Section 13. MAPP: Mobilizing for Action through Planning and Partnerships

Introduction

Mobilizing for Action through Planning and Partnerships (MAPP) is a framework for community health assessment and improvement planning developed by the National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC). MAPP outlines a three-phase process for communities to assess their public health needs and resources through a community health assessment (CHA), prioritize issues for improvement, and develop a collective community health improvement plan (CHIP) to address priorities and achieve health equity. The goal of MAPP is to achieve health equity, defined as “the assurance of the conditions for optimal health for all people (Jones, 2014).”  MAPP has tools to examine the root causes of health inequities and social determinants of health to understand what is behind health inequities. It requires cross-sector collaboration among organizations to address these drivers, and broad engagement of community members for a community-owned process.

How to Access MAPP 2.0

MAPP 2.0 includes the following materials which are available for free download at Mobilizing for Action through Planning and Partnerships (MAPP) - NACCHO

1. MAPP 2.0 User’s Handbook
2. Starting Point Assessment
3. Community Partner Assessment
4. Community Status Assessment
5. Community Context Assessment
6. Power Primer
7. Supplemental Tools: A downloadable folder of editable documents to use throughout MAPP

What is MAPP 2.0?

Mobilizing for Action through Planning and Partnerships (MAPP) is a framework for community health assessment and improvement planning. Through a three-phase process with unique tools and assessments, MAPP helps communities assess their public health needs and resources, prioritize issues for improvement, and develop collaborative community-wide strategies to achieve health equity.

History Of MAPP

MAPP was originally developed in 2001 by the National Association of County and City Health Officials (NACCHO) with support from the Centers for Disease Control and Prevention (CDC) as a framework for assessing and addressing community health needs with active community involvement. After a national evaluation of MAPP in 2019 and feedback from MAPP users, MAPP was updated to “MAPP 2.0” in 2023. MAPP 2.0 is grounded in a set of foundational principles promoting health equity and community engagement throughout the entire MAPP process. Read more about the history of MAPP in the MAPP Blueprint Executive Summary (PDF) (NACCHO, 2020), which outlines the history of MAPP and the original recommendations for MAPP’s redesign.

Why is MAPP Used?

MAPP is used to systematically identify what the most pressing issues are affecting population health at the community level and to make an actionable, realistic plan for how those issues can be addressed through the collective efforts of organizations and agencies across the entire community. 

Addressing Health Equity through MAPP

The goal of MAPP is to achieve health equity, which is “the assurance of the conditions for optimal health for all people (Jones, 2014).” To achieve health equity, communities need to explore what root causes are driving health inequities — “differences in the distribution of disease, illness, and death that are systematic and unjust, actionable, and associated with imbalances in political power.  (Whitehead, 1992).” MAPP helps communities explore what factors and conditions contribute to these unjust differences in health outcomes.
MAPP includes a reference tool, the Health Equity Action Spectrum, to explain the different kinds of factors that contribute to poor health outcomes: 

• Health outcomes and behaviors (right): These can be measured to understand a community's current health status. This includes rates of illness, disease, and death, as well as the prevalence of healthy and unhealthy behaviors, such as exercising regularly or smoking tobacco.
• Social determinants of health (middle): These are living and working conditions in the community that contribute to the health outcomes and behaviors on the right. In this model, social determinants of health include service conditions, physical conditions, social conditions, and economic conditions. See examples in the graphic below.
• Root causes (left): The root causes of inequity are the many underlying factors, such as a society’s norms and values, culture, institutions, narratives, etc., that perpetuate discriminatory belief systems and ideologies.

 

 

Example: Redlining

Redlining can be defined as “a discriminatory practice that consists of the systematic denial of services such as mortgages, insurance loans, and other financial services to residents of certain areas, based on their race or ethnicity (Cornell Law School Legal Information Institute, n.d.).”  This housing policy “blocked Black households and other communities of color from accessing home mortgages – and as a result homeownership – for decades (Gerken et al., 2023).” This was during a time of suburbanization, so Black households were left to stay in central cities while the population declined and investment in public services declined. In this example, this institution represents a “mechanism of power” influenced by, and perpetuating, racism. This, in turn, leads to residents of color experiencing poorer housing quality, healthcare access, and/or economic stability (the social determinants of health), resulting in inequitable health outcomes among those racial and ethnic groups who were discriminated against.  
 

These root causes of inequity must be confronted, understood, and resolved. MAPP helps communities assess the health status of their community and take action to address the underlying factors to see positive change in population health. 

The Foundational Principles of MAPP

The Foundational Principles were developed during the redesign of MAPP to MAPP 2.0 as the guiding values for all updates to the framework. Each step and tool of MAPP 2.0, the current version of MAPP, is grounded in these foundational principles: 

• Equity: Encourages shared exploration of and community action to address the social injustices that create and maintain inequities. 
• Flexible: Meets the needs of diverse MAPP communities through an adaptable framework. 
• Continuous: Promotes continuous learning and improvement through multiple cycles of community assessment, planning, action, and evaluation. 
• Community Power: Builds community power to ensure those most impacted by inequities are those who guide the process.
• Inclusion: Fosters belonging by identifying and removing barriers to community participation. 
• Trusted Relationships: Builds connection and trust by honoring the knowledge, expertise, and voice of community members and stakeholders. 
• Data and Community Informed Action: Identifies priorities, strategies, and action plans based in data of community needs.
• Strategic Collaboration and Alignment: Creates a strategy to improve community health that aligns the missions, goals, resources, and reach of partners across sectors.
• Full Spectrum Actions: Encourages community improvement through approaches addressing root cause, social determinants of health, and health outcomes that enable health and well-being for all.  

