Committee on Valuing Community-Based,
Non-Clinical Prevention Policies and Wellness Strategies

Board on Population Health and Public Health Practice


Washington, D.C.

The National Academies of Sciences, Engineering, and Medicine
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AN INTEGRATED FRAMEWORK FOR ASSESSING THE VALUE OF COMMUNITY-BASED PREVENTION Committee on Valuing Community-Based, Non-Clinical Prevention Policies and Wellness Strategies Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by contracts between the National Academy of Sciences and the California Endowment (20091915), the de Beaumont Foundation, the Robert Wood Johnson Foundation (68317), and the W.K. Kellogg Foundation (P3016629). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13:  978-0-309-26354-2 International Standard Book Number-10:  0-309-26354-9 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; For more information about the Institute of Medicine, visit the IOM home page at: Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent ad- opted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2012. An integrated framework for assessing the value of community-based prevention. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engi­ neers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences ­ in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The C ­ ouncil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

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COMMITTEE ON VALUING COMMUNITY-BASED, NON-CLINICAL PREVENTION POLICIES AND WELLNESS STRATEGIES ROBERT S. LAWRENCE (Chair), Center for a Livable Future Professor and Professor of Environmental Health Sciences, Health Policy, and International Health; Director, Center for a Livable Future, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD KIRSTEN BIBBINS-DOMINGO, Associate Professor and Attending Physician, University of California, San Francisco LAURA K. BRENNAN, President and Chief Executive Officer, Transtria, LLC, St. Louis, MO NORMAN DANIELS, Mary B. Saltonstall Professor of Population Ethics and Professor of Ethics and Population Health, Harvard University, Cambridge, MA DARRELL J. GASKIN, Associate Professor, Deputy Director, Center for Health Disparities Solutions, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD LAWRENCE W. GREEN, Professor, Department of Epidemiology and Bisostatistics, University of California, San Francisco ROBERT HAVEMAN, Professor Emeritus of Public Affairs and Economics and Faculty Affiliate, Institute for Research on Poverty, University of Wisconsin–Madison JENNIFER JENSON, Managing Senior Fellow, Partnership for Prevention, Washington, DC F. JAVIER NIETO, Helfaer Professor of Public Health, Professor of Population Health Sciences and Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison DANIEL POLSKY, Professor of Medicine and Healthcare Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania; Director of Research, Leonard Davis Institute of Health Economics, Philadelphia LOUISE POTVIN, Professor, Social and Preventive Medicine, Faculty of Medicine, University of Montréal, Institut de Recherche en Santé Publique de l’Université de Montréal, Canada NICOLAAS P. PRONK, Vice President and Health Science Officer, HealthPartners, Minneapolis, MN LOUISE B. RUSSELL, Research Professor of Economics, Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick v

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STEVEN M. TEUTSCH, Chief Science Officer, Los Angeles County Department of Public Health, California CHAPIN WHITE, Senior Health Researcher, Center for Studying Health System Change, Washington, DC Consultant CATHERINE M. JONES, University of Montréal, Canada Study Staff LYLA M. HERNANDEZ, Study Director MELISSA FRENCH, Associate Program Officer ANDREW LEMERISE, Research Associate ANGELA MARTIN, Senior Program Assistant ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice vi

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Reviewers This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Laurie M. Anderson, Washington State Institute for Public Policy Charles C. Branas, University of Pennsylvania Norman Fost, University of Wisconsin–Madison Marthe R. Gold, City University of New York Medical School Dana Goldman, University of Southern California Mary Mincer Hansen, Des Moines University Robert Jeffery, University of Minnesota Michael Maciosek, HealthPartners Research Foundation Vickie Mays, University of California, Los Angeles Barbara A. Ormond, The Urban Institute Patrick Remington, University of Wisconsin–Madison Barbara Rimer, University of North Carolina vii

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viii REVIEWERS James F. Sallis, University of California, San Diego Jane E. Sisk, Institute of Medicine Pierre Vigilance, George Washington University Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclu- sions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Georges C. Benjamin, American Public Health Association, and Charles E. Phelps, University of Rochester. Appointed by the Institute of Medicine and the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Acknowledgments Many people contributed to the development of An Integrated Frame- work for Assessing the Value of Community-Based Prevention. The com- mittee would like to acknowledge and thank those individuals whose input invigorated committee deliberations and enhanced the quality of this report. First, we would like to thank the sponsors of this project, the Califor- nia Endowment, the de Beaumont Foundation, the Robert Wood Johnson Foundation, and the W.K. Kellogg foundation. We are particularly appre- ciative of the efforts of Angela McGowan, James Sprague, Marion Standish, and Alice M. Warner-Mehlhorn. The committee greatly appreciated the input of David Paltiel and Charles Poole and the speakers whose presentations informed committee thinking, including Bridget Booske, Rob Grunewald, Veva Islas-Hooker, M. Rebecca Kilburn, Tyler Norris, Deirdre Oakley, Brian Smedley, Harold Sox, Brenda Spencer, Kenneth Thorpe, Steven H. Woolf, and Chen Zhen. The committee was very fortunate in its staffing for this study. We wish to thank our study director, Lyla M. Hernandez, and our associate program officer, Melissa French, for their efforts in producing a clearly written, well- organized report that reflects the collective thought of the committee. Our appreciation also goes to Andrew Lemerise for his exceptional research support and tireless efforts in tracking down elusive references, and to Angela Martin for her excellent administrative and logistical support. We were also fortunate that Catharine M. Jones at the University of Montréal was available to provide important research assistance. ix

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Contents SUMMARY 1 1 INTRODUCTION 13 Committee Charge, 13 Definitions, 14 Why Is Community-Based Prevention Important?, 15 How Is Community-Based Prevention Different?, 17 Why Is It So Hard to Assess the Value of Community-Based   Prevention?, 18 A Roadmap for the Rest of the Report, 20 References, 21 2 COMMUNITY-BASED PREVENTION 23 Community, 23 Important Features of Community-Based Prevention, 24 Historical Perspective, 27 Approaches to Community Intervention, 32 Models, 37 Impact of Community-Based Prevention, 44 Evaluation of Community-Based Prevention, 47 References, 52 xi

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xii CONTENTS 3 COMMUNITY-BASED PREVENTION: MORE THAN THE SUM OF ITS PARTS 61 Applying Systems Science to Community-Based Prevention, 64 Valuing Community-Based Prevention: Domains and Elements, 64 Valuing Resources and Costs for Community-Based Prevention, 74 Data Sources and Indicators for Valuing Community-Based   Prevention, 78 References, 81 4 EXISTING FRAMEWORKS 89 What Is a Framework for Assessing Value?, 89 Eight Existing Frameworks, 93 Valuing Community-Based Prevention: Is a New    Framework Needed?, 112 References, 114 5 A FRAMEWORK FOR ASSESSING THE VALUE OF COMMUNITY-BASED PREVENTION 119 A Framework for Assessing Value, 119 Information Needed to Assess Value Using This Framework, 132 How to Use the Framework in the Community Context, 133 Implications for State and National Policy, 136 Conclusion, 137 References, 138 APPENDIXES A GLOSSARY 139 B EXAMPLES OF SYSTEMS SCIENCE APPROACHES TO VALUING COMMUNITY-BASED PREVENTION 143 C OPEN MEETING AGENDAS 153 D COMMITTEE BIOGRAPHICAL SKETCHES 159