A community health needs assessment (CHNA) is a systematic process for identifying the most pressing health problems in a defined geographic area and figuring out what resources already exist to address them. It combines hard data (disease rates, demographics, hospital visits) with direct input from residents to build a picture of where a community’s health is falling short. The end product is a report that ranks priority health issues and lays the groundwork for targeted action plans.
Why CHNAs Exist
The core purpose of a CHNA is straightforward: you can’t fix health problems you haven’t measured. Local leaders and healthcare organizations use the assessment to understand which issues are most urgent, what’s already being done, and where gaps remain. That might mean discovering a spike in diabetes rates in a specific neighborhood, or learning that residents in one ZIP code have no nearby urgent care facility and limited public transportation to reach one.
CHNAs also serve a legal function. The Affordable Care Act of 2010 requires every nonprofit hospital in the United States to conduct a CHNA at least once every three years and to adopt a written plan, called an implementation strategy, for addressing the needs it uncovers. This requirement falls under Section 501(r) of the IRS tax code, and hospitals must meet it on a facility-by-facility basis to maintain their tax-exempt status. The implementation strategy must be formally adopted by the hospital’s governing body within about five months of the end of the tax year in which the CHNA is completed.
Who Conducts Them
Both nonprofit hospitals and local health departments carry out community health assessments, though their motivations differ. Hospitals are driven largely by the federal tax requirement and their obligation to provide community benefit. Public health departments, on the other hand, conduct assessments as part of their core mission to monitor population health and plan prevention programs. Health departments seeking national accreditation are expected to complete their own community health assessment in collaboration with local partners.
In practice, these efforts often overlap. A national survey of local health departments found that 58% of those collaborating on a CHNA jointly conducted an assessment that served both the health department’s needs and the hospital’s regulatory requirement. About 53% of health departments helped hospitals engage community organizations and residents in the process. This kind of partnership reduces duplicated effort and tends to produce a more complete picture of community health.
How the Process Works
While no two assessments look exactly the same, the CDC outlines a common framework with several phases that often run in parallel:
- Organize and plan. The hospital or health department assembles a steering committee, defines the geographic boundaries of the community being assessed, and sets a timeline.
- Engage the community. Federal requirements specify that the process must involve people with public health expertise as well as leaders and representatives of medically underserved, low-income, and minority populations.
- Collect and analyze data. Teams gather both quantitative and qualitative information (more on this below).
- Prioritize health issues. Stakeholders review the findings and rank the most significant needs based on severity, scope, and the community’s capacity to address them.
- Develop an implementation strategy. For each prioritized need, the organization outlines specific actions it will take, resources it will commit, and how it will measure progress.
- Monitor and evaluate. The plan is revisited regularly and must be updated at least every three years, or sooner if a major change in community health status occurs.
Where the Data Comes From
A strong CHNA draws on two broad categories of information. Secondary data is existing information pulled from public sources: Census Bureau demographics, state and county vital statistics (birth and death records), hospital utilization data, and population-level health surveys. These datasets reveal patterns like rising rates of chronic disease, gaps in insurance coverage, or disparities across racial and income groups.
Primary data is collected firsthand from the community itself. The most common methods are surveys distributed to residents, focus groups with specific populations (parents of young children, older adults, people experiencing homelessness), and one-on-one interviews with key informants like physicians, social workers, school nurses, and elected officials. Many hospitals use all three methods together. A children’s hospital might survey families about nutrition and exercise habits, then hold focus groups to dig deeper into barriers to care. The qualitative side of the assessment captures things that numbers alone miss: why people skip preventive screenings, which neighborhoods feel unsafe for walking, or how long the wait is to see a mental health provider.
Beyond Clinical Health: Social Determinants
Modern CHNAs go well beyond disease rates and hospital visits. They increasingly examine social determinants of health, the non-medical factors that shape whether people get sick in the first place. Housing quality and affordability, food access, transportation, neighborhood safety, educational attainment, and employment all show up as priority areas in recent assessments.
These factors are deeply interconnected. A community with limited public transit, for example, may also have residents who struggle to reach grocery stores, primary care clinics, or job training programs. One assessment in Austin and Travis County, Texas, elevated transportation as a central cross-cutting theme because it affected nearly every other health priority in the plan. In Norwalk, Connecticut, the assessment recommended improving pedestrian infrastructure and active transportation options as strategies to address chronic disease and obesity. When a neighborhood lacks nearby clinics and has no urgent care or emergency facilities, transportation becomes a health issue in its own right.
What Happens After the Assessment
The CHNA report itself is only the starting point. The implementation strategy that follows is where commitments become concrete. For each prioritized health need, the hospital or health department spells out what programs or policy changes it will pursue, what partners it will work with, and what outcomes it expects to achieve. If the assessment identifies a shortage of affordable mental health services, for instance, the implementation strategy might include expanding telehealth counseling, funding community-based support groups, or partnering with schools to place behavioral health staff on campus.
Organizations aren’t expected to tackle every need the assessment uncovers. They prioritize based on the severity of the problem, the number of people affected, and what they’re realistically positioned to do. For needs they choose not to address directly, they typically explain why and note which other organizations in the community are working on those issues.
How to Find Your Community’s CHNA
Nonprofit hospitals are required to make their completed CHNA reports widely available. In practice, most hospitals post the full report as a downloadable PDF on their website, often under a “community benefit” or “community health” section. You can also search for a specific hospital’s CHNA on its IRS Form 990 Schedule H, which is publicly accessible through the IRS or nonprofit transparency sites. Local health departments frequently publish their own community health assessments on their websites as well, sometimes with interactive dashboards showing health data by neighborhood or demographic group.
Reading your local CHNA can be genuinely useful. It tells you what your community’s biggest health challenges are, what resources are available, and what specific organizations have committed to doing about them over the next three years. If you’re involved in local advocacy, public health, education, or social services, it’s one of the most data-rich documents available about the place where you live.