Read the full definitions of the Foundational Principles in the MAPP 2.0 Handbook (PDF), available at Mobilizing for Action through Planning and Partnerships (MAPP) - NACCHO

When Should You Use MAPP?

MAPP is an appropriate framework to use for projects designed to assess health needs of a community and develop an actionable plan to address them with collaboration of agencies, organizations, groups, and individuals across the community.

There are certain circumstances that may indicate that a community health improvement process using MAPP would be beneficial:

1. When there is an interest in exploring root causes of inequity. More sectors are continually becoming interested in understanding how social and systemic factors influence the well-being of the public. This can be seen in public health, education, healthcare, economic development, food security, and more. If shared root causes are coming to the attention of multiple sectors in the community, it may be helpful to explore them together.
2. When there’s been an issue or crisis that resulted in lessons learned. When an epidemic, pandemic, community-wide infectious disease outbreak, or natural disaster occurs, the community may be interested in evaluating its public health system as it strives toward a healthy community.
3. When it is mandated. Some municipalities or organizations may be required by the local, state, or federal government, or another authorizing body, to complete health improvement activities. These scenarios might prompt an organization to consider MAPP.
4. When there’s money available for public health improvement. State, federal, and international agencies, as well as private foundations, may sometimes offer grants to conduct a process such as MAPP.  Note that, with full community participation, a MAPP process could be conducted without outside funding.
   • See the Tool Box section on Chapter 42, Section 4. Applying for a Grant and Chapter 42. Section 5. Writing a Grant
5. When strategic planning across the community is needed for a specific public health priority. Although MAPP is intended to assess community health broadly, it can be adapted to guide a community-wide strategic planning process for a specific health priority. Current MAPP supplements can help guide this process to adapt MAPP for promoting healthy aging (pdf) and brain health (pdf). 

MAPP is an adaptable framework, meaning that the guidance, assessments, and tools can be modified to fit the specific needs of a community. For example, one community might use MAPP assessment tools for their entire community health assessment, while another may use the quantitative Community Status Assessment and the qualitative Community Context Assessment as written, but develop their own survey tool to use in place of the Community Partner Assessment (a mixed-methods tool that engages members of the local public health system to identify how well they are working together to achieve health equity). MAPP is used by cities and counties, regions (e.g., multiple counties working together on one CHI process), states, and Tribes.

Who is Involved?

MAPP is implemented by the entire local public health system, which includes all organizations, agencies, and groups that contribute to population health including those in education, transportation, urban planning, agriculture, and more. The social determinants of health and root causes of inequity, which drive differences in health behaviors and outcomes, cut across many aspects of our lives and require investment of many sectors to be improved. The “Local Public Health System Jellybean Diagram” below depicts this diverse network. The community at the center illustrates that public health is about the community’s health and not the work of any one organization. 

 

The following groups might be involved in MAPP to widely represent the community and the factors that contribute to community health:

• Community members: Remember that “the community” is at the center of the local public health system. The purpose of a CHIP process is to improve community health, so MAPP should actively involve community members to contribute their perspectives on how MAPP is implemented, their top health priorities, and the factors that contribute to and hinder community members’ opportunity for optimal health.
• Members of the local public health system:
  • Local, state, or Tribal health department: The local health department, in line with recommendations from Public Health 3.0, can act as a convenor of partners across the community to collaboratively address challenges. Local health departments are frequently leaders of MAPP processes, although it could be led by others.
  • Community-based organizations (CBOs): CBOs who offer health and non-health related services to the community should be involved in the MAPP process because of their proximity to community members and understanding of needs of specific populations. Residents may have more trust in CBOs than in government agencies or healthcare entities, so they provide a critical connection to community members, particularly those most negatively impacted by health inequities.
  • Health centers, including federally qualified health centers (FQHCs): Health centers provide valuable services to community members and increase access to care for many. They can provide valuable information about community needs and may offer insightful data about the region they serve. Health centers complete needs assessments every three years and may be interested in collaborating with other agencies through MAPP to complete their assessment.
  • Nonprofit hospitals: Nonprofit hospitals invest their profits into their community and offer a variety of services for free. They are important partners in MAPP due to their broad community reach, understanding of community needs through their community health needs assessment data, and potential ability to support future programming because of the CHIP.
  • Organizations who contribute to the social determinants of health include the following. See NACCHO’s toolkit, Using Healthy People 2030 to Develop Multisector Partnerships, for information about partnerships across the SDOH and how to use Healthy People 2030 objectives to address community issues:
    • Health care access and quality (e.g., social services organizations, public insurance)
    • Food security (e.g., food banks, supplemental nutrition programs (WIC))
    • Neighborhood and built environment (e.g., parks and recreation, transportation)
    • Education (e.g., department of education, community colleges)
    • Economic stability (e.g., housing agencies, unemployment support)
• Community power-building organizations: These groups are sometimes called “grassroots” organizations, “community organizers,” or “base-building groups.” They advocate for the needs of the community and needed changes, including those outside of government (Lead Local, n.d.).
• Resource contributors: Philanthropies, local foundations, grantors, or local businesses who can contribute resources such as funding to support staff time and purchasing of materials.

