validation of the framework could include a consideration of its scalability and sustainability, whether it can support capacity building for health in communities, whether it can address health equity effectively, and whether it is generalizable across many contexts and settings.

It will also be important to validate the framework by showing repeatedly that it correctly distinguishes between interventions that improve community well-being and those that do not. This process of validation will almost certainly require refining the framework and expanding the underlying evidence base. Following consensus and validation, the framework can be formally incorporated into the policy-making process. This formal role could consist of a requirement that legislative or grant proposals be accompanied by an objective impact assessment based on the framework or of a requirement that executive branch agencies use the framework in evaluating the output of their programs. A formal role could also consist of a requirement that discretionary funding be distributed based on valuations that use the framework. Although that type of role may be many years off, the existing frameworks described in Chapter 4 provide clear precedents for such a progression.

CONCLUSION

Two transitions have led to changes in perspective about the kinds of interventions needed to address today’s challenges to living a healthy life: (1) the shift in major causes of illness and death from communicable diseases to chronic diseases, and (2) an increased emphasis on the social determinants of health. Community-based prevention interventions seek to address the distribution of health and risk factors in populations (e.g., the social determinants of health) that contribute to today’s primary causes of death and disease. But determining the value of community-based interventions has proven difficult. Existing frameworks for valuing interventions fall short, and the committee concluded that what is needed is a framework that focuses on population-level impact and that can take account of intersectoral action, community participation and empowerment, context, and systems thinking.

The framework proposed by the committee is comprehensive and includes the assessment of the benefits, harms, and resource use of community-based prevention interventions in the three major domains of health, community well-being, and community process. The framework also proposes that summary measures or single indicators be developed to assess value in these three areas and that these be compared with a summary measure of resource use. Until such time as a single indicator for each domain exists, however, it will be appropriate to use different metrics for



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