Community Health Profile Essay On A Place

Examine the community and record your findings in a community description or overview for credibility and awareness.


  • What is a community?

  • What do we mean by understanding and describing the community?

  • Why make the effort to understand and describe your community?

  • Whom should you contact to gather information?

  • How do you go about understanding and describing the community?

For those of us who work in community health and development, it's important to understand community -- what a community is, and the specific nature of the communities we work in. Anything we do in a community requires us to be familiar with its people, its issues, and its history. Carrying out an intervention or building a coalition are far more likely to be successful if they are informed by the culture of the community and an understanding of the relationships among individuals and groups within it.

Taking the time and effort to understand your community well before embarking on a community effort will pay off in the long term. A good way to accomplish that is to create a community description -- a record of your exploration and findings. It's a good way to gain a comprehensive overview of the community -- what it is now, what it's been in the past, and what it could be in the future. In this section, we'll discuss how you might approach examining the community in some detail and setting down your findings in a community description.

What is a community?

While we traditionally think of a community as the people in a given geographical location, the word can really refer to any group sharing something in common. This may refer to smaller geographic areas -- a neighborhood, a housing project or development, a rural area -- or to a number of other possible communities within a larger, geographically-defined community.

These are often defined by race or ethnicity, professional or economic ties, religion, culture, or shared background or interest:

  • The Catholic community (or faith community, a term used to refer to one or more congregations of a specific faith).
  • The arts community
  • The African American community
  • The education community
  • The business community
  • The homeless community
  • The gay, lesbian, bisexual, and transgender community
  • The medical community
  • The Haitian community
  • The elderly community

These various communities often overlap. An African American art teacher, for example, might see herself (or be seen by others) as a member of the African American, arts, and/or education communities, as well as of a particular faith community. An Italian woman may become an intensely involved member of the ethnic and cultural community of her Nigerian husband. Whichever community defines your work, you will want to get to know it well.

What do we mean by understanding and describing the community?

Understanding the community entails understanding it in a number of ways. Whether or not the community is defined geographically, it still has a geographic context -- a setting that it exists in. Getting a clear sense of this setting may be key to a full understanding of it. At the same time, it's important to understand the specific community you're concerned with. You have to get to know its people -- their culture, their concerns, and relationships -- and to develop your own relationships with them as well.

  • Physical aspects. Every community has a physical presence of some sort, even if only one building. Most have a geographic area or areas they are either defined by or attached to. It's important to know the community's size and the look and feel of its buildings, its topography (the lay of the land -- the hills, valleys, rivers, roads, and other features you'd find on a map), and each of its neighborhoods. Also important are how various areas of the community differ from one another, and whether your impression is one of clean, well-maintained houses and streets, or one of shabbiness, dirt, and neglect.

    If the community is one defined by its population, then its physical properties are also defined by the population: where they live, where they gather, the places that are important to them. The characteristics of those places can tell you a great deal about the people who make up the community. Their self-image, many of their attitudes, and their aspirations are often reflected in the places where they choose -- or are forced by circumstance or discrimination -- to live, work, gather, and play.

  • Infrastructure. Roads, bridges, transportation (local public transportation, airports, train lines), electricity, land line and mobile telephone service, broadband service, and similar "basics" make up the infrastructure of the community, without which it couldn't function.
  • Patterns of settlement, commerce, and industry. Where are those physical spaces we've been discussing? Communities reveal their character by where and how they create living and working spaces. Where there are true slums --  substandard housing in areas with few or no services that are the only options for low-income people -- the value the larger community places on those residents seems clear. Are heavy industries located next to residential neighborhoods? If so, who lives in those neighborhoods? Are some parts of the community dangerous, either because of high crime and violence or because of unsafe conditions in the built or natural environment?
  • Demographics.  It's vital to understand who makes up the community.  Age, gender, race and ethnicity, marital status, education, number of people in household, first language -- these and other statistics make up the demographic profile of the population. When you put them together (e.g.,  the education level of black women ages 18-24), it gives you a clear picture of who community residents are.
  • History. The long-term history of the community can tell you about community traditions, what the community is, or has been, proud of, and what residents would prefer not to talk about. Recent history can afford valuable information about conflicts and factions within the community, important issues, past and current relationships among key people and groups -- many of the factors that can trip up any effort before it starts if you don't know about and address them.
  • Community leaders, formal and informal. Some community leaders are elected or appointed -- mayors, city councilors, directors of public works. Others are considered leaders because of their activities or their positions in the community -- community activists, corporate CEO's, college presidents, doctors, clergy.  Still others are recognized as leaders because, they are trusted for their proven integrity, courage, and/or care for others and the good of the community.
  • Community culture, formal and informal. This covers the spoken and unspoken rules and traditions by which the community lives. It can include everything from community events and slogans -- the blessing of the fishing fleet, the "Artichoke Capital of the World" -- to norms of behavior -- turning a blind eye to alcohol abuse or domestic violence -- to patterns of discrimination and exercise of power. Understanding the culture and how it developed can be crucial, especially if that's what you're attempting to change.
  • Existing groups.  Most communities have an array of groups and organizations of different kinds -- service clubs (Lions, Rotary, etc.), faith groups, youth organizations, sports teams and clubs, groups formed around shared interests, the boards of community-wide organizations (the YMCA, the symphony, United Way), as well as groups devoted to self-help, advocacy, and activism.  Knowing of the existence and importance of each of these groups can pave the way for alliances or for understanding opposition.
  • Existing institutions. Every community has institutions that are important to it, and that have more or less credibility with residents. Colleges and universities, libraries, religious institutions, hospitals -- all of these and many others can occupy important places in the community. It's important to know what they are, who represents them, and what influence they wield.
  • Economics.  Who are the major employers in the community?  What, if any, business or industry is the community's base? Who, if anyone, exercises economic power? How is wealth distributed? Would you characterize the community as poor, working, class, middle class, or affluent?  What are the economic prospects of the population in general and/or the population you're concerned with?
  • Government/Politics. Understanding the structure of community government is obviously important. Some communities may have strong mayors and weak city councils, others the opposite. Still other communities may have no mayor at all, but only a town manager, or may have a different form of government entirely.  Whatever the government structure, where does political power lie? Understanding where the real power is can be the difference between a successful effort and a vain one.
  • Social structure. Many aspects of social structure are integrated into other areas -- relationships, politics, economics -- but there are also the questions of how people in the community relate to one another on a daily basis, how problems are (or aren't) resolved, who socializes or does business with whom, etc. This area also includes perceptions and symbols of status and respect, and whether status carries entitlement or responsibility (or both).
  • Attitudes and values. Again, much of this area may be covered by investigation into others, particularly culture. What does the community care about, and what does it ignore? What are residents' assumptions about the proper way to behave, to dress, to do business, to treat others? Is there widely accepted discrimination against one or more groups by the majority or by those in power? What are the norms for interaction among those who with different opinions or different backgrounds?