Different Agencies can use MAPP to Meet Accreditation Requirements and Organizational Standards

Multiple different types of organizations within healthcare and public health are required to complete some version of a community health assessment to maintain their organizational status, and MAPP can be used to meet those requirements:

• Health departments (local, state, Tribal) complete a community/state/Tribal health assessment and develop a community/state/Tribal health improvement plan every five years for accreditation or reaccreditation (The Public Health Accreditation Board is the national accrediting body for public health in the U.S.) See the MAPP 2.0 and PHAB Version 2022 Crosswalk (PDF) for information on how MAPP can be used to meet the most updated PHAB accreditation standards and measures.
• Health centers complete or update a needs assessment of their service area every three years (Requiring body: Bureau of Primary Health Care (BPHC) within the Health Resources and Services Administration (HRSA)), requirements).
• Nonprofit hospitals complete a community health needs assessment (CHNA) and develop a plan to address the needs every three years to maintain their 501(c)(3) nonprofit status (Authority: Internal Revenue Service (IRS)), requirements. 

Who Is Involved?

Engaging Community Members

The purpose of MAPP is to improve the health of residents within a community, so residents should be engaged in MAPP from the very beginning. Community members do contribute to MAPP by engaging in the assessments and highlighting health needs and resources available to address them, but they also contribute to implementing the process itself. Community members should be made aware of MAPP as a process that they can become involved in, whether it be in a leadership position to set the direction for the process, help design the assessments, or contribute to selecting priorities for the community health improvement plan. MAPP begins with a “Stakeholder and Power Analysis” to assess who in the community should be involved in MAPP based on whether the process will impact them (e.g., through a new program or initiative to address inequities resulting from the CHIP), and their knowledge of community needs.

Engaging partners across sectors

Organizations, agencies, people, and groups across the local public health system should be actively involved in MAPP. No one agency or sector can improve population health alone – it requires the investment of many different people across all sectors within the community who can provide insight on what gets in the way of health, what resources can be used or acquired to improve health, and what actions can be taken to improve conditions that contribute to health and serve the community. Partners become engaged in all areas and steps of MAPP, including serving on the leadership committees, on the Assessment Design Team that implements the community health assessment process, or the Priority Issue Sub-committees that carry out the actions of the community health improvement plan.

Conducting a community health assessment (CHA) of needs and resources

Conducting the community health assessment involves determining what the assessment will measure, how the tools will gather that information, and how the data will be analyzed to uncover community health priorities. The community health assessment brings together qualitative data in the form of direct interactions with community members through interviews, focus groups, town halls, or other methods; quantitative data, or information that can be counted, from existing (secondary) sources or by gathering new (primary) data; and an assessment of the local public health system itself to identify opportunities to better work together to achieve health equity. The leadership committees, partners, and community members are all involved in this process.

Developing a community health improvement plan (CHIP) to address needs

After conducting the community health assessment, partners and community members analyze the data of the three assessments through “data triangulation” and use a set of criteria to uncover the community health issues and determine which will be included in the community health improvement plan (the “priority issues”). Those included in the CHIP will be the focus of future actions, initiatives, or programs to work toward improvement. Developing the CHIP involves creating a set of goals and objectives for each priority issue to outline what progress is expected within the next 3–5 (or more) years and working with organizations across the community to determine what actions will be taken by those organizations to make improvements. This might involve starting up new programs, improving existing programs, collecting new data about services, or reallocating resources from one initiative to another.

Continuous Quality Improvement

MAPP involves principles and activities of continuous quality improvement to enhance how the MAPP process itself is implemented and to improve effectiveness of the community health programs that are implemented because of MAPP. 

The Three-Phased Process

MAPP outlines a three-phase process with steps and tools grounded in the Foundational Principles to complete these activities, described in the sections below.

1. Phase I: Build the Community Health Improvement Foundation
2. Phase II: Tell the Community Story
3. Phase III: Continuously Improve the Community

MAPP, and community health improvement, is a cyclical process. When Phase III of one cycle is finished, Phase I of the next cycle begins to revisit community and partnership engagement, evaluate what could be improved in the process from the last cycle, and prepare for an updated assessment.

How do you MAPP?

Phase I - Build the Community Health Improvement Foundation

 

Phase I includes activities that build commitment and ownership among a wide variety of participants to set the stage for the rest of MAPP. This phase includes building relationships with community members and organizations, so the people involved in MAPP represent the entire community.

The goals of Phase I are to: 

• Involve community members who represent populations experiencing inequities to guide and participate in MAPP planning ​
• Build strategic relationships with new and existing partners to engage throughout MAPP
• Establish the MAPP Core Group and Steering Committee that represent the community ​
• Develop a shared understanding of MAPP and the community’s vision for the future ​
• Evaluate what resources are available and needed to achieve MAPP’s goals effectively ​
• Create workgroups to build the infrastructure for CHI

There are seven steps within Phase I, described below.

 

Step 1: Do a Stakeholder and Power Analysis. MAPP begins with a Stakeholder and Power Analysis to create a list of potential people and groups to involve in MAPP based on an understanding of who could be affected by MAPP and who could have an impact on its success. The resulting list of groups and individuals is referenced throughout the rest of MAPP when opportunities arise to engage more people, and helps the community engage a wide array of community groups, community members, organizations, and agencies.

Example: City of Milwaukee’s Stakeholder and Power Analysis

The City of Milwaukee Health Department implemented the Stakeholder and Power Analysis as part of their 2023-2028 MKE Elevate community health improvement planning process. They utilized the MAPP planning spreadsheet and created an interview guide to conduct three interviews with community leaders. The interviews helped to uncover how the stakeholders might impact or be impacted by the MAPP process, deepened relationships with those stakeholders, and resulted in two of the three joining the MKE Elevate Steering Committee. This activity also resulted in a list of additional key stakeholders and a power analysis to help prioritize who to engage in the CHIP process. After priority issues were selected, the power analysis was repeated to inform specific strategies.
 

