An Integrated Framework for Assessing the Value of Community-Based Prevention (2012) / Chapter Skim
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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 causes of morbidity and mortality, factors such as the social determinants of health. Many community-based prevention interventions target such conditions.
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• Analyze current frameworks used to assess the value of community based, non-clinical prevention policies and wellness strategies, including o the methodologies and measures used and o 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 cap ture the breadth and complexity of community-based, non-clinical prevention policies and wellness strategies, including interventions that target specific behaviors and health outcomes.
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The committee concluded that community-based prevention interventions are population-based interventions that are aimed at preventing the onset of disease, stopping or slowing the progress of disease, reducing or eliminating the negative consequences of disease, increasing healthful behaviors that result in improvements in health and well-being, or decreasing disparities that result in an inequitable distribution of health. The committee also concluded that, in addition to a focus on population health, community-based prevention interventions also may address changes in the social and physical environment, involve intersectoral action, highlight community participation and empowerment, emphasize context, or include a systems approach.
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Decision makers, funders, and stakeholders will all benefit from an approach that looks not just at health impacts, but at other impacts as well, and thus assesses the true value of community-based prevention. The committee concluded that the outcomes of community-based prevention interventions can be divided into three distinct but interrelated categories, or domains of value: health, community well-being, and community process.
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(For a detailed discussion of the analysis, see Chapter 4.) Therefore, the committee concluded that a new framework was needed to assess the value of community-based prevention interventions.
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or Health-Adjusted B enefits and Harms Harms Life Expectancy (HALE) Benefits Community Community Well-Being Community Benefit Well-Being Indicator Harms Benefits Community Community Process Process Indicator Value Harms The Value of an Intervention Considers Its Benefits, Harms, and Costs R es ourc es Us ed Valuing -- What Should Be Counted?
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Such efforts will require an increased focus on identifying appropriate information gaps and data sources. Recommendation 2: The committee recommends that the CDC a.
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, an interagency group established by the Patient Protection and Affordable Care Act and chaired by the Surgeon General, recognizes that the health of a community is influenced by a number of factors outside of the health care and public health sectors, including education, housing, and transportation. Such a group is well positioned to encourage the research needed by the many different sectors that need to be involved in developing a community benefit indicator.
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Recommendation 5: The committee recommends that those involved in decision making ensure that the elements included in valuing c ommunity-based prevention interventions reflect the preferences of an inclusive range of stakeholders. One dimension of the health outcomes that affects value is the possible conflict between equity and improving aggregate health for a population.
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Such a broadly inclusive framework may seem overly abstract or unreliable to some observers. As the framework is applied, new measures and data sources will need to be developed, as will an appropriate methodology for creating valid single indicators for community well-being and community process.
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Chapter 4 provides a list of elements that a framework for assessing value should possess, examines how a framework for valuing resides within a decision-making context, reviews eight frameworks currently used to assess community-based prevention, and discusses the strengths and limitations of each for addressing the special characteristics of community-based prevention. In Chapter 5, the committee lays out its vision for the future of valuing community-based prevention.
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