We'll discuss all of these aspects of community in greater detail later in the section.

There are obviously many more aspects of community that can be explored, such as health or education.  The assumption here is that as part of an assessment, you'll aim for a general understanding of the community, as described in this section, and also assess, with a narrower focus, the specific aspects you're interested in.

Once you've explored the relevant areas of the community, you'll have the information to create a community description. Depending on your needs and information, this description might be anything from a two-or three-page outline to an in-depth portrait of the community that extends to tens of pages and includes charts, graphs, photographs, and other elements. The point of doing it is to have a picture of the community at a particular point in time that you can use to provide a context for your community assessment and to see the results of whatever actions you take to bring about change.

A community description can be as creative as you're capable of making it.  It can be written as a story, can incorporate photos and commentary from community residents (see Photovoice), can be done online and include audio and video, etc. The more interesting the description is, the more people are likely to actually read it.

Why make the effort to understand and describe your community?

You may at this point be thinking, "Can't I work effectively within this community without gathering all this information?" Perhaps, if it's a community you're already familiar with, and really know it well. If you're new to the community, or an outsider, however, it's a different story. Not having the proper background information on your community may not seem like a big deal until you unintentionally find yourself on one side of a bitter divide, or get involved in an issue without knowing about its long and tangled history.

Some advantages to taking the time to understand the community and create a community description include:

  • Gaining a general idea, even before an assessment, of the community's strengths and the challenges it faces.
  • Capturing unspoken, influential rules and norms. For example, if people are divided and angry about a particular issue, your information might show you an event in the community's history that explains their strong emotions on that subject.
  • Getting a feel for the attitudes and opinions of the community when you're starting work on an initiative.
  • Ensuring the security of your organization's staff and participants.  There may be neighborhoods where staff members or participants should be accompanied by others in order to be safe, at least at night. Knowing the character of various areas and the invisible borders that exist among various groups and neighborhoods can be extremely important for the physical safety of those working and living in the community.
  • Having enough familiarity with the community to allow you to converse intelligently with residents about community issues, personalities and geography. Knowing that you've taken the time and effort to get to know them and their environment can help you to establish trust with community members.  That can make both a community assessment and any actions and activities that result from it easier to conduct.
  • Being able to talk convincingly with the media about the community.
  • Being able to share information with other organizations or coalitions that work in the community so that you can collaborate or so that everyone's work can benefit.
  • Providing background and justification for grant proposals.
  • Knowing the context of the community so that you can tailor interventions and programs to its norms and culture, and increase your chances of success.

When should you make an effort to understand and describe the community?

  • When you're about to launch a community assessment.  The first step is to get a clear sense of the community, before more specifically assessing the area(s) you're interested in.
  • When you're new to a community and want to be well informed before beginning your work. If you've just started working in a community -- even if it's work you've been doing for years -- you will probably find that taking the time to write a community description enriches your work.
  • When you've been working in a community for any length of time and want to take stock. Communities are complex, constantly-changing entities. By periodically stopping to write a detailed description of your community, you can assess what approaches have worked and what haven't; new needs that have developed over time and old concerns that no longer require your effort and energy; and other information to help you better do your work.
  • When you're feeling like you're stuck in a rut and need a fresh perspective. Organizations have to remain dynamic in order to keep moving forward. Reexamining the community -- or perhaps examining it carefully for the first time -- can infuse an organization with new ideas and new purpose.
  • When you're considering introducing a new initiative or program and want to assess its possible success.Aside from when you first come to a community, this is probably the most vital time to do a community description.
  • When a funder asks you to, often as part of a funding proposal.

While researching and writing a community description can take time, your work can almost always benefit from the information you gather.

Whom should you contact to gather information?

Much of your best and most interesting information may come from community members with no particular credentials except that they're part of the community. It's especially important to get the perspective of those who often don't have a voice in community decisions and politics -- low-income people, immigrants, and others who are often kept out of the community discussion. In addition, however, there are some specific people that it might be important to talk to. They're the individuals in key positions, or those who are trusted by a large part of the community or by a particular population. In a typical community, they might include:

  • Elected officials
  • Community planners and development officers
  • Chiefs of police
  • School superintendents, principals, and teachers
  • Directors or staff of health and human service organizations
  • Health professionals
  • Clergy
  • Community activists
  • Housing advocates
  • Presidents or chairs of civic or service clubs -- Chamber of Commerce, veterans' organizations, Lions, Rotary, etc.
  • People without titles, but identified by others as "community leaders"
  • Owners or CEO's of large businesses (these may be local or may be large corporations with local branches)

How do you go about understanding and describing the community?

General Guidelines

To begin, let's look at some basic principles to keep in mind.

  • Be prepared to learn from the community. Assume that you have a lot to learn, and approach the process with an open mind. Listen to what people have to say. Observe carefully. Take notes -- you can use them later to generate new questions or to help answer old ones.
  • Be aware that people's speech, thoughts, and actions are not always rational. Their attitudes and behavior  are often best understood in the context of their history, social relations, and culture. Race relations in the U.S., for example, can't be understood without knowing some of the historical context -- the history of slavery, Jim Crow laws, and the work of Martin Luther King and the Civil Rights Movement.
  • Don't assume that the information people give you is necessarily accurate. There are a number of reasons why informants may tell you things that are inaccurate. People's perceptions don't always reflect reality, but are colored instead by what they think or what they think they know.  In addition, some may intentionally exaggerate or downplay particular conditions or issues for their own purposes or for what they see as the greater good. (The Chamber of Commerce or local government officials might try to make economic conditions look better than they are in the hopes of attracting new business to the community, for instance.)  Others may simply be mistaken about what they tell you  -- the geographical boundaries of a particular neighborhood, for example, or the year of an important event. Get information, particularly on issues, conditions, and relationships from many sources if you can. As time goes on, you'll learn who the always-reliable sources are.
  • Beware of activities that may change people's behavior. It's well known that people (and animals as well) can change their normal behavior as a result of knowing they're being studied.  Neighborhood residents may clean up their yards if they're aware that someone is taking the measure of the neighborhood. Community members may try to appear as they wish to be seen, rather than as they really are, if they know you're watching. To the extent that you can, try not to do anything that will change the way people go about their daily business or express themselves. That usually means being as unobtrusive as possible -- not being obvious about taking pictures or making notes, for instance. In some circumstances, it could mean trying to gain trust and insight through participant observation.

