indicators of the health of a population. A broader definition, however, allows efforts to measure community health to go beyond traditional public health measures, incorporating measures of functional status and general health perceptions. Communities embarking on health improvement initiatives should consider carefully their definition of health and ground their work in an evidence-based conceptual model of the determinants of health. Three arguments supporting such action are discussed below.
The origins of good health are multiple and cross-sectorial. Origins of good health include factors such as genetic makeup, environmental conditions, nutrition and exercise, access to health care, social support systems, and many others. Some of the factors, such as genetic makeup, are nearly impossible to alter whereas others are amenable to change. In addition, some of the factors influence a variety of health outcomes (e.g., on a population basis, dietary habits and education are known to influence multiple health outcomes). Careful consideration of what is known about the determinants of health highlights the tension between factors that are easily measurable now (e.g., hospitalization rates) and factors that may be equally or more important in the long run (e.g., teenagers' perception of their future) but are much more difficult to measure and monitor. Grounding community health improvement in a broad model of the determinants of health can remind communities to consider multiple and cross-sectorial influences when selecting health issues to target and when designing possible interventions.
A focus on the origins of health emphasizes the need for cross-sectorial assumptions of responsibilities. For various stakeholders to be accountable, the roles of those stakeholders in producing illness or health must be defined. A broad conceptual model of the determinants of health includes the full spectrum of possible influences on health. Such a model provides a valuable framework for communities to use as they consider the roles (and potential contributions) of the various stakeholders and thus each stakeholder's responsibility for health improvement in the community.
A focus on the origins of health creates multiple options for intervention. A conceptual model of the determinants of health can serve as the starting point for communities to identify what is known about issues they wish to address. Options for intervening can reflect the unique characteristics of the community vis-à-vis available resources, cultural norms, and target populations. Per