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.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON VALUING COMMUNITY-BASED, NON-CLINICAL PREVENTION POLICIES AND WELLNESS STRATEGIES
• Reviewers
• Acknowledgments
• Summary
  • DEFINITIONS
  • DOMAINS OF VALUE
  • FRAMEWORK FOR VALUING
  • IMPLICATIONS FOR POLICY
• 1. Introduction
  • COMMITTEE CHARGE
  • DEFINITIONS
  • WHY IS COMMUNITY-BASED PREVENTION IMPORTANT?
  • HOW IS COMMUNITY-BASED PREVENTION DIFFERENT?
  • WHY IS IT SO HARD TO ASSESS THE VALUE OF COMMUNITY-BASED PREVENTION?
  • A ROADMAP FOR THE REST OF THE REPORT
  • REFERENCES
• 2. Community-Based Prevention
  • COMMUNITY
  • IMPORTANT FEATURES OF COMMUNITY-BASED PREVENTION
  • HISTORICAL PERSPECTIVE
  • APPROACHES TO COMMUNITY INTERVENTION
  • MODELS
  • PRECEDE–PROCEED
  • IMPACT OF COMMUNITY-BASED PREVENTION
  • EVALUATION OF COMMUNITY-BASED PREVENTION
  • REFERENCES
• 3. Community-Based Prevention: More Than the Sum of Its Parts
  • APPLYING SYSTEMS SCIENCE TO COMMUNITY-BASED PREVENTION
  • VALUING COMMUNITY-BASED PREVENTION: DOMAINS AND ELEMENTS
  • VALUING RESOURCES AND COSTS FOR COMMUNITY-BASED PREVENTION
  • DATA SOURCES AND INDICATORS FOR VALUING COMMUNITY-BASED PREVENTION
  • REFERENCES
• 4. Existing Frameworks
  • WHAT IS A FRAMEWORK FOR ASSESSING VALUE?
  • EIGHT EXISTING FRAMEWORKS
  • VALUING COMMUNITY-BASED PREVENTION: IS A NEW FRAMEWORK NEEDED?
  • REFERENCES
• 5. A Framework for Assessing the Value of Community-Based Prevention
  • A FRAMEWORK FOR ASSESSING VALUE
  • INFORMATION NEEDED TO ASSESS VALUE USING THIS FRAMEWORK
  • HOW TO USE THE FRAMEWORK IN THE COMMUNITY CONTEXT
  • IMPLICATIONS FOR STATE AND NATIONAL POLICY
  • CONCLUSION
  • REFERENCES
• APPENDIXES
  • A Glossary
  • B Examples of Systems Science Approaches to Valuing Community-Based Prevention
  • C Open Meeting Agendas
  • D Committee Biographical Sketches

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.

Suggested citation:

IOM (Institute of Medicine). 2012. An integrated framework for assessing the value of community-based prevention. Washington, DC: The National Academies Press.

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.