PH 415/442 Conferencing Exercise

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In order to complete this conferencing exercise, you will need to download the file with a community priority setting simulation and then run that simulation on your computer. The simulation exercise may take you several hours to complete. It will result in the development of priorities based on your consideration and scoring of various health problems. When you have completed the simulation, this conferencing exercise calls for you to compare the priorities that you developed through this exercise with those from the community planning group in the simulation. Carefully review the instructions for this exercise in the PH 415/442 Exercises document. After you have completed the simulation, be sure to record the priorities that you come up with at the end of program, as well as those that were developed by the community planning group. You should also review the results of several anonymous individuals who have previously completed this exercise.

For this exercise, via the Submit Assignments link:
--list the priorities that you identified in completing this simulation
--indicate similarities and differences with the list developed by the community planning group in the simulation, and
--explain why and how the differences occurred.

The priorities that were identified before discussion of the committee were as follows:
1. Injuries
2. Infectious Disease/AIDS
3. Homicide Disease/Suicide
4. Cancer
5. Heart Disease
6. Youth Tobacco
7. Teen Pregnancy

After the committee discussed the issues and took the BPR system and PEARL factors into account the priorities were as follows:
1. Injuries
2. Cancer
3. Infectious Disease/AIDS
4. Homicide/Suicide
5. Youth tobacco
6. Teen pregnancy
7. Heart disease

This new list of priorities is similar in that the top four priorities remained the top four priorities and Injury remained the number one priority. Changes in the rankings are due to community acceptability, resource availability, and economic feasibility.

Health Priorities for Rollins County:

Injuries 72
Cancer 69
Teen pregnancy 69
AIDS 56
Homicide/suicide 48
Heart disease 48
Youth tobacco 40

The community planning group and I both gave injuries and cancer number one and two priority respectively. The community had originally chosen AIDs as the third priority, but due to pressure from the minister and others in the group, gave homicide/ suicide spot number three. In
fact, AIDs was dropped completely off the top four list and teen pregnancy was given the number four spot. The differences in my rankings and the community planning group’s arose, for the most part, from their biases going into the meeting. All of the members came to the meeting with an agenda and this kept certain causes of death from getting on the top four list. Youth tobacco, for instance, was vehemently opposed by the business representative because of possible economic ramifications. My own biases are apparent in the list I generated. I tended to given higher priority to things that affect young people the most and to issues whose C values (effectiveness of solutions) were high.

My Rankings
Injuries 8/8/4
Cancer 7/7/4
Heart Disease 6/5/4
Teen Preg 7/6/3
ID/AIDS 8/9/2
Homi/Suicide 8/8/2
Youth tobacco 9/5/2

Community Rankings
Injuries 8/8/4
Cancer 7/8/3
ID/AIDS 7/7/7
Homi/Suicide 8/10/2
Youth tobacco 5/4/4
Teen Preg 9/5/2
Heart Disease 7/6/1

The Community Planning Group (CPG) and I agree on the top two priorities being injuries and cancer, based on the BPR System. The similarities end there. Their last two priorities match my fourth and third, respectively. Heart disease is their least important priority, even though it is the leading cause of death in their community.

The discrepancies in the rankings occurred for several reasons. The CPG used different scales for each component as compared to the scales used by those of us who were completing the simulation. For example, looking at heart disease, the community group selected the size of the problem as a 7. The simulation limited the user to selecting either 5 or 6, as heart disease affected less than 10% of the population. The CPG scale must have allowed a higher rating for health problems affecting that certain percentage of the population. The highest rating of seriousness I was allowed to select was 5, while the group chose 6. The CPG rated the effectiveness of interventions at 1, and I selected 4, thinking the interventions were more effective. Based on the BPR formula, my ranking for heart disease was higher than the CPG, even though they rated the size (A) and seriousness (B) higher than I did. The low rating of effectiveness of their interventions caused the ranking to be lower, as the sum of (A + 2B) is multiplied by the effectiveness (C). Clearly, their scales for size, seriousness and effectiveness were defined differently. The scales selected for each component are not uniform and can change the priority rankings even though the same data is utilized.

In addition, more than one person contributed to the CPG rankings. My rankings reflected the ideas and biases of just one person. Several people from different factions of the community, and the interests and biases they brought with them, directed the CPG rankings. Available resources and politics further affected the final rankings, i.e. more willingness to provide money for certain issues, and the lack of desire to deal with AIDS and to interfere with the local tobacco profit.

During the process of this simulation, my own list of priorities for Rollins County turned out to be:
Teen Pregnancy 92
Cancer 84
Injuries 66
Heart Disease 56
Infectious Disease/AIDS 50
Homicide/Suicide 38
Youth Tobacco Use 38

This differed quite a bit from the prioritized list of the community planning group, which included:
Injuries 96
Cancer 69
Infectious Disease/AIDS 63
Homicide/Suicide 56
Youth Tobacco Use 44
Teen Pregnancy 38
Heart Disease 19

Although we used the BPR system for scoring priorities, everyone has their own agendas of importance. Therefore, although only three out of my top five health concerns matched that of the Community Planning Group's list, I feel that each member of the community has different priorities of concern. For example, both my list and the community list had injuries, cancer, and infectious disease/AIDS in the top five priorities. However, based on how many points the other concerns were given, issues that topped my list did not necessarily top theirs. For my part, I awarded points on the basis of how close the percentages were to the limits of the ranges for each category. Percentages that were closer to the higher limit received the highest number of points in the range. However, given the relative importance of each health concern for each individual, the points awarded may have varied.
In the end, even the Community Planning group's list of the top four priorities changed slightly during the discussion of the PEARL factors. Although a health issue may seem to be of pressing importance, if the intervention process would not be accepted by the community (for example, the Youth Tobacco Program) or additional funds would be able to be obtained for other important issues (for example, Teen Pregnancy), often the list needs to be modified. In the end, the top four health priorities turned out to be Injuries, Cancer, Teen pregnancy, and Homicide/Suicide. Because each community presents different PEARL factors, there is a resultant difference in their list of health priorities. In addition, although the dynamics of the community may not change drastically from year to year, health priorities must continue be reevaluated due to such factors as changing economic feasibility or community acceptability.

