Community Health Assessment Mapping for Health Departments
Community health assessment (CHA) mapping means choosing geographies, mapping indicators and access, testing reliability, and sharing maps to meet PHAB's 2026 measures.
What PHAB and MAPP 2.0 expect
PHAB Standards & Measures (2026)
PHAB's refreshed Standards & Measures went into effect on July 1, 2026. Health departments applying on or after July 1, 2026 use the 2026 version.
PHAB calls the refresh "a refinement, not an overhaul," with about 40 fewer required documents for initial accreditation. If you started under Version 2022, use PHAB's Version 2022 to 2026 crosswalk.
PHAB's September 2026 draft templates list the measures below. Confirm each number against PHAB's Standards & Measures for Initial Accreditation 2026 before citing it.
| 2026 measure | Measure name | Template detail or mapping link |
|---|---|---|
| 1.1.1 A | Develop a community health assessment | Template requires primary data plus at least two secondary data sources, at least four demographic variables, and outcome differences for at least two subpopulations |
| 1.1.2 A | Ensure the community health assessment is accessible and used to improve population health | For initial accreditation, the template says to actively share the full assessment and key findings with the public and outside organizations |
| 7.1.1 A | Engage with health care delivery system partners to assess access to health care services | Template sets a minimum review of access to primary care and behavioral health care |
| CHIP adoption (Domain 5) | Adopt a community health improvement plan | Template says the link from assessment findings to chosen priorities should be visible |
| Domain 5 | Address factors that contribute to higher health risks and poorer health outcomes experienced by specific populations | Subpopulation and place maps show which groups face higher risks |
| 7.1.2 A | Implement and evaluate strategies to improve access to health care, behavioral health, and social services | Template marks it as applicable if access is among plan priorities or strategies |
Sources for this table: the Health Assessment Template and Health Improvement Plan Template.
Two template details shape the mapping plan:
- Its services section asks for "the number and geographic distribution of providers, provider-to-population ratios".
- It defines primary data as data "newly collected specifically to inform the health assessment."
Check PHAB's 2026 Standards & Measures for how recent the assessment must be.
Version 2022 numbered CHIP adoption 5.2.2 A (NACCHO crosswalk); check PHAB's 2026 document for the current number.
MAPP 2.0
MAPP 2.0 is NACCHO's framework for community health improvement, updated in 2023. Its three phases are Build the Community Health Improvement Foundation, Tell the Community Story, and Continuously Improve the Community.
Phase 2 runs three assessments:
| MAPP 2.0 assessment | Method | What it covers | Mapping role |
|---|---|---|---|
| Community Partner Assessment | Partner assessment survey | Partners' systems, processes, and capacities, and the network's capacity to address health inequities | Map partner sites against need |
| Community Status Assessment | Quantitative | Demographics, health status, and social determinants of health | Most indicator and access maps |
| Community Context Assessment | Qualitative | Community strengths and assets, built environment, and forces of change | Asset maps and resident map annotations |
NACCHO's 2024 crosswalk ties these Phase II assessments to Measures 1.1.1 A and 1.1.2 A under PHAB Version 2022, and links the Community Status Assessment's access indicators to Measure 7.1.1 A.
Step-by-step: the mapping and data work
Step 1: Choose geographies
| Geography | Size | Use it for | Watch for |
|---|---|---|---|
| County | Varies | Matching county sources such as AHRF and County Health Rankings | Hides differences inside the county |
| Census tract | Generally 1,200 to 8,000 people, optimum 4,000 | Neighborhood detail from PLACES, SVI, and ACS 5-year data | Residents do not know tract numbers, so label maps with place names |
| ZCTA | Approximates USPS ZIP Code service routes | Matching ZIP-based hospital and program data | ZIP codes change, while ZCTAs stay fixed for 10 years |
Pick one primary map geography and keep it next cycle so trends compare cleanly. See ZCTA vs. ZIP code.
Coordinate with nonprofit hospitals in your jurisdiction, since shared geographies save everyone work. Each must seek CHNA input from a governmental public health department or a State Office of Rural Health. See the CHNA access gap mapping guide.
Step 2: Select indicators
| Source | What it provides | Geographies | Note |
|---|---|---|---|
| CDC PLACES | 40 model-based health measures | County, place, tract, ZCTA | The December 2025 release uses 2023 BRFSS for 35 measures |
| ACS 5-year estimates | Demographics, income, insurance, language | All areas | 1-year estimates cover only areas of 65,000+ |
| CDC/ATSDR SVI | 16 ACS variables in four themes | Census tracts, counties | Ranks relative vulnerability |
| HRSA AHRF | More than 6,000 variables | County, state, national | Updated December 18, 2025, as of November 2026 |
| County Health Rankings | County measures, such as the primary care physician ratio | County | Ratio excludes nurse practitioners and physician assistants |
Download PLACES from its data portal, which offers each release in open data and GIS-friendly formats. See ACS 5-year estimates.
