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New Horizons in Health: An Integrative Approach
limited to urban settings and areas of disadvantage. Most of the U.S. population lives in suburban areas, and the relationship of socioeconomic status and health holds at the upper end of the socioeconomic distribution as well as the lower end (Robert, 1999b). Yet much of the extant research literature is limited to the study of poverty in inner-city communities, underscoring the need to assess suburban and rural contexts. Moreover, there is a need for research on how public policies (e.g., on housing, transportation, and economic development) influence the collective properties of environments. Understanding community social processes requires a simultaneous focus on multiple social contexts and institutional (including governmental) domains.
We recommend a coordinated effort in the institutes to investigate the collective properties of social environments that extant research suggests are promising for a deeper understanding of the etiology of health outcomes and for the development of community-based prevention strategies. Because community contexts are important units of analysis in their own right, they call for concrete strategies that have heretofore been neglected in the institutes. We also underscore the importance of attending to cultural diversity in how healthy communities are defined and realized. Regarding the future, NIH-supported research on healthy communities should include the following kinds of work:
development of a “benchmark” assessment (standardized approach) of the collective health of communities;
selection of and support for longitudinal studies that target data augmentation and multilevel analysis, with a particular focus on personenvironment interactions;
investigation of contextual factors (e.g., cohesion, informal social control, physical disorder, local support networks) as mediators of health or disease outcomes;
design of prevention strategies to promote aggregate-level health by changing social and community environments (e.g., regulation of smoking in public places, taxation policies).
Berkman LF , Syme SL. 1979 “Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents” American Journal of Epidemiology 109/2 : 186-204 .
Green B. 1999 An Evaluation of the Caring Community Initiative of the Leaders Roundtable ( Portland OR : Northwest Professional Consortium, Inc. )