contributions to performance monitoring efforts by conducting research on the effectiveness of interventions, providing analytic training for public health practitioners, and serving as source of expert advice for communities.

Any effort to propose a model for a performance monitoring system must take into account the social, political, economic, and organizational differences among states and communities, all of which influence capacity and willingness to address community health. An assessment of how well private sector health plans are serving their members and the community is seen by many as an appropriate element of the community monitoring process. Questions arise, however, about the extent to which health plans can and should be held accountable for the health status of all residents in the community.

Another important issue is understanding how to achieve constructive change in communities. The differences across communities and among the participants and audiences within communities emphasize the need for the committee to discuss performance monitoring in a way that is understandable from many perspectives.

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