Know the PLACES limits before you map it:
- No age-adjusted prevalence is published at tract or ZCTA level.
- Estimates should not be used to evaluate local programs, and the model does not support tracking local change over time.
- CDC encourages communities that have their own local estimates to use them first.
- In the December 2025 release, 2023-based estimates were not available for Kentucky or Pennsylvania.
Plan the subpopulation work early. PHAB's template asks for at least four demographic variables and outcome differences for at least two subpopulations, so map those where numbers allow.
Step 3: Map access and shortage measures
Start with primary care and behavioral health, the minimum PHAB's template sets for the access review.
- Download HRSA's Shortage Areas file as XLSX, CSV, or SHP. It covers primary care, dental, and mental health HPSAs in geographic, population, and facility designations, plus MUA/Ps.
- Note HPSA scores. Primary care and mental health scores run 0 to 25, and dental 0 to 26.
- Build provider supply from the NPPES monthly file, filtered to primary care and behavioral health taxonomy codes. The data are self-reported by providers, so label counts as headcounts.
- Compute provider-to-population ratios by area. For reference, a geographic primary care HPSA needs a population to FTE physician ratio of at least 3,500:1.
- Add travel time. HPSA rules use 30 minutes travel time between population centers to define rational service areas.
See HPSA, MUA/MUP, NPI taxonomy codes, and drive-time access.
For travel time, QGIS is free and open source on Windows, Mac, and Linux. openrouteservice offers 500 free isochrone requests per day, as of November 2026. ArcGIS Pro service areas consume credits when ArcGIS Online is the network source, and suit departments that already license it.
Desktop GIS such as QGIS or ArcGIS Pro is the stronger choice for joining your own surveillance or survey data to custom boundaries. For quick exploration, GeoChat AI has a free tier with no credit card required. It offers interactive maps of supply-demand gaps, provider deserts, and population health patterns, built on public data such as ACS and NPPES.
Its AI chat lets you drill into ZIP codes and compare regions in plain language, and nonprofit organizations can request new maps. The platform is new: the current version is GeoChat Atlas (version 2).
Step 4: Handle small numbers and ACS margins of error
All published ACS margins of error (MOEs) use a 90 percent confidence level. Small areas need a reliability check before they go on a map.
- Convert each MOE to a standard error by dividing by 1.645.
- Compute the coefficient of variation (CV): standard error divided by the estimate, times 100. A lower CV means a more reliable estimate.
- Set a CV cutoff before mapping, and write it in your methods.
- Before combining areas or categories, check for a published collapsed table. If none exists, approximate the MOE of a sum as the square root of the sum of squared MOEs. For percentages built from two ACS estimates, use the proportion formula in Chapter 8, not the sum formula.
- Use as few component estimates as possible, because the approximation ignores covariance and drifts as you add terms.
- Test differences before you call one area worse. The Census Bureau says to check margins of error and confirm differences are statistically significant when comparing ACS estimates, and offers a testing tool.
Counts need their own rules. CDC WONDER suppresses death counts of 0 to 9 and marks rates unreliable when deaths number fewer than 20. Apply your state's suppression policy first, then pool years or areas as needed.
PLACES publishes confidence intervals, and CDC warns against drawing conclusions from estimates with very broad intervals. On maps, hatch or lighten unreliable areas and state the rule in the legend.
Step 5: Present maps to community partners
Measure 1.1.2 A asks that the assessment be accessible and used. Maps help only if partners can read them in a meeting.
- Map rates, percentages, or ratios, not raw counts.
- Use one light-to-dark color ramp per map, with low values light.
- Label towns and neighborhoods instead of tract or ZCTA codes.
- Put a one-sentence finding above each map.
- Pair each map with a data table for screen-reader users and for print.
- Bring printed maps to sessions and let residents mark them.
Record those marks with date and session. PHAB's template defines primary data as data newly collected for the assessment, and MAPP's Community Context Assessment centers people with lived experience.
Step 6: Document limitations
PHAB's template asks you to describe "missing data, small numbers, response bias, timeliness, geographic limitations," and how you addressed them. A short table per data source covers it.
| Limitation | Example | What to write |
|---|---|---|
| Model-based estimates | PLACES tract prevalence | Model-based from BRFSS; not for program evaluation |
| Sampling error | ACS tract poverty | CV cutoff used, and which areas were flagged or combined |
| Small numbers | Tract-level deaths | Suppression rule and years pooled |
| Timeliness | PLACES December 2025 release | Uses 2023 BRFSS for 35 measures |
| Geography | ZIP-coded program data | Crosswalk used to reach ZCTAs or tracts |
| Provider data | NPPES | Self-reported; counts are headcounts, not FTEs |
Our methods page shows how we document data sources.
Next steps
- Confirm which PHAB version applies to your application, and cite 2026 measure numbers if you apply on or after July 1, 2026.
