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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
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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 Govern-
ing Board of the National Research Council, whose members are drawn from the
councils of the National Academy of Sciences, the National Academy of Engineer-
ing, and the Institute of Medicine. The members of the committee responsible for
the report were chosen for their special competences and with regard for appropri-
ate 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 ad-
opted 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.
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“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
Advising the Nation. Improving Health.
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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 Acad-
emy 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 engi
neers. 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 engineer-
ing programs aimed at meeting national needs, encourages education and research,
and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi-
dent 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 Insti-
tute 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
C
ouncil 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
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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
v
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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
vi
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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
vii
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viii REVIEWERS
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 conclu-
sions 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.
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Acknowledgments
Many people contributed to the development of An Integrated Frame-
work for Assessing the Value of Community-Based Prevention. The com-
mittee 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 Califor-
nia Endowment, the de Beaumont Foundation, the Robert Wood Johnson
Foundation, and the W.K. Kellogg foundation. We are particularly appre-
ciative 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.
ix
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Contents
SUMMARY 1
1 INTRODUCTION 13
Committee Charge, 13
Definitions, 14
Why Is Community-Based Prevention Important?, 15
How Is Community-Based Prevention Different?, 17
Why Is It So Hard to Assess the Value of Community-Based
Prevention?, 18
A Roadmap for the Rest of the Report, 20
References, 21
2 COMMUNITY-BASED PREVENTION 23
Community, 23
Important Features of Community-Based Prevention, 24
Historical Perspective, 27
Approaches to Community Intervention, 32
Models, 37
Impact of Community-Based Prevention, 44
Evaluation of Community-Based Prevention, 47
References, 52
xi
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xii CONTENTS
3 COMMUNITY-BASED PREVENTION:
MORE THAN THE SUM OF ITS PARTS 61
Applying Systems Science to Community-Based Prevention, 64
Valuing Community-Based Prevention: Domains and Elements, 64
Valuing Resources and Costs for Community-Based Prevention, 74
Data Sources and Indicators for Valuing Community-Based
Prevention, 78
References, 81
4 EXISTING FRAMEWORKS 89
What Is a Framework for Assessing Value?, 89
Eight Existing Frameworks, 93
Valuing Community-Based Prevention: Is a New
Framework Needed?, 112
References, 114
5 A FRAMEWORK FOR ASSESSING THE VALUE OF
COMMUNITY-BASED PREVENTION 119
A Framework for Assessing Value, 119
Information Needed to Assess Value Using This Framework, 132
How to Use the Framework in the Community Context, 133
Implications for State and National Policy, 136
Conclusion, 137
References, 138
APPENDIXES
A GLOSSARY 139
B EXAMPLES OF SYSTEMS SCIENCE APPROACHES
TO VALUING COMMUNITY-BASED PREVENTION 143
C OPEN MEETING AGENDAS 153
D COMMITTEE BIOGRAPHICAL SKETCHES 159