Step 2: Establish or Revisit CHIP Leadership Structures. Using the results of the Stakeholder and Power Analysis, convene the two committees who facilitate MAPP:

• Core Group: This is a small group of 2-3 individuals who manage the daily administration of MAPP (e.g., managing timelines, partner roles, funding, etc.)
• Steering Committee: A larger group of 10-20 individuals who include organizations across the local public health system and community members who provide direction to the MAPP process, similar to a board of directors.

Step 3: Engage and Orient the Steering Committee. The Steering Committee should be introduced or re-introduced to the MAPP process with each new MAPP cycle. Their orientation includes an overview of the MAPP process, opportunities for their participation, and health equity concepts. The Steering Committee develops a mission statement for their work together and values to guide how that work is done.

For example, a Steering Committee’s mission statement might be, "To better the health of county residents by building relationships, promoting healthy living, and advocating for lasting improvements across the community.”

Step 4: Establish Administrative Structures for MAPP. The community decides how the MAPP process will be administered, including how the logistics, funding, and partners are managed. For example, the Steering Committee could remain an informal coalition of partners, or they could become a formalized nonprofit organization with 501(c)(3) status to open more opportunities to receive funding. Guidance for arranging the administration, with insights on pros and cons of the various models, is included.

Step 5: Develop the Community Vision. The community vision is the long-term (10-15 year), aspirational goal for the community’s health. The vision is established through a facilitated, collaborative workshop among partners and community members. The vision statement depicts what the community is working toward through iterative MAPP cycles. The vision should be shared widely and recognized at each MAPP event.
For example, the community vision might be, “Our vision for a healthy future is a community in which every person can thrive physically, mentally, spiritually.”

Step 6: Do the Starting Point Assessment. The Starting Point Assessment (SPA) is a tool for continuous quality improvement. The SPA is used to assess performance in past MAPP cycles and set goals for improvement in the current cycle. The SPA explores six domains of a MAPP process: community engagement, partnerships, data and assessments, community health improvement plan priorities, leadership support for health equity, and resources and skills available. The Steering Committee uses the assessment questions and suggested metrics to assess those activities from their last MAPP cycle and set goals for improvement in the current cycle.

Step 7: Identify CHI Infrastructure Priorities and Develop Workgroups. The Steering Committee reviews the results of the Starting Point Assessment and prioritizes 2-5 continuous quality improvement goals for sub-committees called CHI Infrastructure Workgroups to address in the current cycle. For example, the community might create two CHI Infrastructure workgroups, with one dedicated to improving how community members are engaged throughout MAPP, and the other working to identify sustainable funding opportunities for the community health improvement work.

Step 8: Develop the Workplan and Budget. At this stage, the leadership committees have been formed, the vision for MAPP is set, and priorities to improve the current cycle are identified. The Steering Committee and Core Group can now build the workplan of key activities and budget to support them for the remaining two Phases of MAPP. 
 

Phase II - Tell the Community Story

Phase II is all about collecting data to tell the story of the community’s health and well-being. Guidance and activities within this phase support communities in conducting a community health (needs) assessment (CH[N]A) by exploring health outcomes and behaviors, social determinants of health (SDOH), and root causes among all sub-populations within the community.
The goals of Phase II are to:

• Engage the community in developing a comprehensive and timely CH[N]A
• Identify the top population health priorities and health inequities in the community, including their root causes

There are six steps within Phase II, described below.

Step 1: Form the Assessment Design Team. Phase II begins with forming the Assessment Design Team (ADT), which is a diverse team representative of the community that brings various areas of expertise and resources to coordinating the design, implementation, and interpretation of the three MAPP assessments. Having one team that is responsible for, and can participate in, all aspects of Phase II, ensures communities can easily find connections through the spectrum of indicators (from downstream to upstream) and use these connections to describe the extent of the health issues in their communities.

Step 2: Design the Assessment Process. Once the ADT is formed, they will identify guiding questions that the community is looking to answer through the CH[N]A. These guiding questions will inform the assessments and help the community understand what “big picture” information to collect. Once the guiding questions are chosen, the ADT will determine how data answers these guiding questions, identify current resources and activities that can be leveraged to help the community collect data, and refine the CHI workplan to note which order the assessments will be completed in.

Step 3: Do the Three Assessments. The three MAPP assessments are an essential component of Phase II, as they support communities in gathering data and information from several perspectives including qualitative and quantitative sources to deepen their understanding of health inequities. This involves examining a range of indicators, including health outcomes and behaviors, SDOH, and root causes of health, or systems of power, privilege, and oppression. The ADT works with a broad network of sectors and partners to guide their community through an analysis of historical and structural factors that reveal the root causes of inequity, while also ensuring that rich views and strengths-based data from lived experience is included.
The three MAPP assessments are described briefly below, but more detailed information regarding each assessment can be found in the below sections. Click the title of the assessment to jump to the detailed assessment overview.
The Community Partner Assessment (CPA) is used to understand partners’ individual systems, processes and capacities, and the collective capacity as a network to address health inequities.
The Community Status Assessment (CSA) collects quantitative data on demographics, health status, and health inequities and highlights inequities related to health outcomes and behaviors, SDOH, and systems of power, privilege, and oppression.
The Community Context Assessment (CCA) collects qualitative data on the insights, expertise, and views of people negatively impacted by inequities to understand the community’s strengths, assets, and culture.

