may address changes in the social and physical environment, involve intersectoral action, highlight community participation and empowerment, emphasize context, or include a systems approach.

Community-based prevention is not focused on changing individual characteristics. Rather, the focus is on population health, that is, on “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” (Kindig and Stoddart, 2003). For example, implementing nutritional standards for a population is a community-based prevention intervention. Such standards require decision making by a school district and their development may include elected officials, parents, administrators, and students. They affect all of the students and parents in the school district. An individual buying a Stairmaster and using it at home is also taking part in a nonclinical prevention program, but it is not community-based. The owner of the Stairmaster need not consult the neighbors before purchasing it, nor are the neighbors helped by the purchase.

Changes in social and physical features of the environment constitute valued outcomes for community-based prevention because the distributions of risk factors, health outcomes, and wellness indicators in a population are largely shaped by social and physical environments. Research has shown that social characteristics such as socioeconomic status, social cohesion, social capital, and friendship networks are associated with health and well-being (Adler et al., 2008; Berkman and Kawachi, 2000). The same is true for such features of the natural and built physical environment as poor housing, increased levels of pollution, the presence of green spaces, quality of housing, the safety and pleasantness of the walking infrastructure, and many others (Gauderman et al., 2004; Handy, 2004; IOM, 2000a; Kawachi and Berkman, 2003; Nelson et al., 2006).

Research also has demonstrated that intersectoral action is an important component of interventions aimed at population health (Gibson et al., 2007; Kreisel and Schirnding, 1998). Intersectoral action refers to engaging and coordinating actors from a variety of relevant sectors in the planning, implementation, and governance of interventions. Because most of the social and environmental determinants of population health exist outside the sphere of influence of the health sector, such intersectoral partnerships are key processes by which changes in the main determinants of health can happen (Gibson et al., 2007).

The health in all policies (HiAP) approach to address the social determinants of health encourages governments to include multiple sectors (e.g., taxation, education, transportation) in programs and policies to improve population health (WHO, 2010). Examples can be found in the Institute of Medicine (IOM) report that examined the role of laws and other policies on the public’s health. That report endorsed the potential of HiAP in population health improvement and provided examples of local, state, and



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement