prevention requires that before someone becomes sick, society invest the financial and other resources necessary to make the required changes in individual and community life associated with preventing illness. Some of the persons who receive the intervention would never become sick, yet they share the costs of the intervention. These certain costs of improving health often outweigh the perceived benefits of community-based prevention, especially if individuals perceive their own risk of illness as low.

Four foundations—the California Endowment, the de Beaumont Foundation, the Robert Wood Johnson Foundation, and the W.K. Kellogg 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 further defined as follows:

  • Define “community-based, non-clinical prevention policy and wellness strategies.”
  • Define “value” for community-based, non-clinical prevention policy and wellness strategies.
  • 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 communities, including health care spending and public health.
  • If warranted, propose a new framework or frameworks that capture the breadth and complexity of community-based, non-clinical prevention policies and wellness strategies, including interventions that target specific behaviors and health outcomes.

The framework should

  • consider the sources of data that are needed and available;
  • consider the concepts of generalization, scaling up, and sustainability of programs; and
  • address national and state policy implications associated with implementing the framework.

DEFINITIONS

One of the first tasks facing the committee was defining the terms related to its charge. The phrase “community-based, non-clinical prevention



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