other housing dedicated to seniors and people with disabilities
• Availability and use of community mediation – mediation covers divorce and family mediation, landlord-tenant disputes, small claims, conflicts among neighbors or organizations, etc. Community mediation is meant both to demonstrate better ways to resolve conflict, and to relieve the burden on an overworked court system.
• Number of complaints of discrimination reported and/or investigated, including discrimination in the workplace, housing, the granting of bank loans, etc.
• Availability of affordable (usually sliding fee-scale) community mental health services
• Availability and use of transition services – housing, employment, and support – for those recently released from prison
• Handicapped accessibility to various services and agencies

Education. From pre-school to college, as well as non-traditional education. There’s usually an emphasis here on publicly-funded or otherwise universally-available education, so that private schools and colleges are not part of the mix, except insofar as they offer scholarships or the equivalent. Many private schools in smaller towns, for instance, offer free tuition to local youth who can meet admission standards.

• Number of slots in affordable pre-school programs – Head Start, subsidized pre-school slots for low-income families, school district early education programs
• School status: dropout rate, number of children in grades 3-12 more than one grade level behind in reading or math
• Availability of bilingual and other programs aimed at helping immigrant children
• Class size, age and condition of public school buildings, teacher pay scale, amount spent per pupil, and other indications of community commitment to education
• Private schools and colleges offering scholarships or free tuition earmarked for local youth
• The percentage of children attending private or parochial schools
• Availability of alternative high schools and charter schools
• Number of local graduates attending college
• Community scholarships for post-secondary education available to residents
• Handicapped accessibility to educational facilities

Community development

Community development includes a number of areas, spanning the economic, the social/demographic, and the cultural.

Economic. You may be looking at the economic development of the community as a whole or that of specific groups within it. Community-level indicators to consider:

• The number of new businesses starting annually
• The number of business failures or bankruptcies each year
• The average income level
• The average education level
• The unemployment rate
• Local revenue from taxes and fees
• The percentage of businesses and industries that are locally owned
• The average commute to work for local residents
• The default rate on local business and mortgage loans
• Average housing prices
• The percentage of residents who own their own homes
• The percentage of people who are below the poverty line, homeless, or receiving public assistance
• The percentage of children receiving free school lunches

Social/demographic. The social indicators include how people relate to one another in the community, and what people do as groups to participate in the community and hold it together. Demographic indicators describe the community’s residents – their ethnic, gender, age, and racial diversity, their geographic distribution, etc. Social indicators are important in understanding how people are connected to one another, as well as how they sometimes discriminate against or distrust one another. Demographic indicators help to understand population shifts, changes in the nature of the community, and what services might be needed for particular groups.

• Number of service clubs, fraternal organizations, churches, and other gathering points
• Percent of citizens voting
• The number of single-parent families, and of children living with caregivers other than their parents
• The diversity of the population – number and size of various ethnic and racial groups, number of ethnic societies and organizations, number of kids under 18 – and population trends – how these numbers have changed in the past year, five years, ten years
• Where various groups live, if they aren’t dispersed evenly throughout the community, and whether different groups mix socially and otherwise
• The number of community activist and citizen advocacy groups and organizations (block associations, groups organized for a specific task, watchdog or oversight groups, policy change advocates, etc.)

Cultural. “Cultural” is used here to refer to both “culture” in the sense of arts, entertainment, and knowledge (which are, in fact, the passing on of the valued products of the majority culture), and “culture” in the sense of the customs and world view of the various ethnic, racial, and religious groups in the community. The availability of culture in both senses adds tremendously to citizens’ quality of life.

• Number of performance centers in the community – theaters, concert halls, clubs, etc.
• Number of low-cost or free performances (music, dance, theater, film, readings) available to the community
• Availability of affordable learning opportunities in the arts for children
• The number of free and/or affordable classes in the arts and other subjects for adults
• Number and character of museums in the community (and the number of visitors they receive)
• Availability of the public library – hours, number of branches, accessibility, etc. – and its use
• The number of after-school and summer recreation programs for children and youth
• Number of ethnic and religious festivals and other such multi-cultural events

Public safety

Since 2001, public safety, in many cities, at least, has come to mean more than police protection or earthquake-proof buildings. It also means safety from terrorism, which, in turn, raises issues of privacy and civil rights when “protection” becomes too vigorous. As with health, the most effective way to ensure public safety is to take preventive measures long before any threat exists.

In the examples of community-level indicators below, we offer measures of prevention, of the balance between safety and civil liberties, and of traditional public safety activities.

• The existence of emergency management plans, earthquake-, hurricane-, or tornado-proofing in buildings (in areas where that’s necessary), flood control measures, and other protections against natural disasters
• The number of fire stations and/or firefighters available to respond to fires and other emergencies, as well as the average response times in various neighborhoods
• The existence of neighborhood watch programs, good street lighting, police on foot patrol, etc.
• Relationship between the police and the minority and/or low-income community, as reported by members of that community, particularly youth
• The extent to which the ethnic/racial composition of the police force mirrors that of the community as a whole
• Equal police presence and enforcement of laws in all neighborhoods
• The existence of police/community relations boards or something similar
• Number of reports of police brutality, racial/ethnic profiling, or excessive force, and the number of those reports actually investigated
• Number of homicides annually in the community
• Number of violent crimes (rape, armed robbery, criminal or domestic assault, etc.) annually in the community
• Number of homicides and violent crimes in which victims and/or perpetrators are under 18
• Number of arrests of youth under 18
• Crime rate by neighborhood
• The number of police

The environment

The state of both the natural and the “built” (i.e., man-made) environment has a great deal to do with the quality of life in a community. Open space and wild places provide not only beauty, opportunities for exercise, and an escape from crowds and noise, but also sources of oxygen, fresh water, and wildlife habitat. Rundown buildings and streets full of trash can have a depressing effect on those who live there, and make life seem bleak and change impossible. Air, water, and soil pollution can threaten both wildlife and human health.

• The amount and condition of open space in the community (including public parks, conservation land and other protected areas, wildlife refuges, state forest, farmland, and protected or unprotected wild areas)
• Amount of protected land in the community
• Efforts to preserve and restore historic buildings, monuments, spaces, etc.
• The quality and adequacy of drinking water in the community (measurable pollutants, threats to or problems with the water source, size of the water supply and its ability to meet future needs, etc.)
• Air quality in the community
• Efforts by local government to reduce its effect on the environment (e.g., mandated use of low-emissions vehicles on government business, low-emissions or electric vehicles used for public transportation and garbage pickup)
• Availability and ease of recycling of paper, plastic, hazardous waste, and metal for both households and business/industry
• Level of regulation and enforcement of environmental standards for business and industry
• Local sponsorship of or support for public art (e.g., sculpture in public spaces, murals painted by teenagers in neighborhoods)

These are some examples of community-level indicators, but there are thousands more possibilities, depending upon your issue and your community.

In Summary

Community-level indicators – measures that show what the conditions are for the community or a large part of the community, as opposed to specific individuals – can be useful in evaluation, assessment, accountability, and policy change. You can find community-level indicators – either gleaned from available information, such as census data, or collected locally by observation and other methods – that will help you understand issues and trends for just about anything that affects the community.

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