Participant observation is a technique that anthropologists use.  It entails becoming part of another culture, both to keep people in it from being influenced by your presence and to understand it from the inside.  Some researchers believe it addresses the problem of changing the culture by studying it, and others believe that it makes the problem worse.

  • Take advantage of the information and facilities that help shape the world of those who have lived in the community for a long time. Read the local newspaper (and the alternative paper, too, if there is one), listen to local radio, watch local TV, listen to conversation in cafes and bars, in barbershops and beauty shops.  You can learn a great deal about a community by immersing yourself in its internal communication. The Chamber of Commerce will usually have a list of area businesses and organizations, along with their contact people, which should give you both points of contact and a sense of who the people are that you might want to get in touch with. Go to the library -- local librarians are often treasure troves of information, and their professional goal is to spread it around. Check out bulletin boards at supermarkets and laundromats.  Even graffiti can be a valuable source of information about community issues.
  • Network, network, network.  Every contact you make in the community has the potential to lead you to more contacts. Whether you're talking to official or unofficial community leaders or to people you just met on the street, always ask who else they would recommend that you talk to and whether you can use their names when you contact those people. Establishing relationships with a variety of community members is probably the most important thing you can do to ensure that you'll be able to get the information you need, and that you'll have support for working in the community when you finish your assessment and begin your effort.

Gathering information

To find out about various aspects of the community, you'll need a number of different methods of gathering information. We've already discussed some of them, and many of the remaining sections of this chapter deal with them, because they're the same methods you'll use in doing a full community assessment. Here, we'll simply list them, with short explanations and links to sections where you can get more information about each.

  • Public records and archives. These include local, state, and federal government statistics and records, newspaper archives, and the records of other organizations that they're willing to share. Many of the public documents are available at public and/or university libraries and on line at government websites. Most communities have their own websites, which often contain valuable information as well.
  • Individual and group interviews. Interviews can range from casual conversations in a cafe to structured formal interviews in which the interviewer asks the same specific questions of a number of carefully chosen key informants. They can be conducted with individuals or groups, in all kinds of different places and circumstances. They're often the best sources of information, but they're also time-consuming and involve finding the right people and convincing them to consent to be interviewed, as well as finding (and sometimes training) good interviewers.

Interviews may include enlisting as sources of information others who've spent time learning about the community.  University researchers, staff and administrators of health and human service organizations, and activists may all have done considerable work to understand the character and inner workings of the community.  Take advantage of their findings if you can.  It may save you many hours of effort.

  • Surveys. There are various types of surveys. They can be written or oral, conducted with a selected small group -- usually a randomized sample that represents a larger population -- or with as many community members as possible. They can be sent through the mail, administered over the phone or in person, or given to specific groups (school classes, faith congregations, the Rotary Club). They're often fairly short, and ask for answers that are either yes-no, or that rate the survey-taker's opinion of a number of possibilities (typically on a scale that represents "agree strongly" to "disagree strongly" or "very favorable" to "very unfavorable.")  Surveys can, however, be much more comprehensive, with many questions, and can ask for more complex answers.
  • Direct or participant observation.  Often the best way to find out about the community is simply to observe. You can observe physical features, conditions in various areas, the interactions of people in different neighborhoods and circumstances, the amount of traffic, commercial activity, how people use various facilities and spaces, or the evidence of previous events or decisions. Participant observation means becoming part of the group or scene you're observing, so that you can see it from the inside.

Observation can take many forms.  In addition to simply going to a place and taking notes on what you see, you might use other techniques -- Photovoice, video, audio, simple photographs, drawings, etc.  Don't limit the ways in which you can record your observations and impressions.

Understanding the Community

Now let's consider what you might examine to understand and describe the community. You won't necessarily look for this information in the order given here, although it's a good idea to start with the first two.

The community's physical characteristics.

Get a map of the community and drive and/or walk around. (If the community isn't defined by geography, note and observe the areas where its members live, work, and gather.) Observe both the built and the natural environment. In the built environment, some things to pay attention to are:

  • The age, architecture, and condition of housing and other buildings. Some shabby or poorly-maintained housing may occupy good buildings that could be fixed up, for example -- that's important to know. Is there substandard housing in the community? Look for new construction, and new developments, and take note of where they are, and whether they're replacing existing housing or businesses or adding to it. (You might want to find out more about these. Are they controversial? Was there opposition to them, and how was it resolved? Does the community offer incentives to developers, and, if so, for what?)  Is housing separated by income or other factors, so that all low-income residents, for instance, or all North African immigrants seem to live in one area away from others? Are buildings generally in good condition, or are they dirty and run-down? Are there buildings that look like they might have historic significance, and are they kept up? Are most buildings accessible to people with disabilities?
  • Commercial areas.  Are there stores and other businesses in walking distance of residential areas or of public transportation for most members of the community? Do commercial buildings present windows and displays or blank walls to pedestrians? Is there foot traffic and activity in commercial areas, or do they seem deserted? Is there a good mix of local businesses, or nothing but chain stores? Are there theaters, places to hear music, a variety of restaurants, and other types of entertainment? Do many buildings include public spaces -- indoor or outdoor plazas where people can sit, for example? In general, are commercial areas and buildings attractive and well-maintained?
  • The types and location of industrial facilities. What kind of industry exists in the community? Does it seem to have a lot of environmental impact -- noise, air or water pollution, smells, heavy traffic? Is it located close to residential areas, and, if so, who lives there? Is there some effort to make industrial facilities attractive -- landscaping, murals or imaginative color schemes on the outside, etc?
  • Infrastructure.  What condition are streets in?  Do most streets, at least in residential and commercial areas, have sidewalks? Bike lanes? Are pedestrians shielded from traffic by trees, grass strips, and/or plantings? Are roads adequate for the traffic they bear? Are there foot bridges across busy highways and railroad tracks, or do they separate areas of the community and pose dangers for pedestrians? Is there adequate public transportation, with facilities for people with physical disabilities? Does it reach all areas of the community? Can most people gain access to the Internet if they have the equipment (i.e., computers or properly equipped cell phones)?

