What types of interventions and strategies might be defined as public health approaches?

The term “community health intervention” refers to the community-wide approach to health behavior change. While there are shared terms and differences among community health interventions, community-based participatory research, and social epidemiology, they remain different approaches to improving community health. Rather than focusing primarily on the individual as change agent, community interventionists recognize a host of other factors that contribute to an individual’s capacity to achieve optimal health. This approach recommends that a multisectoral strategy be undertaken in order to make changes to create an environment or foundation of a healthy community. These modifications can be environmental, political, economic, and/or sociocultural. Community health interventions have deep roots in the theories of not only health behavior, but also in those of social change. Increasingly, this tactic of community intervention has been adopted by public health researchers and practitioners in many countries. This article provides a collection of articles, books, and monograms illustrative of the history and theoretical foundations of community health interventions. This article also provides examples of community health intervention in practice, strategies, and techniques for interventions and evaluation literature on the topic.

Understanding the social foundations of health and addressing inequalities are crucial elements in health promotion, and this has been expressed by a number of authors. Frieden 2015 is on future directions of the discipline of public health and discusses the importance of a multisectoral approach in community health interventions. Galea and Annas 2013 notes that public health workers should be prepared for multisectoral work in complex community health problems. Fielding, et al. 2010 asserts that public health workers need to work to change social, political, and environmental factors to improve public health. Marmot 2005 describes the importance of the World Health Organization’s “Commission on Social Determinants of Health” and changing policies to create a better environment for health improvement. Wallerstein, et al. 2011 highlights the differences and the similarities between and collaborative energies of social epidemiology and community health interventions. Israel, et al. 1998 discusses the important components for successful community health interventions. Trickett, et al. 2011 describes advances made in understanding community health interventions and pleads for more research to enhance expertise. Brownson, et al. 2006 examines the many approaches being used in prevention of chronic disease. Green and Kreuter 2005 offers the PRECEDE-PROCEED model for successful program planning, and this framework contains guidelines for assessment and evaluation of social and ecological factors when planning a health promotion program.

• Brownson, Ross C., Debra Haire-Joshu, and Douglas A. Luke. 2006. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annual Review of Public Health 27:341–370.

  DOI: 10.1146/annurev.publhealth.27.021405.102137

  Categorizes evidence from community health interventions for the areas of the physical environment, the communication environment, and the economic environment. They recommend that change energies should be focused first on environmental and policy approaches.

• Fielding, Jonathan, Steven Teutsch, and Lester Breslow. 2010. A framework for public health in the United States. Public Health Reviews 32:174–189.

  DOI: 10.1007/BF03391597

  Public health requires understanding of interactions of factors such as workplace, physical surroundings, environmental conditions, and cultural factors. In order to have the ability to realize optimal health, the community must have the capacity for the good health of its citizenry. Examines the determinants of health within the ecologic model and how community health interventions need to assess and modify social, physical, and environment in order to achieve success.

• Frieden, Thomas R. 2015. The future of public health. The New England Journal of Medicine 373:18.

  DOI: 10.1056/NEJMsa1511248

  In this Shattuck Lecture, Frieden describes the five levels of the Health Impact Pyramid in which socioeconomic factors form the base. Community interventions in a variety of countries use a multisectoral approach involving groups such as governments, businesses, public health departments, clinical care providers, and individuals. Gives examples of community health interventions that employed a community-wide intervention such as the reduction of sodium intake in the United Kingdom.

• Galea, Sandro, and George J. Annas. 2013. Aspirations and strategies for public health. Journal of the American Medical Association 315:655–656.

  DOI: 10.1001/jama.2016.0198

  Asserts that public health must exceed traditional public health work (e.g., vaccinations) and engage in social, political, and economic concerns that impact community health. Advocacy work is discussed. Health is determined by a complex interaction of factors; therefore, public health workers and researchers must move in the direction of multisectoral community health interventions. (See also the Oxford Bibliographies article in Public Health “Public Health Advocacy”.)

• Green, Lawrence W., and Marshall W. Kreuter. 2005. Health program planning: An educational and ecological approach. 4th ed. New York: McGraw-Hill.

  Handbook of community health interventions is a source for planning work in the community. Authors explain how to design a community health program from needs assessment to outcome evaluation using the PRECEDE-PROCEED model. This model covers all aspects of program design including the importance of policy and administrative backing as key components of community health intervention planning.

• Israel, Barbara, Amy J. Schulz, Edith A. Parker, and Adam B. Becker. 1998. Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health 19:173–202.

  DOI: 10.1146/annurev.publhealth.19.1.173

  Main elements of community-based research are described in the context of social inequities and impact on health. Discusses the underlying principles of community-based research in terms of understanding the identity and resources of the community. Asserts importance of building collaborative partnerships, community empowerment, bringing knowledge gleaned back into the research, and dissemination of the results. Champions the importance of community involvement for short- and long-term gains. Delineates challenges and potential conflicts.

• Marmot, Michael. 2005. Social determinants of health inequalities. Lancet 365:1099–1104.

  DOI: 10.1016/S0140-6736(05)74234-3

  Social determinants of health must be acknowledged as an underlying cause of health inequalities and, therefore, are issues of social justice. Social economic and policy change are as important as treating disease. All policies that may harm human health should be exposed. World Health Organization (WHO) launched “Commission on Social Determinants of Health,” which will review and recommend policy changes and seeks to use public health knowledge to drive political action.

• Trickett, Edison J., Sarah Beehler, Charles Deutsch, et al. 2011. Advancing the science of community-level interventions. American Journal of Public Health 101:1410–1419.

  DOI: 10.2105/AJPH.2010.300113

  Discusses design of a community health intervention paradigm and impact on planning, measurement, and research. Four main areas are: (1) focus on community results and capacity building, (2) use a multisector approach, (3) interventions must involve community collaboration and empowerment, and (4) cultural sensitivity should be present from needs assessment to evaluation of intervention. Intervention workers should be immersed in the community. Theory, research, and long-term community development should be stressed.

• Wallerstein, Nina B., Irene H. Yen, and S. Leonard Syme. 2011. Integration of social epidemiology and community-engaged interventions to improve health equity. American Journal of Public Health 101:822–830.

  DOI: 10.2105/AJPH.2008.140988

  Describes difference between and growth of social epidemiology and community health interventions. Calls for collaboration and linkages between individuals working in these areas. Discusses key tenets of community health intervention research such as community engagement, using community-level change theories, cultural relevancy, and participation by community as co-partners in the research team. In community health interventions, special emphasis placed on longer-term changes in power structure and policy by engaged community members.

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