Assess the Health of the Population

Disclaimer: Having trouble viewing the contents of this site? Update your internet browser to the latest version for the best viewing experience. A PDF version of this page is available.

Population health planning starts with an assessment of whole populations and groups within that whole. It requires looking at not only health status, but the factors and environments that influence health and well-being.

This can be achieved by gathering and analyzing:

  • Quantitative data - information that can be measured in numbers and may indicate prevalence and trends. Because it can be measured in numbers, this type of data lends credibility to your assessment.
  • Qualitative data - information that is non-numeric. It can help with understanding the “why and how” of a population’s health status. Qualitative data can be gathered from surveys, focus groups, key informant interviews, environmental scans, and asset mapping.

Data and tools are included in the Resources at the end of this webpage, including the Washington State Health Assessment and an evidence based Guide to Effective Focus Groups.

Health Equity and the Social Determinants of Health

It’s essential to pay attention to health equity and the social determinants of health. Learn more by expanding the options below.

Health Equity

What is health equity and why is it important to population health?

Health equity means equal access to health (not just health care) for all members of our population. Partners will need to be alert to the unique strengths and vulnerabilities of specific populations within a patient panel or geographic region.

The Guide offers data and resources on health equity concerns specific to several priority health issues. In addition, the resources below offer guidance on applying a health equity lens to population health:

Department of Health’s website provides health equity definitions, literature and a Tool for Policy Planning.

Washington Health Alliance 2016 Disparities in Care Report offers information on disparities in care among minority populations in Washington State.

American Indian Health Commission (AIHC). A unique aspect to working with tribal partners is the sovereignty of American Indian and Alaska Native (AIAN) nations, and operating within the government-to-government relationship. Other important considerations include the overlap of tribal boundaries with health system regions, and the needs of the urban Indian population as Assess the Health of the Population contrasted with those living on reservations. New AIHC resource: Tribal Services Profile, providing geographic and demographic details along with information about health care and community services.

Foundation for Healthier Generations provides information on some of the nuances of health equity, including how it intersects with social determinants of health such as housing and employment.

The Centers for Disease Control and Prevention offers health equity resources about chronic disease prevention and health promotion. The site includes links to health equity information on specific physical and behavioral health issues.

Social Determinants of Health

According to Healthy People 2020, social determinants of health are conditions in which people live their lives that impact health and quality of life. These conditions are both physical and social.

How clean is the air? How safe are the streets? What about housing? Employment? These are all factors in population health and are important to consider when conducting an assessment. For example, if your community is focusing on prevalence of obesity and diabetes, are you also tracking access to healthy food and physical activity?

The Washington State Health Assessment includes a section about Social and Economic Determinants of Health, and social determinants data is included in data gathered by the Washington Tracking Network that allows for interactive searches.


Challenge: National or state data may not reflect your community, and local data may not be available.

Try: Engage community partners in local surveys, key informant interviews, and focus groups. If you have a nearby community college or university, contact a health occupations or sociology instructor to see if gathering local data could be a class or individual student project. For tools on gathering good qualitative data, see the Assessment Tools at the bottom of this page.


Challenge: Available data, even when local, may not provide enough data for a specific population.

Try: Reach out to local schools and nonprofit organizations. They may have data available and/or be able to help gather it. Explore grant and philanthropic funding to support the data gathering. Also, let your local health jurisdictions and tribal governments know what your data needs are. Your input can help their data teams plan future state and local assessments. 

Give us your feedback and we will share with appropriate local and state data stewards. Send comments to


Challenge: Data may not adequately reflect social determinants.

Try: Resources such as the Washington Tracking Network can help. Also, local government and community partners may have qualitative data to provide. Some communities have engaged partners and volunteers in Photovoice projects, to capture social determinant information in a way that can drive policy change.


Data Sources

Health-related data at the state and county level, primarily quantitative

  • Washington State Health Assessment identifies and prioritizes issues that affect the health of Washingtonians and includes data for health outcomes, health behaviors, access to care, the physical and built environment, and social determinants topics. The Executive Summary provides key population health highlights and analysis.
  • Washington Tracking Network provides information about the social determinants of health, including interactive dashboards, map layers, and a new tool for environmental health topic.
  • Healthier Washington Data Dashboard is an interactive tool for community assessments, with integrated data from multiple sources including Medicaid claims data. It is provided to all Accountable Communities of Health and local health jurisdictions.
  • Health of Washington State Report provides summary of information on health status, health risks and health care services in Washington, including health behaviors that influence outcomes.
  • Washington | County Health Rankings & Roadmaps offers county-level information with county health rankings.
  • Health Behaviors of Washington State provides data on behaviors and attitudes that affect health.
  • Behavioral Health Decision Support provides data on substance abuse and mental health.

Assessment Tools

Tools to help you gather information, including qualitative data