The first step in planning a public health intervention is to write a problem statement that clearly describes the problem.

A health problem is defined as:

the difference between the desired health status of a population and the actual health status of the population as measured by health status indicators.

How To Do It

Briefly state the problem by answering these questions:

• What "should" be occurring? (for example: Based on the national average, no more than 20% of adolescents under age 18 in our community should smoke more than three cigarettes per day.)
  
  
• What is occurring? (for example: A recent survey among adolescents under age 18 in our community reported that 56% of these youth smoke at least three cigarettes per day.)
  
  
• What could happen if the problem is not addressed? (for example: The high rate of smoking among youth in our community may lead to an increasingly higher rate of smoking among adults in our community.)

You can approach this task in many ways. For example, you can define the health problem by describing the difference between desired health status and actual health status using one or more of the following health indicators:

• Death (for example: the number and rate of deaths)
  
  
• Illness (for example: the incidence or prevalence of diseases, either an acute communicable disease like measles or a chronic condition like asthma)
  
  
• Injuries (for example: the number of injuries sustained in a particular activity, such as, children injured on playgrounds or on bicycles)
  
  
• Disabilities (for example: the number of people permanently disabled, such as, work disabilities or those resulting from automobile accidents)
  
  
• Reasons for death, illness, injury, and disability:
  
  • genetic (such as, the incidence of PKU, hemophilia, or sickle-cell anemia)
  • biological (such as, pathogens)
    
  • cognitive (such as, lack of knowledge concerning health hazards)
    
  • psychomotor (such as, lack of skills needed to engage in health-enhancing behavior)
    
  • psychological (such as, mood or personality disorders)
    
  • behavioral (such as, sedentary lifestyle or unhealthy diet)
    
  • social (such as, lack of social support)
    
  • environmental factors (such as, poor air quality or dangerous roads)
    
    
• Community services (for example: access to or availability of community services such as health, social, and recreational services)

Health problems can be assessed based on subjective or objective information. Ideally, this information can help determine if difference exist between what experts and/or the community sees to be an acceptable state of public health affairs and the actual state of affairs. In other words, the difference between what should happen and what is actually happening.

You can objectively identify these differences with the help of various sources like the following:

• Vital records
  
• Hospital records
  
• Primary care records
  
• Reportable disease statistics
  
• Accident reports
  
• Data registries (for example: birth and death registry data)
  
• Surveillance systems
  

The information sources listed above can be accessed through these sites or organizations:

• Centers for Disease Control and Prevention (http://www.cdc.gov)
  
  
  • National Center for Health Statistics (http://www.cdc.gov/nchs/)
  • Behavioral Risk Factor Surveillance System (http://www.cdc.gov/brfss/)
  • Morbidity and Mortality Weekly Report (http://www.cdc.gov/mmwr/)
    
    
• National Institutes of Health (http://www.nih.gov)
  
  
• State and local health departments (See Resources)

At the end of this step, you should have written a brief problem statement using health indicators and a variety of sources.