Step 4: Triangulate Data, Identify Themes, and Develop Issue Statements. After the three MAPP assessments are conducted, the ADT will work with key influencers, partners, and community members to identify cross-cutting themes that are supported by the assessment findings through a data triangulation process. Issue statements will be developed for each, cross-cutting them to identify and summarize why and how the issue occurs, how serious it is, and its outcomes and impacts. 

Step 5: Develop Issue Profiles through Root Cause Analysis. Issue profiles are 1–2-page documents for each cross-cutting theme, or issue, that connect the status of the community’s health and well-being to potential strategies. They are used in the community’s full CH[N]A report to highlight key aspects of community health revealed by the data, when prioritizing which issues the CHIP will focus on, and when creating community partner profiles for the chosen priority issues in Phase III. Conducting a root-cause analysis, such as a Fishbone Diagram or 5 Whys, of each issue will help build out the components of an issue profile, as a root-cause analysis can help reveal the systems of power, privilege, and oppression that might be impacting health outcomes in a community.

Example from the Field: Johnson County Public Health in Johnson County, Iowa (Healthy JoCo) involved many key influencers, partners, and community members in their data triangulation process, which resulted in 13 issue profiles. They hosted a “Theme Matching Day” where key influencers, partners, and community members were asked to review data collected from the three assessments to develop themes that aligned with the following categories: health behaviors and health outcomes; social determinants of health; systems of power, privilege, and oppression; and community strengths and organizational capacity. Participants were able to visually see and organize the data along these categories and it allowed the group to identify gaps in the data. Healthy JoCo also conducted a community-wide survey to involve the broader community in this theming process in which participants were able to review the data and create their own themes within these categories. From the in person “Theme Matching Day” and the community-wide thematic survey, JoCo created 13 issue profiles that included the definition and summary, issue statement, prevalence and trends, equity, contributing factors, and community input and thoughts for all identified issues. JoCo used an online platform to share these issue profiles with their community. Visit the HealthyJoCo webpage for more information.

Step 6: Share CH[N]A Findings. Many communities will develop a written CH[N]A report, which allows them to include sections that align with assessment requirements for different requiring bodies such as PHAB, IRS, and HRSA. In addition to sharing a written report, communities should also consider sharing methods and platforms that can be updated annually and easily understood by community members. This includes online data dashboards, online summary reports, community presentations, or an interactive website.

The Three Assessments

Below are detailed overviews of the three assessment tools that make up the MAPP 2.0 community health assessment. These are conducted earlier in Phase II. 
 

Community Partner Assessment

The Community Partner Assessment (CPA) is designed to assess both the individual and collective capacities of community partners to improve health equity and strengthen the local public health system. In this assessment, organizations examine how they contribute to, or inhibit, progress toward health equity through a survey of each organization in the local public health system and a series of discussion meetings to consider opportunities for improvement in addressing systemic health inequities.
The CPA has five goals:

• Describe why community partnerships are critical to community health improvement (CHI) and how to build or strengthen relationships with community partners and organizations
• Name the specific roles of each community partner to support the local public health system (LPHS) and engage communities experiencing inequities produced by systems
• Assess each MAPP partner’s capacities, skills, and strengths to improve community health, health equity, and advance MAPP goals
• Document the landscape of MAPP community partners, including grassroots and community power-building organizations, to summarize collective strengths and opportunities for improvement
• Identify whom else to involve in MAPP and ways to improve community partnerships, engagement, and power-building

To achieve these goals, the CPA includes guidance to facilitate an orientation meeting for partners, a survey to gather information about the local public health system, and a series of discussion meetings to reflect on the findings and identify opportunities for improvement. 

• Orientation Meetings: The process begins with two orientation meetings for members of the local public health system who are invited to participate in the CPA. The meetings create a foundation for collaboration by introducing the purpose of the CPA and fostering trust among partners. These sessions clarify how different organizations contribute to public health, build consensus on shared values, and ensure that all voices are heard before moving into data collection and analysis.
• CPA Survey: The survey gathers data about organizational capacities, roles, and relationships between members of the local public health system to assess the strengths and gaps of the system. The survey is distributed to all participating organizations. The CPA findings are summarized into accessible and actionable results that provide a strong foundation for partner discussions and decision-making. Organize findings into “What’s working,” “What needs improvement,” and “Who else should be involved?” If qualitative responses are included, pull powerful quotes to highlight key insights
• Partner discussion meetings: Following the survey, the partners are engaged in facilitated conversations and activities to process survey findings, explore systemic challenges, and foster a collaborative approach to health equity. These conversations further build trust, challenge existing power dynamics among partners, and strengthen their commitment to advancing health equity. The discussions build a deeper understanding of how community partners can work together and lead to actionable strategies for improving public health systems.

Tips to Encourage Survey Participation

Surveys can feel like a burden to busy partners. Use these tips to increase participation:
•    Frame participation as a benefit and highlight how the data will be used 
•    Ensure survey questions are concise and relevant  
•    Offer multiple ways to complete the survey (online, paper, or interviews)
•    Set clear deadlines, but allow room for flexibility if needed
•    Send personal reminders to complete the survey

Results of the CPA survey and discussion meetings are summarized in a final report of key findings and themes (e.g., LPHS strengths, capacities, and challenges advancing equity), and recommendations to guide public health decision-making. A draft of the report should be shared with partners for feedback and revisions, published as part of the comprehensive community health assessment. 

