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Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
×

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

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
×

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 Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate 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; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

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 adopted 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.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”

—Goethe











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INSTITUTE OF MEDICINE
               OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

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 Academy 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 engineers. 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 engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president 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 Institute 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 Council 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.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
×

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

Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
×

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

Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
×

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

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
×

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 conclusions 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.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
×

Acknowledgments

Many people contributed to the development of An Integrated Framework for Assessing the Value of Community-Based Prevention. The committee 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 California Endowment, the de Beaumont Foundation, the Robert Wood Johnson Foundation, and the W.K. Kellogg foundation. We are particularly appreciative 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.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. An Integrated Framework for Assessing the Value of Community-Based Prevention. Washington, DC: The National Academies Press. doi: 10.17226/13487.
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During the past century the major causes of morbidity and mortality in the United States have shifted from those related to communicable diseases to those due to chronic diseases. Just as the major causes of morbidity and mortality have changed, so too has the understanding of health and what makes people healthy or ill. Research has documented the importance of the social determinants of health (for example, socioeconomic status and education) that affect health directly as well as through their impact on other health determinants such as risk factors. Targeting interventions toward the conditions associated with today's challenges to living a healthy life requires an increased emphasis on the factors that affect the current cause of morbidity and mortality, factors such as the social determinants of health. Many community-based prevention interventions target such conditions.

Community-based prevention interventions offer three distinct strengths. First, because the intervention is implemented population-wide it is inclusive and not dependent on access to a health care system. Second, by directing strategies at an entire population an intervention can reach individuals at all levels of risk. And finally, some lifestyle and behavioral risk factors are shaped by conditions not under an individual's control. For example, encouraging an individual to eat healthy food when none is accessible undermines the potential for successful behavioral change. Community-based prevention interventions can be designed to affect environmental and social conditions that are out of the reach of clinical services.

Four foundations - the California Endowment, the de Beaumont Foundation, the W.K. Kellogg Foundation, and the Robert Wood Johnson Foundation - asked the Institute of Medicine to convene an expert committee to develop a framework for assessing the value of community-based, non-clinical prevention policies and wellness strategies, especially those targeting the prevention of long-term, chronic diseases. The charge to the committee was to define community-based, non-clinical prevention policy and wellness strategies; define the value for community-based, non-clinical prevention policies and wellness strategies; and analyze current frameworks used to assess the value of community-based, non-clinical prevention policies and wellness strategies, including the methodologies and measures used and the short- and long-term impacts of such prevention policy and wellness strategies on health care spending and public health. An Integrated Framework for Assessing the Value of Community-Based Prevention summarizes the committee's findings.

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