Minority Health Archive

MedStar Community Health Assessment 2012 - FULL Report

Lutter, C. K.

Lutter, R.

Fetal and Early Childhood Undernutrition, Mortality, and Lifelong Health

Shavers, Vickie L.

Fagan, Pebbles

Jones, Dionne

Klein, William M. P.

Boyington, Josephine

Moten, Carmen

Rorie, Edward

The State of Research on Racial/Ethnic Discrimination in The Receipt of Health Care

Rosenbaum, Sara

Lopez, Nancy

Burke, Taylor

Dorley, Mark

State Health Insurance Exchange Laws: The First Generation

Abstract available at publisher's website

Peek, M. E.

Wilkes, A. E.

Roberson, T. S.

Goddu, A. P.

Nocon, R. S.

Tang, H.

Quinn, M. T.

Bordenave, K. K.

Huang, E. S.

Chin, M. H.

Early Lessons From An Initiative On Chicago's South Side To Reduce Disparities In Diabetes Care And Outcomes

Barkin, S. L.

Gesell, S. B.

Po'e, E. K.

Escarfuller, J.

Tempesti, T.

Culturally Tailored, Family-Centered, Behavioral Obesity Intervention for Latino-American Preschool-aged Children

Carter-Pokras, Olivia D.

Offutt-Powell, Tabatha N.

Kaufman, Jay S.

Giles, Wayne H.

Mays, Vickie M.