This is a topic that is ripe for examination. In many rural areas, particularly in developing countries, but often in the developed world as well, there is very little infrastructure.  Roads and bridges may be impassable at certain (or most) times of year, phone service and TV reception nonexistent, Internet access a distant dream. Public transportation in many places, if it exists at all, may take the form of a pickup truck or 20-year-old van that takes as many passengers as can squeeze into or onto the bed, passenger compartment, and roof. Is any of this on the government's or anyone else's radar as a situation that needs to be addressed? What is the general policy about services to rural and/or poor populations?  Answers to these and similar questions may both explain the situation (and the attitudes of the local population) and highlight a number of possible courses of action.

In the category of natural features, we can include both areas that have been largely left to nature, and "natural" spaces created by human intervention.

  • Topography. An area's topography is the shape of its landscape. Is the community largely hilly, largely flat, or does it incorporate areas of both? Is water -- rivers, creeks, lakes and ponds, canals, seashore -- a noticeable or important part of the physical character of the community? Who lives in what areas of the community?
  • Open space and greenery. Is there open space scattered throughout the community, or is it limited to one or a few areas? How much open space is there? Is it mostly man-made (parks, commons, campuses, sports fields), or is there wilderness or semi-wilderness? Does the community give the impression  of being green and leafy, with lots of trees and grass, or is it mostly concrete or dirt?
  • Air and water. Is the air reasonably clear and clean, or is there a blanket of smog? Does the air generally smell fresh, or are there industrial or other unpleasant odors? Do rivers, lakes, or other bodies of water appear clean? Do they seem to be used for recreation (boating, swimming, fishing)?

There is an overlap between the community's physical and social characteristics. Does the lay of the land make it difficult to get from one part of the community to another? (Biking, or in some cases even walking, is difficult in San Francisco, for example, because of the length and steepness of the hills.)  Are there clear social divisions that mirror the landscape -- all the fancy houses in the hills, all the low-income housing in the flats, for instance?

Studying the physical layout of the community will serve you not only as information, but as a guide for finding your way around, knowing what people are talking about when they refer to various areas and neighborhoods, and gaining a sense of the living conditions of any populations you're concerned with.

Community demographics.

Demographics are the facts about the population that you can find from census data and other similar statistical information. Some things you might like to know, besides the number of people in the community:

  • Gender
  • Racial and ethnic background
  • Age.  Numbers and percentages of the population in various age groups
  • Marital status
  • Family size
  • Education
  • Income
  • Employment - Both the numbers of people employed full and part-time, and the numbers of people in various types of work
  • Location - Knowing which groups live in which neighborhoods or areas can help to recruit participants in a potential effort or to decide where to target activities

In the U.S., most of this and other demographic information is available from the U.S. Census, from state and local government websites, or from other government agencies.  Depending on what issues and countries you're concerned with, some sources of information might be the U.S. Centers for Disease Control, the U.S. Department of Health and Human Services, similar websites in other countries, and the various agencies of the United Nations.

On many of these websites, notably the U.S. Census, various categories can be combined, so that you can, for example, find out the income levels in your community for African American women aged 25-34 with a high school education. If the website won't do it for you, it's fairly easy to trace the patterns yourself, thus giving you a much clearer picture of who community residents are and what their lives might be like.

Another extremely useful resource is County Health Rankings & Roadmaps, which provides rankings for nearly every county in the nation. The County Health Rankings model includes four types of health factors: health behaviors, clinical care, social and economic, and the physical environment. The County Health Rankings illustrate what we know when it comes to what’s making people sick or healthy, and the new County Health Roadmaps show what we can do to create healthier places to live, learn, work and play. These reports can help community leaders see that our environment influences how healthy we are and how long we live, and even what parts of our environment are most influential.

Community history.

This can be a complex topic. The "standard" history -- when the community was founded and by whom, how long it has existed, how people lived there in the past, its major sources of work, etc. -- can often be found in the local library or newspaper archives, or even in books or articles written for a larger audience. The less comfortable parts of that history, especially recent history -- discrimination, conflict, economic and/or political domination by a small group -- are may not be included, and are more likely to be found by talking to activists, journalists, and others who are concerned with those issues. You might also gain information by reading between the lines of old newspaper articles and tracking down people who were part of past conflicts or events.

If this all sounds a lot like investigative reporting, that's because it is.  You may not have the time or skills to do much of it, but talking to activists and journalists about recent history can be crucial.  Stepping into a community with an intervention or initiative without understanding the dynamics of community history can be a recipe for failure.

Community government and politics.

There are a number of ways to learn about the structure and operation of local government:

  • Go to open meetings of the city council, town boards, board of selectmen, or other bodies, as well as to public forums on proposed actions, laws, and regulations.  Such meetings will be announced in the local paper.

In most of the U.S., these meetings are public by state law, and must be announced in specific ways at least two days ahead.

  • Community bylaws and regulations are often available at the public library.
  • Make an appointment to talk to one or more local government officials.  Many hold regular office hours, and might actually take pleasure in explaining the workings of the local government.
  • Talk to community activists for a view of how the government actually operates, as opposed to how it's supposed to operate.
  • Read the local newspaper every day.

Reading the newspaper every day is a good idea in general if you're trying to learn about the community.  It will not only have stories about how the community operates, but will give you a sense of what's important to its readers, what kinds of activities the community engages in and views as significant, what the police do -- a picture of a large part of community life. Real estate ads will tell you about property values and the demand for housing, ads for services can help you identify the major businesses in town, and the ages and education levels of the people in the marriage and birth announcements can speak volumes about community values.  Newspaper archives can also reveal the stories that help you understand the emotions still surrounding events and issues that don't seem current.  The newspaper is an enormous reservoir of both direct and between-the-lines information.

As we all know, government isn't only about the rules and structures that hold it together. It's about people and their interactions...politics, in other words. The political climate, culture, and assumptions in a particular community often depend more on who elected and appointed officials are than on the limits or duties of their offices.

The politics of many communities embody the ideal of government working for the public good. In other communities, politics takes a back seat to economics, and politicians listen largely to those with economic power -- the CEO's, owners, and directors of large businesses and institutions.  In still others, the emphasis is on power itself, so that political decisions are made specifically to keep a particular party, group, or individual in control.

Obviously, only in the first case is the public well served. In the other situations, fairness and equity tend to go out the window and decisions favor the powerful. Understanding the politics of the community -- who has power, who the power brokers are, who actually influences the setting of policy, how decisions are made and by whom, how much difference public opinion makes -- is fundamental to an understanding of the community as a whole.