- Agree on one primary map geography with partners, including hospitals planning CHNAs.
- List primary data plus at least two secondary sources, four demographic variables, and two subpopulations.
- Draft primary care and behavioral health access maps first.
- Write your CV cutoff and suppression rules before you make any map.
- Schedule partner map reviews early in MAPP Phase 2.
For more free mapping options, see free tools for healthcare access mapping.
Frequently asked questions
Which PHAB measure covers the community health assessment?
PHAB's 2026 Standards & Measures took effect July 1, 2026. 'Develop a community health assessment' was Measure 1.1.1 A in Version 2022 and keeps that number in PHAB's draft 2026 templates. Confirm numbers in PHAB's official 2026 document.
Should a health department map census tracts or ZIP codes?
Use census tracts for neighborhood detail, since PLACES, SVI, and ACS 5-year data all publish at that level. Use ZCTAs when partners and hospital data work in ZIP codes, and check margins of error either way.
How do I handle ACS margins of error on a map?
ACS margins of error use a 90 percent confidence level. Divide each MOE by 1.645 to get the standard error, compute the coefficient of variation, and flag or combine areas whose CV exceeds your cutoff.
Can CDC PLACES data show whether our local programs worked?
No. CDC says PLACES model-based estimates should not be used to evaluate local public health programs, and the current model does not support tracking local change over time.
How does MAPP 2.0 relate to PHAB accreditation?
MAPP 2.0 is NACCHO's community health improvement framework, and PHAB sets the accreditation measures. NACCHO's 2024 crosswalk maps MAPP 2.0 phases to PHAB Version 2022 CHA and CHIP measures.
Map access gaps for your community. GeoChat AI is free to use, with no credit card required. Ask questions in plain language, drill into ZIP codes and compare regions.
Sources
- PHAB: Standards & Measures for Initial Accreditation 2026 (accessed November 2, 2026)
- Standards & Measures - Public Health Accreditation Board (accessed November 2, 2026)
- Initial Accreditation - Public Health Accreditation Board (accessed November 2, 2026)
- Health Assessment & Improvement Planning Templates - PHAB (accessed November 2, 2026)
- Health Assessment Template, PHAB Standards and Measures (2026) (accessed November 2, 2026)
- Health Improvement Plan Template, PHAB Standards and Measures (2026) (accessed November 2, 2026)
- Refreshed Standards Crosswalk: Initial Accreditation Version 2022 to Version 2026 - PHAB (accessed November 2, 2026)
- MAPP 2.0 - NACCHO (accessed November 2, 2026)
- MAPP 2.0 Continues to Serve Health Departments after Two Years - NACCHO (accessed November 2, 2026)
- MAPP 2.0 and Healthy People 2030 - NACCHO (accessed November 2, 2026)
- MAPP and PHAB Crosswalk 2024 - NACCHO (accessed November 2, 2026)
- Glossary - Geography Program, U.S. Census Bureau (accessed November 2, 2026)
- About PLACES - CDC (accessed November 2, 2026)
- PLACES Current Release Notes - CDC (accessed November 2, 2026)
- PLACES Frequently Asked Questions - CDC (accessed November 2, 2026)
- PLACES Data Portal - CDC (accessed November 2, 2026)
- When to Use 1-year or 5-year Estimates - American Community Survey (accessed November 2, 2026)
- Understanding and Using ACS Data: Glossary (2018 handbook) (accessed November 2, 2026)
- Understanding and Using ACS Data: Calculating Measures of Error for Derived Estimates (2020 handbook) (accessed November 2, 2026)
- Do I need to consider the margins of error when comparing ACS estimates? - Census Bureau (accessed November 2, 2026)
- CDC/ATSDR Social Vulnerability Index (accessed November 2, 2026)
- Data Downloads - HRSA Data Warehouse (accessed November 2, 2026)
- Area Health Resources Files - HRSA (accessed November 2, 2026)
- Shortage Areas - HRSA Data Warehouse (accessed November 2, 2026)
- Scoring Shortage Designations - HRSA Bureau of Health Workforce (accessed November 2, 2026)
- 42 CFR Appendix A to Part 5 - Criteria for Designation of Areas Having Shortages of Primary Medical Care Professional(s) (Cornell LII) (accessed November 2, 2026)
- Data Dissemination (NPPES) - CMS (accessed November 2, 2026)
- Primary Care Physicians - County Health Rankings & Roadmaps (accessed November 2, 2026)
- Underlying Cause of Death help - CDC WONDER (accessed November 2, 2026)
- QGIS (accessed November 2, 2026)
- openrouteservice Plans (accessed November 2, 2026)
- Service area analysis layer - ArcGIS Pro documentation (accessed November 2, 2026)
- Community Health Needs Assessment for Charitable Hospital Organizations - Section 501(r)(3) (accessed November 2, 2026)