Epidemiology, Policy, and Racial/Ethnic Minority Health Disparities

For more information visit www.iom.edu/valuingprevention 
An Integrated 
Framework for Assessing 
the Value of Community-
Based Prevention   
Over the last century, the major causes of disease and death among Amer-
icans have changed, shifting from predominantly communicable diseases 
spread by germs to chronic ailments. This shift has been accompanied by a 
deeper understanding about what keeps people healthy or leaves them vul-
nerable to becoming ill. To get at the heart of the challenges to living a healthy 
life, we must increasingly emphasize factors that affect today’s causes of mor-
bidity and mortality.
 Despite their importance to preventing illness, determining the value 
of community-based interventions has proven difficult. Preventing illness 
requires immediate investments with benefits that might not be realized for 
many years. Another complicating factor: Some people would remain healthy 
even in the absence of an intervention, but share its cost.
 In its new study, An Integrated Framework for Assessing the Value of Com-
munity-Based Prevention, an Institute of Medicine (IOM) committee proposes 
a framework to assess the value of community-based, non-clinical prevention 
policies and wellness strategies. Sponsored by the California Endowment, 
the de Beaumont Foundation, the Robert Wood Johnson Foundation, and 
the W.K. Kellogg Foundation, the report aims to enhance intelligent decision 
making about which prevention activities and interventions are worthwhile.
Essential Framework Elements
For the purposes of its report, the IOM committee defines community-based 
prevention interventions as focused on populations with the aim of prevent-
ing disease from occurring, increasing behaviors that improve health and 
Despite their importance to pre-
venting illness, determining the 
value of community-based inter-
ventions has proven difficult.
REPORT BRIEF  NOVEMBER 2012
2well-being and—when disease does occur—slow-
ing or stopping its progress, reducing or elimi-
nating negative consequences, and decreasing 
disparities that result in inequitable distribution 
of health. In its report, the committee concludes 
that a comprehensive framework for valuing 
community-based prevention programs and poli-
cies should meet three major criteria. 
 First, the framework should account for ben-
efits and harms in physical and mental health, 
community well-being, and community process. 
The physical and mental health domain includes 
reductions in the incidence and prevalence of dis-
ease, declines in mortality, and increases in health-
related quality of life. The community well-being 
domain includes social norms, how people relate 
to each other and their surroundings, and their 
willingness to invest in themselves and the people 
around them. The community process domain 
encompasses elements that influence community 
participation in decision making, such as civic 
engagement, development of local leaders, social 
support, and social networks.
 Second, the framework should consider the 
resources used and compare the benefits and 
harms associated with those resources. To effec-
tively compare interventions, it is essential to 
quantify the magnitude of benefits in relation to 
the associated cost for each intervention. Third, 
the framework must take into account differ-
ences among communities that can affect the link 
between interventions and outcomes.
 Because none of the eight existing frame-
works that were analyzed met all of these criteria, 
the IOM committee proposes a new framework to 
assess the value of community-based prevention 
interventions. (See Figure.) 
Taking a Comprehensive View
Selecting one community-based prevention pol-
icy or program over another can be difficult, and 
this challenge can be further complicated by a 
large menu of intervention options with a diz-
zying array of desired outcomes. The committee 
FIGURE: Framework for Assessing the Value of Community-Based Prevention Interventions 
B
en
ef
its
 a
nd
 H
ar
m
s
R
es
ou
rc
es
 U
se
d
Health
Benefits
Harms
Benefits
Harms
Benefits
Harms
Quality-Adjusted Life Years 
(QALYs) or Health-Adjusted 
Life Expectancy (HALE)
Community Well-Being
Indicator
Savings
Costs
Monetary Units (USD)
Value
The Value of an
Intervention Considers
Its Benefits, Harms, 
and Costs
Community Benefit
Community Costs
Valuing—What Should Be Counted?
Valuing—What Should Be Counted?
Community Process
Indicator
Community
Well-Being
Community
Process
Identification
of
Investments
and
Resources
3important to a different community. The value of 
an intervention depends on the community’s per-
spectives, beliefs, and priorities. The value of an 
intervention also hinges on how, where, and how 
effectively it is carried out. 
 In addition, the ultimate goal of the inter-
vention has an effect on the perceived value of 
that intervention. A community-based preven-
tion action may improve the overall health of a 
community, for example, but may achieve more 
strikingly positive results among citizens with a 
certain income level or occupation, exacerbating 
health disparities. If achieving health equity is at 
odds with improving overall community health, 
priorities will have to be determined.
 Decision makers should consult with the com-
munity and other stakeholders to ensure that the 
value of community-based prevention policies and 
wellness strategies reflect their preferences. Even 
if the appropriate decision makers are involved, 
they must be sure to make decisions in the right 
way in order to gain legitimacy. The committee’s 
framework emphasizes the importance of trans-
parency. Open and transparent assessments of 
the value of a given intervention can enhance its 
legitimacy among community members.
 To ensure transparency, the committee rec-
ommends that analysts make public the evidence 
used to value a prevention action and provide 
estimates of the uncertainty of their results, and it 
counsels decision makers to make their rationales 
for decisions public.
Because prevention can save 
money that otherwise would be 
spent treating illness, the commit-
tee notes, it is important to assess 
changes that are expected to occur 
as a result of the intervention.
recommends that decision makers weigh the ben-
efits and harms to health, community well-being, 
and community process as they assign value to 
specific interventions. 
 While changes to population health can be 
documented by using quality-adjusted life years or 
health-adjusted life expectancy, well-defined data 
sources for valuing community well-being and 
community processes still need to be developed. 
For that reason, the committee recommends that 
the Centers for Disease Control and Prevention 
create an expanded inventory of data sources and 
needs for community-based prevention and, after 
identifying data gaps, develop sources of informa-
tion to fill those gaps.
 In addition, public and private sponsors, 
including the National Prevention, Health Pro-
motion, and Public Health Council, should sup-
port research that develops a single metric for 
community well-being, a single metric for com-
munity processes, and a single metric for combin-
ing the community well-being and community 
process indicators with health to create the single 
indicator of community benefit. One advantage of 
this approach is to facilitate expressing the value 
of community benefits per dollar spent. Because 
prevention can save money that otherwise would 
be spent treating illness, the committee notes, it is 
important to assess changes that are expected to 
occur as a result of the intervention.
The Value of Transparency
What is important to one community may not be 
The Institute of Medicine serves as adviser to the nation to improve health. 
Established in 1970 under the charter of the National Academy of Sciences, 
the Institute of Medicine provides independent, objective, evidence-based advice 
to policy makers, health professionals, the private sector, and the public.
Copyright 2012 by the National Academy of Sciences. All rights reserved.
500 Fifth Street, NW 
Washington, DC 20001 
TEL 202.334.2352 
FAX 202.334.1412
www.iom.edu
Committee on Valuing Community-Based, Non-Clinical 
Prevention Programs
Conclusion
The committee’s framework is just the first step. 
Additional efforts will be needed to build consen-
sus on the importance of its key outcomes—health, 
community well-being, and community process—
in community-based prevention. Though much 
remains to be learned, the framework represents 
a valuable step toward realizing the elusive goal of 
appropriately and comprehensively valuing com-
munity-based prevention.
 This framework has the potential to be used in 
many ways, years down the road: it might be for-
mally incorporated into policy making; funders 
might require its use in impact assessments that 
accompany legislative or grant proposals; or agen-
cies could be required to use the framework to 
evaluate their programs’ output, strengthening the 
evidence base. As a next step, however, communi-
ties and decision makers should begin to use and 
refine the framework, strengthening its value today 
and into the future. f
 
Study Sponsors
The California Endowment
The de Beaumont Foundation
The Robert Wood Johnson Foundation
The W.K. Kellogg Foundation
 
Catherine M. Jones 
University of Montréal, Canada
 
Consultant
 
Study Staff
Lyla M. Hernandez
Study Director
Melissa French
Associate Program 
Officer 
Andrew Lemerise 
Research Associate 
Angela Martin
Senior Program Assistant 
Rose Marie Martinez
Senior Director, Board on 
Population Health and Public 
Health Practice
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, Johns Hopkins 
Bloomberg School of Public 
Health, 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 Biostatistics, 
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
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
 


An Integrative Framework for Assessing the Value of Community-Based Prevention

Hatzfeld, JJ

LaVeist, TA

Gaston-Johansson, FG

Racial/Ethnic Disparities in the Prevalence of Selected Chronic Diseases Among US Air Force Members, 2008

Wimberly, Edward P.

Ethical Responsibility in Healing and Protecting the Families of the U.S. Public Health Service Syphilis Study in African American Men at Tuskegee: An Intergenerational Storytelling Approach

University of Pittsburgh

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