There's no formal way to get this information. Government officials may have very different interpretations of the political scene than activists or other community members. You'll have to talk to a variety of people, take a good look at recent political controversies and decisions (here's where newspaper archives can come in handy), and juggle some contradicting stories to get at the reality.


Community institutions, unless they are dysfunctional, can generally be viewed as assets. Finding them should be easy: as mentioned above, the Chamber of Commerce will probably have a list of them, the library will probably have one as well, the local newspaper will often list them, and they'll be in the phone book. 

They cover the spectrum of community life, including:

  • Offices of local, state, and federal government agencies (Welfare, Dept. of Agriculture, Office of Immigration, etc.)
  • Public libraries.
  • Religious institutions. Churches, synagogues, mosques.
  • Cultural institutions.  Museums, theaters, concert halls, etc. and the companies they support.  These may also encompass community theater and music companies run and staffed by community volunteer boards and performers.
  • Community centers.  Community centers may provide athletic, cultural, social, and other (yoga, support groups) activities for a variety of ages.
  • YMCA's and similar institutions.
  • Senior centers.
  • Hospitals and public health services.
  • Colleges and universities.
  • Public and private schools.
  • Public sports facilities. These might be both facilities for the direct use of the public -- community pools and athletic fields, for example -- or stadiums and arena where school, college, or professional teams play as entertainment.

Groups and organizations.

The groups and organizations that exist in the community, and their relative prestige and importance in community life, can convey valuable clues to the community's assumptions and attitudes. To some extent, you can find them in the same ways that you can find institutions, but the less formal ones you may be more likely to learn about through interviews and conversations. 

These groups can fall into a number of categories:

  • Health and human service organizations.  Known on the world stage as NGO's (Non-Governmental Organizations), these are the organizations that work largely with low-income people and populations at risk. They encompass free or sliding-scale health clinics, family planning programs, mental health centers, food pantries, homeless shelters, teen parent programs, youth outreach organizations, violence prevention programs, etc.
  • Advocacy organizations. These may also provide services, but generally in the form of legal help or advocacy with agencies to protect the rights of specific groups or to push for the provision of specific services. By and large, they advocate for recognition and services for populations with particular characteristics, or for more attention to be paid to particular issues.
  • Service clubs. Lions, Rotary, Kiwanis, Elks, Masons, etc.
  • Veterans' organizations. In the U.S., the American Legion and the Veterans of Foreign Wars are the major veterans' organizations, but many communities may have others as well.
  • Chamber of Commerce and other business organizations. Some of these may be oriented toward specific types of businesses, while others, like the Chamber, are more general.
  • Groups connected to institutions. Church youth or Bible study groups, school clubs, university student groups (e.g., Foreign Students' Association, community service groups).
  • Trade unions. These may be local, or branches of national or international unions.
  • Sports clubs or leagues. Enthusiasts of many sports organize local leagues that hold regular competitions, and that may compete as well with teams from other communities. In many rural areas, Fish and Game clubs may function as informal community centers.
  • Informal groups. Book clubs, garden clubs, parents' groups, etc.


Some of the information about economic issues can be found in public records, but some will come from interviews or conversations with business people, government officials, and activists, and some from observation. It's fairly easy to notice if one huge industrial plant dominates a community, for example, or if every third building appears to be a construction company. There are a number of questions you might ask yourself and others to help you understand the community's economic base and situation: What is the anchor of the community's tax base? Who are the major employers? Does the community have a particular business or business/industry category that underlies most of the jobs? Are there lots of locally-owned businesses and industries, or are most parts of larger corporations headquartered elsewhere?  Are there corporate headquarters in the community? Is there a good deal of office space, and is it empty or occupied?  Is there new development, and is the community attracting new business? What is the unemployment rate?

Social structure.

This may be the most difficult aspect of the community to understand, since it incorporates most of the others we've discussed, and is usually unspoken. People's answers to questions about it may ignore important points, either because they seem obvious to those who've lived with them for all or most of their lives, or because those things "just aren't talked about." Distrust or actual discrimination aimed at particular groups -- based on race, class, economics, or all three -- may be glossed over or never mentioned. The question of who wields the real power in the community is another that may rarely be answered, or at least not answered in the same way by a majority of community members. It's likely that it will take a number of conversations, some careful observation and some intuition as well to gain a real sense of the community's social structure.

Describing the Community

Once you've gathered the information you need, the next step is describing the community. This is not really separate from understanding the community: in the process of organizing and writing down your information, you'll be able to see better how it fits together, and can gain greater understanding.

There are many ways you can create a description of the community. The most obvious is simply to organize, record, and comment on your information by category:  physical description, government, institutions, etc. You can comment about what has changed in the community over time, what has stayed the same, and where you think the community might be going. You might also include an analysis of how the various categories interact, and how that all comes together to form the community that exists. That will give you and anyone else interested a reasonably clear and objective description of the community, as well as a sense of how you see it.

For a fuller picture, you could add photographs of some of the locations, people, conditions, or interactions you describe (perhaps as a Photovoice project), as well as charts or graphs of demographic or statistical information. For even more detail, you might compose a portrait in words of the community, using quotes from interviews and stories of community history to bring the description to life.

Given the availability of technology, you don't have to limit yourself to any specific format. Computers allow you to easily combine various media -- photos, graphics, animation, text, and audio, for example. The description could  add in or take the form of a video that includes a tour of the community, statements from and/or interviews with various community members (with their permission, of course), an audio voice-over, maps, etc.  A video or a more text-based description -- or both -- could then be posted to a website where it would be available to anyone interested.

Once you have a description put together, you might want to show it to some of the community members you talked to in the course of exploring the community. They can suggest other things you might include, correct errors of fact, and react to what they consider the accuracy or inaccuracy of your portrait and analysis of their community. With this feedback, you can then create a final version to use and to show to anyone interested. The point is to get as informative and accurate a picture of the community as possible that will serve as a basis for community assessment and any effort that grows out of it.

The last word here is that this shouldn't be the last community description you'll ever do. Communities reinvent themselves constantly, as new buildings and developments are put up and old ones torn down, as businesses move in and out, as populations shift -- both within the community and as people and groups move in and out -- and as economic, social, and political conditions change. You have to keep up with those changes, and that means updating your community description regularly.  As with most of the rest of the community building work described in the Community Tool Box, the work of understanding and describing the community is ongoing, for as long as you remain committed to the community itself.

