Population Health Assessments: The PHRI Method


The Problem

Social determinants of health (SDOH) are major factors in explaining the health status of populations. Medical care explains only 10% of a populations health status…genetics 20%. Increasingly social determinants along with the physical and social environments and lifestyles are being recognized as the true culprits. The healthcare system alone cannot address deteriorating health, but communities can.  Our approach involves multi-sector collaboration to change health status of populations. 

                                      Drivers of Population Health Status


The Solution

Public Health Research Institute (PHRI) offers two essential services to assist communities in making policy and program changes to improve health. One, we assemble and analyze (with you) the essential data needed understand the specific issues driving the level of health in your community. Two, we work with you to establish a multi-sector collaborative for planning and implement changes that truly improve health.


Data and Information

We employ two critical steps in identifying drivers of population health.

Step one: Assemble and analyze a fundamental set of social, economic, environmental, health status, and clinical indicators providing you with a clear picture of both the health, strengths and needs of the community.  These data may come from data bases PHRI has been working with for decades in its community health planning work across the country and internationally.

Step two: Combine  our knowledge of health care systems, prevention policies and programs, and the influence of social and cultural factors in health behavior to work with,  organize, prioritize, and finally, to  target policies and programs that will work in your community. 

Data on social and economic determinants of health are available from many sources and for several levels of geography (by county, census track, zip codes, state).  They include, for example, the Department of Agriculture (e.g., food deserts, food insecurity), the Department of Justices (e.g., crime data), the Department of Housing and Urban Development (e.g., housing security/stability), the Environmental Protection Agency (e.g., contaminated sites), the Department of Education (e.g., educational disparities), and other non-traditional sources.


Process and Outputs

  • Create/Work with multisector community group/network
  • Create community profile
  • Analyze profile to identify health status and critical drivers
  • Identify high priority opportunities for action
  • Assemble action team(s) from local community
  • Identify model policies and programs to address community priorities 
  • Identify local and national resources to support effort
  • Evaluate interventions

                                      Overview of the Population Health Process