HLTH 6493 Module 3 Needs Identification and Prioritization Example

Seven Needs, Three Priorities: Using the Hanlon Method to Rank Health Needs in Robeson County, North Carolina

Student Name

American College of Education

HLTH6493: Community Health Analysis

Module 3 Assignment

Instructor Name

November 16, 2026

Introduction

The Module 1 profile found Robeson County, North Carolina, carrying heavy burdens of diabetes, high blood pressure, excess weight, cigarette use and missing teeth, along with widespread poverty, food insecurity, transportation barriers and lack of insurance. Module 2 mapped the county's assets, from churches and the Lumbee Tribe to UNC Pembroke, the health department and a community health center. No community can address every need at once, and a health improvement plan that tries to will spread its resources too thin. This paper identifies seven candidate needs, ranks them with a structured method, tests the leading candidates for feasibility and narrows them to three priorities for the improvement plan in Module 6.

Candidate Needs

Seven needs emerged from the profile, each well above state and national benchmarks in the CDC PLACES and census data. They are cardiometabolic disease, meaning diabetes at 16.4% of adults and high blood pressure at 42.9%, with obesity at 48.1%; tobacco use, with 23.1% of adults smoking; food insecurity, at 31.2%; oral health and dental access, with only 48.8% of adults visiting a dentist in a year and 31.1% of older adults having lost all their teeth; transportation barriers, at 17.6%; lack of health insurance, at 14.2% of residents; and mental distress, reported frequently by 20.9% of adults (Centers for Disease Control and Prevention, 2025; U.S. Census Bureau, 2025).

Why a Structured Method

Priorities set informally tend to follow the loudest voices, the latest crisis or the interests of the organizations at the table. A structured method makes criteria explicit and lets others see and challenge the reasoning. The Hanlon method, described in a classic public health administration text, rates each problem on its size, its seriousness and the effectiveness of available interventions, and it combines them in a formula that gives seriousness double weight and multiplies by effectiveness, so that a problem with no effective solution cannot rank high no matter how large it is (Pickett & Hanlon, 1990). A second screen, known by the acronym PEARL, asks whether action on each problem is proper, economically feasible, acceptable to the community, supported by available resources and legal.

Scoring the Needs

Each need was scored from 0 to 10 on size, based on prevalence and the number of people affected; on seriousness, based on severity, premature death, economic loss and effects on others; and on effectiveness, based on evidence for interventions that a county coalition could deliver. The priority score is size plus twice seriousness, multiplied by effectiveness. Cardiometabolic disease scored 8 for size, 8 for seriousness and 6 for effectiveness, for a score of 144. Tobacco use scored 6, 8 and 7, for 154, reflecting strong evidence for cessation support and smoke-free policies. Food insecurity scored 8, 7 and 5, for 110. Oral health scored 6, 5 and 6, for 96. Transportation scored 5, 5 and 5, for 75. Lack of insurance scored 4, 7 and 7, for 126; its effectiveness score is high because North Carolina's expansion of Medicaid in December 2023 means that enrollment assistance can now bring many uninsured adults into coverage. Mental distress scored 6, 7 and 5, for 100.

The Ranking and Its Sensitivity

By score, the order is tobacco use, cardiometabolic disease, lack of insurance, food insecurity, mental distress, oral health and transportation. Scores near one another should not be treated as meaningfully different; the gap between tobacco use and cardiometabolic disease reflects one point of effectiveness, and a different panel might reverse them. Raising the effectiveness score for food insecurity from 5 to 6, which is defensible given the county's farms, church kitchens and extension services, would lift it to 132, above lack of insurance. The method's value is not in the decimal places but in making each judgment visible so the community can argue with it.

The PEARL Screen

All seven needs pass the PEARL screen, with cautions. Tobacco control is proper and legal, but some policy options, such as local tobacco retail restrictions, may be limited by state law, so the plan should emphasize cessation support and voluntary smoke-free places. Cardiometabolic programs are acceptable and have resources through the health department, community health center and churches. Insurance enrollment is economically feasible because coverage brings federal and state dollars into the county. Food insecurity efforts are acceptable and draw on agricultural assets. Transportation is the weakest on resources, since public transit is limited and new services are costly.

Adjusting for Assets and Linkages

Scores treat needs as separate, but in Robeson County several are linked. Food insecurity and cardiometabolic disease reinforce each other, since families with limited money buy cheaper, calorie-dense food, and both can be addressed through the same church, extension and farm assets identified in Module 2. Lack of insurance and poor dental access overlap, because adult dental coverage depends on insurance. The asset map also shows that the Tribe, churches and schools could deliver tobacco cessation in culturally grounded ways. These linkages suggest combining related needs rather than ranking them in isolation.

Community Input Still Needed

The scores so far reflect data and professional judgment. Residents' views are essential and will be gathered through the engagement methods examined in Module 4, including community forums in several towns, listening sessions with tribal, Black, White and Hispanic community groups and a short survey distributed through churches and schools. If residents rank a need differently, for example placing mental health or transportation higher, the priorities will be revisited. Prioritization that excludes the people affected risks choosing problems professionals can measure over problems residents live with.

Recommended Priorities

Combining scores, linkages, assets and feasibility, three priorities are recommended for the improvement plan. First, cardiometabolic disease and food insecurity together, addressed through food access, nutrition education, screening and chronic disease self-management. Second, tobacco use, through cessation support and smoke-free environments delivered with tribal, church and school partners. Third, access to coverage and dental care, through Medicaid enrollment assistance and expanded dental services. Mental distress is recognized as a strong candidate for the next planning cycle and will be integrated where possible, for example through stress and depression screening in chronic disease programs.

Needs Not Chosen and Why

Explaining what was not chosen is part of a fair process. Transportation ranked lowest, not because it matters little but because effective, affordable solutions are hard for a county coalition to deliver; it will be addressed indirectly by building services into places people already go, such as churches and schools, and by coordinating volunteer drivers for medical trips. Oral health ranked sixth on its own but is folded into the coverage priority, since adult dental care depends so heavily on insurance and on the few dentists who accept Medicaid. Mental distress ranked fifth and is deferred to the next cycle mainly because the county's behavioral health capacity is limited and the plan could raise expectations it cannot meet; screening within chronic disease programs keeps it in view. Residents and partners who care most about these needs will be told why, and invited to show at the forums whether the ranking should change.

Conclusion

A structured method narrowed seven serious needs to three priorities, while making every judgment visible and open to challenge. The Hanlon scores favor problems with effective, deliverable interventions; linkages among needs and the county's assets refine the list; and the priorities remain provisional until residents weigh in. Module 4 examines the engagement methods through which that input will be gathered.

References

Centers for Disease Control and Prevention. (2025). PLACES: Local data for better health, county data 2025 release [Data set].

Pickett, G., & Hanlon, J. J. (1990). Public health: Administration and practice (9th ed.). Times Mirror/Mosby.

U.S. Census Bureau. (2025). American Community Survey 5-year estimates, 2020-2024 [Data set].