My top seven health priorities:
1. Injury- 96
2. Cancer- 92
3. Teen pregnancy- 88
4. Heart disease- 52
5. Infectious Disease/AIDS- 50
6. Youth Tobacco Use- 40
7. Homicide/Suicide- 21

The Community’s health priorities received the following original ranking:
1. Injury- 96
2. Cancer- 69
3. Infectious Disease/AIDS- 63
4. Homicide/Suicide- 56
5. Youth Tobacco Use- 44
6. Teen Pregnancy- 38
7. Heart Disease- 19

When making my decisions about the size of the problems, seriousness, and effectiveness of the solution I took into account the demographics of Rollins County, as well as information I learned about the leading causes of death in the community, and the leading causes of YPLL. The community and myself chose injury and cancer as numbers one and two. I feel that these are two main problems because of the younger population of the county, and that both of these are in the top four causes of YPLL for the county.

Besides these top two choices, my ranking and the community’s ranking differed greatly. These differences are due to several reasons, one of which is the difference in the BPR scale. For example, I ranked my fourth choice, heart disease, as a 4 for effectiveness, where the community ranked it a 1. I was given the choice to rank it as a 3 or 4, but not as a 1, this is one difference I encountered with several of the health factors. I was very surprised to find heart disease very low on the community list of priorities since it is the leading cause of death in the community and number five on YPLL.

Another reason for the differences is personal beliefs, and that the community had to take into account several people from different backgrounds points of view. My background as a Registered Dietitian makes me have different viewpoints than the other representatives; I see heart disease as more preventable with nutrition and lifestyle intervention than I do homicide, but someone with a different background, such as the YMCA representative, could find the complete opposite. The community combining the points of views also required the combining of different beliefs and political agendas, which affected the rating, evidenced by the addition of teen pregnancy to the top four, replacing AIDS/Infectious diseases. This decision was made when going through the PEARL system, there was a lack of resources for AIDS programs, but there were funds that could be allocated for teen pregnancy, so it replaced AIDS on the list. This exercise was enlightening because it showed resources used to set health priorities, and also showed the compromise and other factors that must be taken into account when making health decisions as a group.

My Ranking
1. Cancer
2. Teen Pregnancy
3. Injuries
4. Infectious Disease/AIDS
5. Heart Disease
6. Youth Tobacco Use
7. Homicide/Suicide

Community Ranking
1. Injuries
2. Cancer
3. Infectious Disease/AIDS
4. Homicide/Suicide
5. Youth Tobacco Use
6. Teen Pregnancy
7. Heart Disease

In examining the top four, as the community stated those were the issues that would be addressed, cancer, infectious disease/AIDS, and injuries were listed in both the community’s rankings and mine. The one difference lies in teen pregnancy being my number two issue and homicide/suicide being the community’s fourth. In the end the community boosted teen pregnancy up into the top four by ousting infectious disease/AIDS due to lack of represented community interest. Unfortunately, this does play a large role in the selection of which programs to community health needs to address. It would be easy to say that it is wrong and political to push infectious disease/AIDS out of the four being addressed simply because of lack of funding or the desire of a few community groups to address a different issue. However, teen pregnancy is still a ranked issue, and better to receive the funding from the outside constituents and be able to make a difference, than to adhere to the top four issues identified by the numbers and not be able to do as much towards efforts addressing these health issues due to lack of funding. Besides, obviously these issues are important to the community or they would not be funding these efforts; therefore, they are a priority health issue. One has to remember; the health department works with the community on the priority health issues. It does not drive or direct the issues.

I feel that differences in the ranking between the community’s ranking and mine develop from the qualitative thinking behind the A, B, and C ranking, and the PEARL items. Size of problem is a fairly quantitative variable, but there is still variability in where you rank the health issue within the scale. Seriousness of the problem, and effectiveness of solution in my opinion are qualitatively affected. Meaning that your opinion of the seriousness of an issue may affect how you ranked these health issues. For example, teen pregnancy is a priority health issue in the county where I work; therefore, I may have instinctively ranked higher due to my preconceived notion of its importance.

Additionally, other issues do cloud judgment when you begin to prioritize. One does think of issues such as how will this issue pan out when we begin addressing it? How will the community react? What will the churches do? Will the school system cooperate? Will we be able to obtain a measure to illustrate effectiveness? How long will it take to view a measured change? This is why you need a representative sample on the committee. A variety of viewpoints will help ensure that a multitude of opinions are expressed. Priority health issues cannot come from statistics and computed numbers alone. These are simply tools to aid in identifying which health issues to look at, and them move forward from there. Unfortunately, in times of limited resources, when decisions have to be made, assets need to be allocated where they will have the most impact on the community and its members.

The Final Top Four Priorities that were identified were:
(a)
1.Injuries
2.Cancer
3.Homicide/Suicide
4.Teen Pregnancy

(b)
My Initial Top Four Priorities were:
1.Injuries
2.Teen Pregnancy
3.Cancer
4.Heart Disease

The Communities Top Four (before further discussion) were:
1.Injuries
2.Cancer
3.Inf.D/Aids
4.Homicide/Suicide

Some of the changes came about after considering PEARL factors.

PH 415/442 Conferencing Exercises last revised March 17, 2004 (epowell)