and language; common norms, interests, or values; and common health risks or conditions (IOM, 1995; Jewkes and Murcott, 1996; Ruderman, 2000; Ricketts, 2001). Members of communities typically experience the shared reality of living or working in the same location or environment and so are in a position to influence and be influenced by the social, economic, and physical risk factors in that environment (Roussos and Fawcett, 2000; Kreuter et al., 2001). Although acknowledging the increasing influence of “communities of interaction” such as online groups, this chapter focuses mainly on activities based in geographic communities—neighborhoods, cities, counties, and in a few cases, states—that are critical to creating the conditions for a community to be as healthy as it can be.
Communities consist of individuals and families, as well as the various organizations and associations that make up a community’s “civil society”: nonprofit, nongovernmental, voluntary, or social entities, including ethnic and cultural groups; advocacy organizations; and the faith community (Salamon et al., 1999; Himmelman et al., 2001). Organizations exist between the level of the individual and that of the community or society. The United States has both a history of individualism and, as de Tocqueville observed in 1831, a rich civic tradition of individuals associating or organizing to accomplish common goals. The public sector at the community level encompasses local government officials and agencies traditionally seen as having health-related responsibilities, as well as many others that have important but sometimes less obvious roles in health but whose policies and objectives may have potential health consequences. The latter may include city councils, public schools, colleges and universities, police and fire departments, zoning boards, housing authorities, parks and recreation agencies, and agricultural development and cooperative extension services. Other members of the community may come from the private sector, including private schools, colleges, and universities; health care providers and payers; and small and large businesses.
A healthy community is a place where people provide leadership in assessing their own resources and needs, where public health and social infrastructure and policies support health, and where essential public health services, including quality health care, are available. In a healthy community, communication and collaboration among various sectors of the community and the contributions of ethnically, socially, and economically diverse community members are valued. In addition, the broad array of determinants of health is considered and addressed, and individuals make informed, positive choices in the context of health-protective and supportive environments, policies, and systems (Goodman et al., 1996; CDC, 1997; Norris and Pittman, 2000).
Health is a “fundamental resource to the individual, the community and to society” (Kickbusch, 1989:13). When people are healthy, they are