NC-CATCH: North Carolina Comprehensive Assessment for Tracking Community Health.

United States invests more resources than any other nation in the world for health, we are far from the healthiest country. In fact, the US languishes in the lower half of industrialized nations for a range of indicators used to measure health status and even trails nations considered to be economically underdeveloped for selected health indicators. 1 Accompanying this disappointing level of overall health status are the enormous disparities in the health of groups defined by race, ethnicity, socioeconomic status, and geography. 2 Despite decades of scrutiny by researchers and health policy analysts and numerous reports and white papers on the subject by prestigious and influential organizations such as the Institute of Medicine (IOM) of the National Academies, these vast differences are pervasive and seemingly intractable. For example, poor White females in Mississippi and in Appalachia experienced declines in life expectancy between 1982 and 2001. 5 Similarly, in North Carolina between 1975 and 2005, despite reductions in absolute rates, Black infant mortality steadily increased from 1.8 to 2.3 times the White rate. While the problem of variation in community health status is complicated and has many underlying causes (known and unknown), there is nearly universal agreement that if we are to have any hope of improving it there must be a monitoring system to measure and benchmark community health status in a systematic way. There have been frequent attempts to provide a framework for community health status monitoring systems. The Planned Approach to Community Health (PATCH) developed in 1985 by the Centers for Disease Control and Prevention (CDC) sought to determine root causes and key intervention points for a few selected health issues. 6 In 1991 the American Public Health Association developed the Healthy People 2000 (and later 2010) protocol for addressing a series of defined national objectives. 7 At about this time, the IOM of the National Academies proposed a model for community health improvement that involved an iterative process that cycled through assessment, evaluation, and action phases. The IOM of the National Academies proposed a set of 25 indicators which expanded on the 18 recommended by the original Healthy People 2000 objectives. 8 The National Association of County and City Health Officials and the CDC developed the Assessment Protocol for Excellence in Public Health (APEXPH) which focused on process indicators to determine the internal capacity of public health organizations, and this protocol was later expanded to include other …