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A Glossary Benefits, for purposes of this report, are defined as the outcomes of a community-based preventive intervention that promote or enhance health, community well-being, or community process. Community, as defined for the purposes of this report, means any group of people who share geographic space, interests, goals, or history. It also includes the built environment, social networks, and the organizations and institutions that sustain the individual and collective life of the community. The committee believes that a community can exist at both a neighborhood and a national level. Community-based activity is an activity that involves members of the af- fected community in the planning, development, implementation, and eval- uation of programs and strategies. Community-based prevention, as defined for purposes of this report, takes a population-based approach to programs and policies oriented to pre- venting the onset of disease, stopping or slowing the progress of disease, reducing or eliminating the negative consequences of disease, increasing healthful behaviors that result in improvements in health and well-being, or decreasing disparities that result in an inequitable distribution of health. Community-based prevention is not primarily based on clinical services although it may involve services provided by health professionals in clinical settings. For purposes of this report, community-based prevention includes both community-based activities and community-placed activities. 139
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140 ASSESSING THE VALUE OF COMMUNITY-BASED PREVENTION Community-based program, as defined for this report, is a coordinated activity or set of activities, such as an educational campaign against smok- ing, improvements to the built environment to encourage physical activity, or a chronic disease education and awareness campaign to improve self- management, or a combination of such interventions that is undertaken to accomplish a health objective or outcome. Community participation refers to the engagement of those affected in the process of transforming conditions. Community-placed activities are activities that are developed without the participation of the affected community at important stages of the project but for which effort is expended to generate community support. Community process refers to several elements influencing community par- ticipation in the decision making as well as the design and implementation associated with community-based interventions. These elements include civic engagement, local leadership development, community representation, trust, skill building, and community history, among others. Community well-being includes social norms, how people relate to each other and to their surroundings, and how much investment they are willing to make in themselves and in the people around them. Elements of commu- nity well-being include wealth, education, employment, safety, transporta- tion, housing, worksites, food, health care, and recreational spaces. Costs, for purposes of this report, are the resources necessary to implement a community-based preventive intervention and produce its benefits. Ecological model “assumes that health and well-being are affected by the interaction among multiple determinants including biology, behavior, and the environment” (IOM, 2003, p. 32). Empowerment refers to the individual or collective capacity to exercise control over the conditions and circumstances that influence health and well-being. Harms are the non-economic costs of an intervention to a community, for example, the inconvenience and noise of construction of a bike or walking path or an increase in disparities caused by an intervention that helps one segment of the population more than another. Health promotion “is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behav- iour towards a wide range of social and environmental interventions” (http:// www.who.int/topics/health_promotion/en/). Health promotion approaches
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APPENDIX A 141 engage people and organizations in the transformation process, and their engagement in the process constitutes in itself a desired change. Intersectoral action refers to an action in which actors from a variety of relevant sectors are engaged and coordinated in the planning, implementa- tion, and governance of interventions. Intervention, as defined for this report, is an umbrella term used to mean either a program or a policy that has the goal of improving health. Opportunity cost is a benefit, profit, or value of something that must be given up to acquire or achieve something else. “Since every resource (land, money, time, etc.) can be put to alternative uses, every action, choice, or decision has an associated opportunity cost” (http://www.businessdictionary.com/ definition/opportunity-cost.html). Policy is a rule or set of guidelines, such as nutritional standards for school lunches. Population health, as defined by Kindig and Stoddart (2003, p. 380), is “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” “These populations often are geographic regions like nations or communities but also can be other groups, like em- ployees, specific ethnic groups, disabled persons, or prisoners.” Present value is “the current worth of a future sum of money or stream of cash flows given a specified rate of return” (http://www.investopedia.com/ terms/p/presentvalue.asp#axzz22UfpMoYB). Social determinants of health are the “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (http://healthypeople.gov/2020/topicsobjectives2020/overview. aspx?topicid=39). Social marketing is the application of marketing principles used to sell products to change attitudes and behaviors. “Social marketing seeks to influence social behaviors not to benefit the marketer, but to benefit the target audience and the general society” (http://www.social-marketing.com/ Whatis.html). Strategy is the method through which programs are implemented, such as television advertisements warning of the dangers of smoking, construction of a bike path, or conducting disease management workshops in churches. Systems science is the study of “dynamic interrelationships of variables at multiple levels of analysis (e.g., from cells to society) simultaneously
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142 ASSESSING THE VALUE OF COMMUNITY-BASED PREVENTION (often through causal feedback processes), while also studying the impact on the behavior of the system as a whole over time” (http://obssr.od.nih. gov/scientific_areas/methodology/systems_science/index.aspx). Value of an intervention is defined as its benefits minus its harms and costs. REFERENCES IOM (Institute of Medicine). 2003. Who will keep the public healthy? Washington, DC: The National Academies Press. Kindig, D. A., and G. Stoddart. 2003. What is population health? American Journal of Public Health 93:366-369.