In Summary

Understanding a community is crucial to being able to work in it. Failing to understand it will deny you credibility and make it difficult for you both to connect with community members and to negotiate the twists and turns of starting and implementing a community initiative or intervention. An extremely important part of any community assessment, therefore, is to start by finding out as much about the community as you can -- its physical and geographical characteristics, its culture, its government, and its assumptions. By combing through existing data, observing, and learning from community members, you can gain an overview of the community that will serve you well. Recording your findings and your analysis of them in a community description that you can refer to and update as needed will keep your understanding fresh and help others in your organization or with whom you collaborate.

Community Profiles

Community profiles are used and recognised as tools for development. They are found to be useful foundations for policy makers and also practitioners within a wide range of service and policy processes (Hawtin M, 2007, p1). These are most popularly used when identifying issues with crime figures or public health. However, they may also be used when identifying any geographical differences within certain areas and influencing local policies, procedures and resource development (Derbyshire County Council, 2014). In order to do this, community profiles contain a number of demographic characteristics such as; population and growth trends, age distribution, house hold size, unemployment rates, at risk groups, living arrangements and many more (Centre for Urban Transport Research, 2000, p4:2-4:3). For confidentiality reasons no names have been mentioned within this community profile therefore no consent was needed.

Smithies and Adams (1990, quoted in Jack K., Holt M: Community Profiling Article, 2008, p52) defined the community as ''people with a basis of common interest and network of personal interaction, grouped either on the basis of locality or on a specific shared concern or both.'' This definition of a community demonstrates the variety within communities, therefore affecting how policy makers implement community profiles.

There are many reasons why a community profile is written. One of the main purposes is to enable service commissioners to target areas within communities that are most in need and make required improvements. This then benefits the local services and their users. In order to efficiently undertake in a community profile, it is firstly important to understand the reasons why it is been done, and what benefits it may essentially bring (Hawtin M, 2007, p12). By understanding the benefits a community profile may bring, and writing about these, it enables commissioners to understand health needs within their local area, therefore ensuring that the local community are able to deliver/provide relevant services to those most in need. In many cases, services may need reviewing and improving to provide better care and target areas most in need of the help. By doing this, service users are more likely to experience the benefits and this can be reviewed in future statistics or further community profiles.

Middlesbrough is a large town situated on the south bank of the River Tees only a few miles from the North Yorkshire National Park. From the 19th century, Middlesbrough was recognized as a major coal port and also a center for ironworks. Previously, it has also been known for its steelworks, and chemical plants (CSE, 2014).

According to census results in 2011 as shown in appendix three, Middlesbrough has an estimated population of 134,400 people. Of these, there were approximately 36,256 0-19year olds, and 28,222 people 60+. Overall, this was a 2% decrease from 2001 and this may have been influenced by many factors (Middlesbrough Council - Census 2011. 2014).

Middlesbrough has recently featured many times in the public eye for its high levels of alcohol misuse, and was recently named ''the worst area in the country for alcohol-related hospital admissions'' (Mike Brown ' Gazette Live, 2014)

Due to the high levels of alcohol misuse within Middlesbrough, this will have an effect on local services such as hospitals, and rehabilitation centers etc. As a result, the town will then be disadvantaged due to financial implications.

Alcohol nationally causes approximately 22,000 preventable deaths per year and is costing the government ??7.3billion in alcohol related crimes and a further ??95million spent on specialist treatment. Within Middlesbrough alone, it has been estimated that 6,860 people are high risk drinkers, 3,773 are dependent drinkers, and there are 24,277 people becoming an increasing risk (Middlesbrough Council, 2014).

In circumstances like these where a health issue is having a considerable financial impact, a community profile may be beneficial if planned and written thoroughly and accurately. It enables service commissioners, and local authorities to explore services within the area in order to find out if the publics need are been met, assess the area's most in need and make required improvements so that strategies can be put in place and implemented. Community profiles provide information so that resources can be proritised to make any funding or resources to the best advantage (Hawtin M, 2007, p13).

For Middlesbrough, a community profile in relation to alcohol would be beneficial in order to find out which services are most in need of improvement. Due to poor statistics in relation to alcohol misuse, the needs of the local community can also be assessed, ideas may be implemented, and new services introduced with an overall goal of improving statistics and reducing levels of alcohol misuse. A strategy for reducing the amount of alcohol misuse could be implemented and then reassessed over a period of time in order to track its progress. Community profiles help to build a better understanding of a subject. By having this greater knowledge, more precise and reliable improvements can be made within the community to contribute in combatting any issues. For Middlesbrough, these issues consist of high levels of alcohol misuse/dependency and alcohol-related hospital treatments required.

As stated previously, Middlesbrough has as estimated population of 134,400. Of these people 6.3% are of a different ethnic origin. Despite the high number of people living in Middlesbrough, from data in 2009 provided by Middlesbrough council, there were 58,100 households within the town. Looking back at the 2001 census, 61% of houses within Middlesbrough are owned by the occupier, 28% rent social housing and 7.1% private rent (Middlesbrough Council - Middlesbrough statistics. 2014).

From data collected in 2010 about the economy in Middlesbrough, 24% of people living in the area were benefit claimants 60.7% were in employment and 7.5% were receiving jobseekers allowance. Comparing the percentage of benefit claimants with Tees Valley at 20.4% and also the national average at 14.5% (as shown in appendix 4), Middlesbrough has a high level of unemployment which could be contributing to alcohol misuse within the town.

Looking at education results within Middlesbrough, 65% of students pass their GCSEs with 5 or more A*-C grades. In comparison with Tees Valley at 69% and the national average at 69.7%, Middlesbrough once again falls below these figures. (As shown in appendix 5). These results could further complement the alcohol misuse, but also the poor crime rates within Middlesbrough. Between 2010/11, there were a total of 108.5 crimes committed per 1,000 people in the town. Again, in comparison with Tees Valley at 0 and National crime statistics at 79.1 per 1,000 people, Middlesbrough comes out exceptionally high (Middlesbrough Council - Middlesbrough statistics. 2014).

Further exploring mortality rates and poverty, Middlesbrough once again shows poorer statistics compared to Tees Valley and the national average. Mortality rates under 100 suggest that individuals are likely to live longer. Both Middlesbrough at 106.8 and Tees Valley at 105.2 have poor results. The national average has a mortality rate of 100. This may be due to poorer living conditions/lifestyles. Middlesbrough is ranked 8th of all local authorities within England and Wales for being the most deprived, 1st being the worst. This will have an adverse effect on individuals' health and their lifestyle (Middlesbrough Council - Middlesbrough statistics. 2014).