Community Status Assessment

The Community Status Assessment (CSA) is a quantitative tool used to collect data about the demographics, health status, and health inequities of a community. It helps a community move upstream and identify inequities beyond health outcomes and behaviors, including their association with the SDOH and systems of power, privilege, and oppression.

The CSA helps a community answer the following questions:

• What does the status of your community look like, including health, socioeconomic, environmental, and quality-of-life outcomes?
• What populations experience inequities across health, socioeconomic, environmental, and quality-of-life outcomes?
• How do systems influence outcomes?

To answer these questions, the CSA encourages communities to identify and select indicators across levels of influence: individual, family, organizational, community, policy, and systems. Indicators are measures that describe community conditions (e.g., poverty rate, insecure housing rate, food insecurity, life expectancy at birth, heart disease mortality rate) now and over time. Identifying indicators that represent health status, behaviors, and outcomes; SDOH; and systems of power, privilege, and oppression will help tell the full story of the community, including the root causes of inequities impacting the community.

Example Indicators

These are some examples of indicators across the Health Equity Action Spectrum:

• Health status: Life expectancy, unhealthy mental health days, unhealthy physical days, self-reported fair/poor health
• Disease/injury: Heart disease prevalence, diabetes prevalence, STD infection rate, nonfatal injury
• Health behaviors: Physical inactivity, teen births, alcohol use, smoking and tobacco use
• Mortality: Infant mortality rate, maternal mortality rate, drug overdose deaths
  Social Determinants of Health:
  • Neighborhood and Built Environment: Air quality, walkability index
  • Economic stability: Children in poverty, living wage, unemployment
  • Social and community context: Social associations, violent crime
  • Healthcare access and quality: Access to primary care, uninsured
  • Education access and quality: High-school drop-out rate, preschool enrollment
• Systems of power, privilege, and oppression: Residential segregation, eviction rate, voter turnout, police officers, employment-population ratio

For more examples of these indicators, see the CSA Indicator Matrix within the CSA tool.

Communities are encouraged to identify and collect two types of data on their chosen indicators:

•  Primary data – Data collected by the researcher (e.g., community-wide survey)
• Secondary data – Existing data or data collected by someone else (e.g., Census Data)

This allows for an opportunity for communities to identify data that they and their partners have already collected (secondary data) on the chosen indicators and then create a data collection plan to collect primary data to fill in any data gaps that are left after identifying available secondary data. 
As the CSA is a community-driven assessment, it is important that community members are involved in all aspects to ensure that this assessment reflects them and the community’s unique characteristics. Community members should be involved in determining the purpose of the CSA; identifying indicators to inform the CSA; data collection, organization, analysis, and interpretation; and presenting and sharing the results of the CSA.

Example from the Field: A Tribal community in the Great Plains offers an example of a community-centered approach to data collection in a rural, reservation-based context. Tribal health administrators worked with an external institute to collect data on adoption programs in the Tribal community. They traveled to communities within the reservation and talked to birth mothers who had placed children for adoption. Before each visit, they promoted the project and shared when they would be there through flyers, radio, and local newspapers. They centered local voices by working with a student who lived on the reservation and helped interview birth mothers. They brought a meal to the community during visits. This respectful strategy led to successful data collection.
 

Community Context Assessment

The Community Context Assessment (CCA) is a qualitative tool to gather community members’ perspectives on the factors that contribute to their health. The CCA explores three domains:

• Community Strengths and Assets: Skills, abilities, and gifts within community members that contribute to the community’s health. For example, creativity and art, education and support of others’ education, communication skills, and healing practices.
• Built Environment: Human-made, physical aspects of the community that contribute to, or hinder, health. For example, housing, green space, public art, bike lanes, public bathrooms, and public transportation.
• Forces of Change: Events that have happened in the past are happening now, or could happen in the future that impact the community’s health. They include trends over time (an aging population or climate change), factors specific to the community (rurality, presence of immigration detention centers), or events (a major employer leaving or coming to the community, a natural disaster).
   

The CCA employs qualitative methods to gather community insights on these domains. Qualitative methods gather non-numerical data and may include focus groups, key informant interviews, windshield or walking surveys, community dialogues, town halls, archival research and analysis, policy analysis, or photovoice.

The CCA is aimed at gathering insights from community members who are most directly, negatively impacted by health inequities so that they can provide insight into what may be contributing to those inequities. This will help the community prioritize the most pressing issues for community members who are most impacted by inequities, and identify solutions to those issues that are relevant to them.
 

Phase III - Continuously Improve the Community

Overview

Phase III is the culmination of the MAPP 2.0 process, where the strategic groundwork established in earlier phases is transformed into actionable efforts. This phase focuses on developing and implementing a Community Health Improvement Plan (CHIP), a three-to-five-year roadmap to address key public health priorities. The CHIP emphasizes equity by targeting the root causes of health disparities and leveraging social determinants of health (SDOH) to create sustainable change. With community collaboration at its core, Phase III ensures that public health improvement efforts are inclusive, data-driven, and continuously refined through methods like continuous quality improvement (CQI) and rapid cycle improvement.

By emphasizing shared goals and partnerships, this phase sets the stage for collective action and accountability. Communities examine where they are, where they want to be, and how they will achieve their vision. Transformational approaches are prioritized to shift systemic inequities, and strategies are tailored to maximize impact and sustainability. Throughout this process, Phase III keeps equity at the forefront by involving diverse stakeholders and ensuring that resources and actions align with the needs of those most affected by health disparities.

