FIGURE 1 A model of the determinants of health. Source: Reprinted from R.G. Evans and G.L. Stoddart, 1990, Producing Health, Consuming Health Care, Social Science and Medicine 31:1347–1363, with permission from Elsevier Science Ltd, Kidlington, UK.

partments, federal agencies, managed care organizations, and national corporations have a broader scope than a single community.

As communities try to address their health issues in a comprehensive manner, all of the stakeholders will need to sort out their roles and responsibilities, which will vary from community to community. These interdependent sectors must address issues of shared responsibility for various aspects of community health and individual accountability for their actions. They also must participate in a process of community-wide social change that is necessary for health improvement efforts and related performance monitoring to succeed (Green and Kreuter, 1990). Most communities will have only limited experience with collaborative or coordinated efforts among these diverse groups. Effective collaboration will require a common language, an understanding of the multidimensional nature of the determinants of health, and a way to accommodate diversity in values and goals.

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