All of these factors together will contribute to Middlesbrough having poor statistics and change the way individuals living here are able to adapt their lifestyles for the better. Changes need to be made with the help of better services and increased knowledge in order to see a change within these numbers. This can be done through the use of a community profile. Each target area should be explored individually and improvements made accordingly.

Due to alcohol misuse being one of the main areas that is in desperate need of improvement within Middlesbrough, it is first essential to understand why and how alcohol leads to poor health, as well as what can be done to prevent its misuse. Often, individuals may use alcohol if they have any problems in their lives. Alcohol is a form of drug and can easily become addictive. Drug use is seen as a response to social breakdowns and a large factor for poor and/or worsening health (Wilkinson, R.G and Marmot, M.G. 2003. p24).
Alcohol has effects on the brain over a period of time with high consumption. Unfortunately, adolescents are more susceptible to the damage, however this is not to say that the adult brain cannot also be affected (Dasgupta, A. 2011. p10). It also has more noticeable effects often as the addiction takes over. This may include poverty, cravings. One of the most serious complications of alcohol misuse is often malnutrition. This is often due to the individual not eating enough to nourish their body. (Kessel, N and Walton, H. 1969. p30).

Chapter Two
According to statistics and media attention, alcohol misuse in Middlesbrough is currently at a high. This suggests that alcohol may be a local health improvement issue. With alcohol being such a large issue within Middlesbrough at the present time, local services and its users may benefit from a community profile in order to identify areas for improvement. Many people who misuse alcohol end up in hospital and within the last year out of every 100,000 of Middlesbrough's population, 3,280 people were admitted to hospital. This is the highest statistic across England (Mike Brown ' Gazette Live, 2014).

A health improvement issue is an area that would benefit from health promotion and improving services provided. The World Health Organisation quoted 'health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.' (WHO | Health promotion. 2014.)

With alcohol been such an issue, it has a large impact on services provided in Middlesbrough both physically and financially. There is strain on the services to provide affective care whilst in high demand. As a result of this, there are cost implications for use of treatments, equipment and time. If the level of alcohol misuse were to be reduced, this would create some relief for services working hard to accommodate. In order to reduce the levels, a community profile is beneficial in order to ascertain where the issues are within the local community and put strategies in place.

Yearly, across the country, alcohol misuse is causing the NHS approximately ??3.5billion (The National Treatment Agency for Substance Misuse. 2014.) Due to this, areas with high levels of alcohol misuse, such as Middlesbrough are forced to put into place and commission alcohol services in order to prevent/treat alcohol misuse.

Looking at the epidemiology of alcohol demonstrates why people may turn to alcohol and what effects it may have on them. Frequent heavy drinking can have many negative effects on the body and a person's health and these may ne short or long term. Some impacts alcohol can have on a person are academic problems, social isolation, physical illnesses such as hangovers or illnesses, memory problems and an increased risk of mental health problems leading to suicide (Galanter, M et al. 1983. p1).

Alcohol starting becoming a rising problem in the 1800s, and the first self help groups were introduced. By the 1930s alcoholics anonymous had been founded and alcohol misuse has continued to grow since (Rose, M.E. and Cherpitel, C.J. 2011. p3)

Chapter Three
Within Middlesbrough, there are a number of services available to those within the community for suffer from alcohol misuse. With these in place, a long term goal is to reduce the amount of individuals reliant on alcohol, to change and improve their lifestyle for the better.

One of the services available to service users is the Middlesbrough Alcohol Treatment Service based in North Ormesby. This service aims to offer advice to its users, provide information and also treatment for alcohol misuse. They aim to do this by offering rehabilitation and detoxification referrals, as well as hepatitis vaccinations. Not only does this service provide care for the individual suffering from the alcohol abuse, but it also offers support to the families of those in need and dealing with the repercussions. This is affective because it takes a holistic approach to the care of the individual as well as their families (Middlesbrough Council - Help with alcohol. 2014.)

The Albert Centre in Middlesbrough are also specialists in providing treatment to those people who are experiencing addiction and struggling to manage it themselves (Middlesbrough Council - Help with alcohol. 2014.) In order to provide person centered care, the Albert Centre provides tailored packages within a community based intervention strategy. Initially, clients who are referred here will be assessed by the center in order to establish how much alcohol they drink, dependency levels and any reasons behind why they may drink. They are then allocated to a support worker who works one to one with the individual and starts to develop a recovery plan. From here, the support worker and the individual discuss and implement any interventions. These may consist of self-motivational tools, worksheets or other exercised to assist the recovery process. Along-side this, the Albert Center provides counselling sessions, alternative therapies, and peer led recovery groups on a support basis. Educational classes are also available to improve awareness around alcohol and the affects it has on stress, health, motivation, confidence and also differing behaviours. Upon reducing the alcohol to a safe level or completely cutting it out, services users are placed on an exit package which includes information and guidance about maintaining recovery (The Albert Centre. 2014).

For those younger individuals who suffer from alcohol misuse, there is a service called 'Platform' within Middlesbrough specifically for young people under 18 years. This demonstrates a clear understanding between the different types of treatment required for adults and adolescents. Often younger people are more vulnerable and need different methods of care for it to be effective. Platform aims to give help support and advice about alcohol misuse and works towards a harm reduction approach for the individual, their families and the community (Platform Middlesbrough. 2014).

A voluntary provider for alcohol misuse is the Middlesbrough Hospital based Primary Alcohol Drug Service, otherwise known as PADS. There are two full time substance misuse workers who are based in A&E of James Cook University Hospital and visit specific wards within the hospital to receive referrals. Both these workers are each trained in counselling and motivational interviewing. They are each able to offer every patient holistic patient centered approaches. Each individual will benefit from this greater than a general approach for someone who comes under the label of alcohol misuse. The substance misuse workers embark in a detailed assessment of the individual which can often identify the underlying causes resulting in the patient drinking. They both motivate the patient to get themselves help from community services but also refer and advocate on their behalf (Public Health England. 2014).
Within the hospital there is also an Alcohol Liaison Nurse who works with the patients specifically admitted to wards and experience alcohol withdrawal symptoms. They will often work in partnership with the community treatment agencies ensuring that any prescribed treatment in hospital compliments the treatment received in the community. This then makes the transfer between community and hospital setting a much easier one especially for the patient who is likely to be finding it hard enough (Public Health England. 2014).
Of these groups, some are volunteer led; such as the service for young people. This means that they are non-statutory. Non statutory services are service providing bodies that are not legal entities in their own right, however they are accountable for the care they provide (Non-statutory organisations | NHS Brand Guidelines. 2014). This, on the other hand means that a statutory service is one provided by the local authority. For individuals suffering from alcohol misuse and seeking help from one of these non-statutory service provisions, clients may often feel empowered as if they are in charge of their own recovery. This may be due to relationships being less formal and no direct authorative figure.