Step 1: Prioritize Issues for the CHIP: The first step in Phase III is prioritizing the strategic issues identified during Phase II. Communities select three to five critical issues that reflect their vision and address the most pressing health challenges. Prioritization is guided by a facilitated process (e.g., multi-voting, prioritization matrices) and criteria such as the issue’s relevance to community members, its magnitude and urgency, the availability of solutions, and the potential for upstream interventions to address root causes. This step ensures resources are directed toward manageable goals, maximizing the potential for meaningful change.
 

Example from the Field: Lawrence-Douglas County Public Health, KS had 14 issues from their CHA. From this number, they prioritized 6 issues for their 2024-2028 CHIP. This included two sustaining issues—safe and affordable housing and behavioral health— from past cycles and 4 new emerging issues: Access to Health Services, Birth Outcomes, Food Security and Jobs, living wage, poverty.

Step 2: Conduct Power Analysis on Each Issue. Once priorities are established, a power analysis is conducted to identify the systems, organizations, and individuals influencing each issue. This analysis helps uncover the factors perpetuating problems, as well as opportunities to build influence among those most impacted. Stakeholders are categorized based on their level of power and support for addressing the issue, creating a strategic map for engagement.

For instance, when addressing housing insecurity, a power analysis might reveal that local policymakers and housing developers hold significant influence over zoning and resource allocation. At the same time, community-based organizations may be strong allies but lack decision-making power. Engaging high-power supporters, shifting power to underrepresented voices, and finding common ground with opponents will be important for making progress. The Stakeholder and Power Analysis from Phase I can be referenced here, and a power mapping exercise is used to visualize these relationships and guide targeted outreach and collaboration.

Step 3: Form Priority Issue Subcommittees. Effective implementation of the CHIP relies on forming subcommittees dedicated to each priority issue. These groups consist of community members, partners, and stakeholders who bring diverse expertise and lived experiences. Subcommittees develop goals, strategies, and action plans while fostering accountability throughout the process.
Membership selection is informed by the Stakeholder and Power Analysis in Phase I, as well as power mapping from Phase III, Step 2. For example, a subcommittee addressing mental health disparities might include public health officials, mental health providers, advocacy groups, and residents from underserved communities. Each subcommittee is guided by a chair who facilitates meetings, tracks progress and ensures alignment with the overall CHIP. By involving those directly impacted by the issues, subcommittees build trust, strengthen partnerships, and ensure the CHIP reflects community priorities.

Step 4: Create Community Partner Profiles. To achieve health equity and ensure the success of the CHIP, Phase III emphasizes the strategic alignment of community partners. Partners are critical for implementing the CHIP effectively. This step involves creating comprehensive profiles for each partner, capturing their values, mission, resources, and programmatic efforts related to the identified priority issues. The profiles provide a structured way to understand how each organization’s work aligns with the goals and priorities of the CHIP. Information collected includes organizational missions, resources available to support CHIP activities (e.g., funding for community engagement, meeting spaces, data-sharing capacities, or technical expertise), current programs (e.g. current advocacy efforts), and the populations they serve. 

Step 5: Develop Shared Goals and Long-Term Measures. Subcommittees work collaboratively to establish broad, long-term goals for each priority issue, supported by shared measures that track progress. Goals should be transformational, aiming to address systemic inequities and achieve the community’s vision. For example, a goal to improve access to healthcare might focus on reducing transportation barriers and increasing provider availability in rural areas.
Shared measures provide a framework for accountability and collective impact. These metrics, such as the percentage of uninsured residents or the availability of public transit options, are agreed upon by all partners to ensure alignment and transparency. Subcommittees use assessment data, issue profiles, and community strengths to inform their decisions, ensuring goals are achievable and grounded in evidence.
 

Transactional vs Transformational Goals

As you form goals, it is important to think about whether your approach is transactional or transformational. Transactional goals address immediate needs but don’t change the conditions that created the problem. Transformational goals shift policies, systems, and power structures to create lasting change.

An example of this goal shift, related to diabetes is: 

•  Transactional: Increase access to diabetes management program.
• Transformational: Change food policies to make fresh, healthy food affordable, and accessible in every neighborhood

This shift focuses on moving from short-term, individual interventions, like increasing access to programs, to addressing root causes through systemic changes, such as altering policies to make healthy food accessible for all.
 

Step 6: Select CHIP Strategies. Strategies are the actions communities take to achieve their goals. These may include policy changes, programmatic interventions, or system-level reforms. Communities prioritize strategies based on their feasibility, impact, and alignment with equity principles. For instance, addressing food insecurity might involve creating a local food hub, advocating for policy changes to support urban agriculture, or expanding food assistance programs.

To ensure success, communities use tools like rapid cycle improvement (Plan-Do-Study-Act) to test and refine strategies. Evidence-based practices and community-driven solutions are prioritized to ensure relevance and effectiveness. Subcommittees also consider the barriers to implementation, such as resource constraints or opposition, and develop plans to address them.

Example from the Field: County of San Luis Obispo Public Health Department, CA implemented a health equity-centered SDOH-level strategy to address farm workers’ health. During the COVID-19 pandemic, they convened a task force of representatives who serve the Latinx/Mixteco communities to advise the LHD on its response and to share information with the community about COVID-19 testing, vaccines, and recovery. This task force, which has simultaneous Spanish and English interpretation, continues to meet monthly and has expanded its scope to share resources and include other topics of interest to the farm worker, Latinx, and Mixteco communities including a focus on other diseases including MPX, Valley Fever, and Heat Stroke/Exhaustion, and issues such as mental health resources, especially for youth; housing, and unemployment benefits.

