available locally (3)
easily accessible (3)
affordable (3)
B. Health care options available within or near the community: Check as many as apply
Basic health care - conventional medical services (2)
Dental care - conventional medical services (2)
Emergency care (2)
Pre-natal care (2)
Maternity care (2)
Pediatric care (2)
Elder care (2)
Care & support for the handicapped/disabled (2)
Care & support for the dying (2)
Traditional services (shamanic ceremonies, counseling, etc.) (2)
Traditional remedies (herbal, nutritional, etc.) (2)
Preventive care/teaching (diet, exercise) (2)
Homeopathy (2)
Alternative/eclectic therapies (body work, hypnosis, biofeedback, energy methods, etc) (2)
Alternative practices (meditation, yoga, etc.) (2)
Other (1 point for each) Specify: _____________________________________________
C. How well health needs are met within or near the community:
Physical
well (2)
adequately (1)
poorly (0)
not at all (-2)
Mental
well (2)
adequately (1)
poorly (0)
not at all (-2)
Emotional
well (2)
adequately (1)
poorly (0)
not at all (-2)
Spiritual
well (2)
adequately (1)
poorly (0)
not at all (-2)
D. Deaths from preventable causes in the community are:
rare (6)
occasional (3)
common (-1)
frequent (-3)
E. Deaths from suicide/homicide/drug abuse in the community are:
rare (6)
occasional (3)
common (-1)
frequent (-3)
F. The incidence of serious communicable diseases in the community is:
rare (6)
occasional (3)
common (-1)
frequent (-3)
G. The extent to which there is a general commitment to healthy living in the community is:
great (6)
somewhat (3)
in small part (1)
not at all (-3)
Add up the numbers in parentheses behind each item above that you checked.
6. Health Care Total:_____
50+Indicates excellent progress toward sustainability 25-49Indicates a good start toward sustainability 0-24Indicates actions are needed to undertake sustainability
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