Community-based prevention includes programs and policies that are aimed at

  • preventing 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. The charge to the committee requested that special attention be given to the prevention of long-term, chronic diseases. Such a focus does not negate the fact that other community-based prevention efforts, such as those directed at unintended and intended injuries and mental health, are also important areas for attention.

The value of an intervention, for the purposes of this report, is defined as its benefits minus its harms and costs. There is an expanded discussion of the concept of value at the end of this chapter and in Chapter 4.

Community has been defined in a variety of ways. The committee uses the term community to mean any group of people who share geographic space, interests, goals, or history. It includes the built environment, social networks, and the organizations and institutions that sustain the individual and collective life of the community. Chapter 2 contains an expanded discussion of the concept of community.

A community-based prevention program is a coordinated activity or set of activities, such as an educational campaign against smoking, improvements to the built environment to encourage physical activity, a chronic disease education and awareness campaign to improve self-management, or a combination of such interventions, that is intended to accomplish a health objective or outcome. A policy is a rule or set of guidelines, such as nutritional standards for school lunches. An intervention is an umbrella term used to mean either a program or a policy with the goal of improving health. A 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.

WHY IS COMMUNITY-BASED PREVENTION IMPORTANT?

Early health-promotion efforts emphasized meeting basic human needs for clean water, adequate nutrition, and shelter. In 1900 a third of all deaths



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