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3. Forces of Change Assessment - Overview

During the Forces of Change Assessment, participants answer the following questions: "What is occurring or might occur that affects the health of our community or the local public health system?" and "What specific threats or opportunities are generated by these occurrences?" The Forces of Change Assessment should result in a comprehensive, but focused, list that identifies key forces and describes their impacts.

Although it may not seem obvious at first, the broader environment is constantly affecting communities and local public health systems. State and federal legislation, rapid technological advances, changes in the organization of healthcare services, shifts in economic forces, and changing family structures and gender roles are all examples of forces of change. These forces are important because they affect—either directly or indirectly—the health and quality of life in the community and the effectiveness of the local public health system.

During this phase, participants engage in brainstorming sessions aimed at identifying forces. Forces are broad and all-encompassing, and include trends, events, and factors.

  • Trends are patterns over time, such as migration in and out of a community or a growing disillusionment with government.
  • Factors are discrete elements, such as a community''s large ethnic population, an urban setting, or the jurisdiction''s proximity to a major waterway.
  • Events are one-time occurrences, such as a hospital closure, a natural disaster, or the passage of new legislation.

How to Conduct the Forces of Change Assessment

Step 1 - Prepare for the Forces of Change Assessment
During this step, a small group responsible for overseeing the Forces of Change Assessment should prepare for the brainstorming sessions. This group determines who will facilitate the process and how the sessions will be run. In addition, each member of the MAPP Committee should begin thinking about the major forces that affect public health or the community. This helps to ensure that everyone comes to the meeting prepared.

Step 2 - Convene a brainstorming session to identify forces of change
Next, the MAPP Committee should hold a brainstorming session to identify forces of change. Through facilitated and structured brainstorming discussions, committee members share ideas, identify new forces, and develop a comprehensive list. Once a comprehensive list of forces has been developed, the MAPP Committee (or a small group of designated individuals) reviews and fully discusses each item on the list. An organized list is developed by combining similar or linked forces. Other items on the list may need to be deleted, added, or further refined.

Step 3 - Identify potential threats and opportunities for each force of change
Committee members evaluate each force, and for each, identify associated threats and opportunities for the community and the local public health system. In some cases, a force might only be identified with a threat, while in other instances it may be perceived as both a threat and an opportunity.

The final list is tabled until it is time to conduct the Identify Strategic Issues phase of the MAPP process. Participants then review each of the issues identified in the other MAPP assessments in light of the forces of change, and discuss the associated threats and opportunities. This activity ensures that strategic issues are relevant to the changing environment.

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