Chapter Four
The role of a nurse in facilitating health care and meeting the needs of each individual is very complex. There are many strategies in place, guidance, codes, laws and legislations. A nurse has to be extremely thorough in the care that he/she provides. As quoted by RCN, nursing is 'the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.'(Royal College of Nursing. 2014. p3)

The purpose of nursing is promote health, wellbeing, and to prevent disease, injury, illness or disability. When a person or their families require nursing interventions, the nurse's role is to minimise distress, pain and suffering. It is also to provide information in a way that the patient can understand in order to help them understand and cope with their illness/disease. If death is inevitable, the nurse should maintain the best quality of life until the very end (Royal College of Nursing. 2014. p3).

Nursing interventions should empower their patients. This helps them to achieve or maintain independence and make the patient feel like they are involved in their care. Nursing is built up of intellectual skills, physical skills and emotion. Nurses need to provide personal care and therapeutic interventions. However, nursing isn't just about personal care, it's also about teaching, policy and knowledge development and management (Royal College of Nursing. 2014. p3).

There are many more characteristics of nursing including unique responses to health, illness. A patient's response may be psychological, physiological, social, cultural or spiritual. Sometimes even a combination of these. Nurses need to be able to deal with all aspects of these. The focus of a nurse is the whole person, rather than just a specific illness or injury. Nursing is focused on ethical values, respecting dignity, being non-judgmental and having empathy. Nurses should also respect autonomy, confidentiality and always be accountable for their actions. Finally, a nurse must be committed to what their practice and partnership with patients, relatives, carers and as part of a multi-disciplinary team (Royal College of Nursing. 2014. p3).
In order to maintain these professional standards at all times, the Nursing and Midwifery council (NMC) put together a code of conduct. This is very similar to the points listed above about how a nurse should act by treating people as individuals, respecting people's confidentiality, collaborate with those in your care, gain consent before doing anything and always maintain clear and professional boundaries (Nursing and Midwifery council. 2014). The code also states that nurses should share information with their colleagues, work effectively as part of a team, delegate and manage risk. All of this can be achieved by using the best available evidence, keeping skills and knowledge up to date and maintaining clear, accurate up to date records. Every nurse should act with integrity, deal with any problems that may arise, be impartial and uphold the reputation of nurses (Nursing and Midwifery Council. 2014).

Throughout the ages from birth to elderly, every individual will need caring for at some point. This means that care will have to be adapted to suit the requirements of this individual. Even if you aren't directly caring for an individual, it is likely you will come across friends and family within nursing across the age continuum and it is essential that skills can be adapted appropriately.

In order to ensure care across the age continuum is implemented, the government introduced a strategy 'making every contact count.' This involved using every day opportunities to help improve people's health and reduce inequalities. For example, a routine dental appointment could be an opportunity to offer advice about stopping smoking. Another example could be a visit from midwife/health visitor which then leads to a discussion about anxieties or fears the family may have and what sort of support is available (Shoni A and Bailey V. 2014).

Once an individual has a great understanding and knowledge of a subject, this then sets in motion change contemplation, even if they never act on it. Many models have been put into place about the stages of change, one of which being done by Prochaska and DiClemente (see appendix 6). This model suggests that each person goes through five stages before making a change.

The first stage of this model suggests pre-contemplation. An individual in this stage doesn't see an issue; however others may not approve of their lifestyle and may offer suggestions. The second stage is contemplation. This is where the person starts weighing up the pros and cons of changing before coming to a decision about whether they are ready to make the change. Active changes are the next stage and this is where any decisions made are put into practice. Sometimes individuals find this too difficult initially and will often take an easy way out. In order to keep the change, it has to be maintained. For some, they will have changed their behavior and possibly never go back, however some will relapse and return to their previous behaviours. After this the cycle starts again.

Often, lifestyle may lead to poorer health and have effects on access to services. Approximately 1.2billion people round the world are living in extreme poverty. Ill-health is caused by poverty because people are forced to live in environments that make them ill. For example, damp and mold are bad for chests (WHO | Poverty and health. 2014). Not only this, but a person living in the country side with no method of transport may struggle to access services and therefore they may not seek the care or treatment they require.

Another method of ensuring patients get the correct level of care is through primary, secondary and tertiary prevention. Primary prevention is about educating the person in the hope of preventing the illness/disease occurring. Secondary prevention is implemented during the early stages of the disease and is the intervention to try and slow down or prevent the disease becoming worse. Tertiary prevention aims to reduce the impact the disease has on the person and aim to promote a good quality of life through rehabilitation (Department of Health - Publications. 2014).

Chapter Five
In conclusion it is clear that Middlesbrough has a high rate of alcohol misuse and that it is causing problems and strain within the local community and services. It is also having large financial implications. By doing a community profile, it makes it clear to recognise areas for improvement, and implement strategies in order to do so. Over a period of time, the aim would be to reduce the levels of alcohol misuse within Middlesbrough, therefore freeing up services, time and money.

Alcohol misuse has been on the rise since the 1800's and was once seen as a social activity. As years have gone on, people have begun to misuse alcohol and have started using it as a form of release if they feel things aren't going to well in their life and many other factors. An overall strategy to increase knowledge about the effects of alcohol and reduce the number of people misusing it is been set in place. Areas most in need can be reviewed using a community profile and make improvements to services accordingly.

There are a number of services within Middlesbrough to help raise awareness, increase knowledge and try prevent alcohol misuse. The services are aimed at a wide range of age groups and offer support to those suffering in the hope of cutting down the alcohol, or completely cutting it out of their lifestyle.

The role of a nurse plays a large factor in building relationships and maintaining trust when caring for individuals. Confidentiality, autonomy, empowering patients and many more interventions build up the bond between the nurse and the client so that care can be delivered more effectively and accurately.

Overall, the benefits of doing a community profile in order to establish areas of services most in need of improvement are highly beneficial to the local community.

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