Step 7: Develop CQI Action Plans. Action planning is a cornerstone of Phase III, translating goals and strategies into detailed steps that guide implementation. Plans include specific objectives, timelines, and responsibilities, ensuring all participants are accountable. Continuous quality improvement (CQI) cycles are embedded in this process to allow for regular evaluation and adaptation.
For example, an action plan to reduce childhood obesity might include objectives like increasing physical activity in schools, launching community education campaigns, and expanding access to healthy foods. Each objective is tied to measurable outcomes, such as the percentage of children meeting physical activity guidelines. CQI cycles help track progress, identify challenges, and refine interventions to maximize impact.

Step 8: Monitor and Evaluate the CHIP. The final component of Phase III is monitoring and sustaining the CHIP. Regular evaluations ensure strategies are implemented as intended and are achieving their desired outcomes. Communities track process metrics, such as the number of participants in a new program, and outcome metrics, like changes in health indicators.
This step emphasizes transparency and community involvement. Sharing progress through dashboards, reports, or public meetings keeps stakeholders informed and engaged. For instance, a community might host quarterly forums to update residents on CHIP activities and gather feedback. By continuously monitoring and adapting the CHIP, communities ensure their efforts remain responsive to changing needs and priorities.

Conclusion

Phase III represents the culmination of the MAPP process, where planning becomes action. By prioritizing equity, fostering collaboration, and using data-driven approaches, communities create sustainable systems of health improvement. This phase empowers local health departments and their partners to address root causes, uplift marginalized voices, and achieve their shared vision of a healthier future.

A Cyclical Process

MAPP, and community health improvement, is a cyclical process. As the community health improvement plan is being implemented, the community will look toward starting up their next Phase I to prepare for an updated community health assessment. Each cycle of MAPP should build upon the last, incorporating lessons learned about how to facilitate the process, who to engage and how, and how to ground the process and vision in equity.

Power Primer

The Power Primer is an optional supplemental tool to MAPP. The Power Primer explains why and how to address power dynamics within MAPP, acknowledge societal power imbalances as a root cause of health inequities, and support building community power throughout MAPP and community health improvement. It is intended for communities who have an established understanding of health equity and how to assess and address health inequities. These communities can use the Power Primer to confront power dynamics within their own MAPP process, to better support building the power of community members as they are involved in MAPP. 
The Power Primer is based on the Power Framework, which presents a cycle of seven Power Practices for the Steering Committee and key partners in MAPP to complete:

1. Process: Unpack personal and organizational power and privilege by reflecting on experiences of power, privilege, and oppression as individuals, and to name power dynamics within the organization(s).
2. Form: Build a container for your work to challenge existing group dynamics and prioritize relationships, trust, and authenticity in your work with each other to unpack and understand power.
3. Study: Learn about the community’s histories to understand why and how inequities came to be.
4. Build: Grow relationships with communities and new partners.
5. Share: Practice power sharing with partners and communities, letting go of historic or status quo practices that have maintained power and advantage for some.
6. Strategize and Act: Implement, amplify, and invest in community-identified priorities and solutions.
7. Evolve: Reflect on process, outcomes, accountability, and sustainability of the MAPP and CHI process, and implementation of these power practices.
    

The Power Primer includes suggested activities for each of the seven Power Practices to be used throughout MAPP. Download the Power Primer (PDF) via the NACCHO Toolbox.

In Summary

Mobilizing for Action through Planning and Partnerships (MAPP) is an effective process for community health improvement that has been tested and informed by public health practitioners nationwide for over twenty years. The most updated version, MAPP 2.0, centers principles of health equity and community engagement. MAPP engages individuals, organizations, agencies, and groups across the community to identify their top health priorities and address them through a collective action plan. It can be used any time there is a pressing health priority that requires broad community investment or a desire from partners across sectors to address shared, underlying root causes of inequities. 

Additional Resources

The following resources may be helpful to communities implementing MAPP:

• NACCHO’s MAPP Webpage includes links to the following:
  • Downloadable MAPP materials: Access the MAPP 2.0 Handbook and all supplemental tools to the framework mentioned above
  • Training information: Details about in-person trainings that walk through the entire MAPP 2.0 process
  • Technical assistance: Guidance to request technical assistance from NACCHO’s MAPP team
  • Supplemental resources: Tools that provide information about how to integrate MAPP with specific public health focus areas (e.g., this guide to Explore Healthy Aging Data through Community Health Improvement (PDF), developed with Trust for America’s Health), or align MAPP with other public health frameworks, (e.g., this MAPP 2.0 and PHAB Version 2022 Crosswalk (PDF) that aligns MAPP 2.0 with public health accreditation standards and measures)
• MAPP Network Virtual Community: The MAPP Network is a virtual community for individuals and organizations who are interested in the MAPP framework for community health improvement. It offers:
  • Tool Repository: Reference materials and templates for your CHI process
  • Discussions: Open forum discussion boards
  • Strategy Bank: Community health improvement plan activities from local health departments and their communities
  • Example CHIPs: Example MAPP community health improvement plan.
  • CHI Webinar Warehouse: Recommended CHI and MAPP 2.0 virtual recorded sessions
    • Asynchronous Trainings: Eleven (11) pre-recorded overviews of each phase and tool of MAPP 2.0
  • Examples from the Field: Story Bank of MAPP communities’ experiences using the framework
• Email [email protected] with questions and to request technical assistance