Putting the Community Back Into Public Health

This issue of Prevention Report highlights programs and resources that focus on a community-driven approach to public health. Community-based public health seeks to improve health policies, programs, and services by focusing on community needs and concerns. In this approach, communities work as equal partners with health professionals and public and community health agencies to assess and find solutions to community health problems. Community-based public health represents a shift from merely providing services in a community to using active partnerships to build a community's capacity to address its own health problems.

Department of Health and Human Services (HHS) Community-Based Programs

Realizing the importance of a healthy lifestyle and making the decision to adopt one is an essential first step toward improved health and well-being. Turning that resolve into effective and sustained action often proves a more difficult step. Communities can play a major role in helping their members start and continue healthy habits.

Community-based organizations can take the lead in promoting health and preventing disease in the places where individuals live, work, and play. Local groups help residents adopt and sustain healthy lifestyles by undertaking or advocating for activities such as walking programs to encourage physical activity or improved school lunch programs to encourage healthier eating. Community groups also use knowledge of their members' cultures, beliefs, and concerns to ensure that activities reflect these values and address local health needs.

Healthy People, Places, and Practices: Taking Action in Communities

Within HHS, the Office of Disease Prevention and Health Promotion (ODPHP) and the regional health administrators are supporting community-based public health activities through the Take Action: Healthy People, Places, and Practices in Communities (Take Action) project. The project provides funding to not-for-profit, community-based groups and coalitions to develop, carry out, and evaluate local activities that support the President's HealthierUS initiative to promote and sustain healthy lifestyles in communities (visit www.healthierus.gov).

With small amounts of funding from the Take Action project, local groups will undertake programs that include or promote at least one of the following types of activities:

• Physical activity
• Nutrition and healthy eating
• Preventive screenings
• Healthy choices and avoidance of risky behaviors.

The Take Action project particularly encourages activities that:

• Focus on eliminating health disparities
• Involve the community in planning
• Can be sustained by non-Federal funding beyond the close of the funding period.

Project Goals

The purpose of the Take Action project is to stimulate community-based public health activities by providing "seed money" to hundreds of local, nonprofit organizations. The project emphasizes innovative activities that have the potential to be sustained and thus to become catalysts for health improvement in communities. By linking these local activities to the larger, national HealthierUS initiative, the project aims to leverage small amounts of funding into widespread action that will improve the health of people throughout the Nation.

Funding

Each selected community group will receive funds in an amount ranging from $2,000 to $5,000. These one-time funds will support activities for the period from July 1, 2007, to June 30, 2008.

Awardees

ODPHP and the regional health administrators received about 2,000 applications from community groups around the country. Awards were made to 112 groups nationwide that proposed a wide range of activities in support of the HealthierUS initiative. The funded groups include local coalitions, faith-based organizations, neighborhood associations, and other small nonprofit groups. These groups will plan and conduct activities such as screening for high blood pressure at grain elevators in rural areas, holding a "cardboard boat regatta" event for abused children, providing exercise equipment for children and teens from families displaced by Hurricane Katrina, and making community gardens handicapped-accessible during the coming year.

The Future of Take Action

HHS hopes that the small awards provided through the project are the kind of help that is needed for communities to start activities that will live on after the funding period has ended. In addition, all community groups will participate in a national evaluation of the project at the end of their 1-year awards. By providing information on how they used project funds and what they accomplished, the community groups will help HHS build future community-based public health programs based on lessons learned at the community level.

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Community-Based Participatory Prevention Research Grants Program

Another aspect of community-based public health is community-based participatory research. This approach helps speed the translation of research findings into health practices by engaging members of the community as equal partners in all aspects of research. In community-based participatory research, researchers work with rather than in communities, collaborating with health professionals, community groups, and others who will be using the intervention under study. Community-based participatory research draws on local knowledge to understand health problems, design interventions, interpret findings, and help ensure that successful interventions are adopted in communities.

Several HHS agencies, including the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention (CDC), are funding community-based participatory research. For example, CDC funds community-based participatory research projects across the country through its Community-Based Participatory Prevention Research Grants program. In these projects, communities play a crucial role in research to develop interventions that address key public health issues, such as childhood obesity, physical activity, and healthy eating. Some preliminary findings from these projects are promising, including the following:

• The community-wide Shape Up project in Somerville, Massachusetts, seeks to curb childhood obesity through low-cost environmental changes such as offering healthier food choices in schools and redeploying school crossing guards to students' most popular walking routes. These efforts led to children buying more fruits at lunchtime, more children walking to school, and students gaining significantly less weight than did children in two neighboring communities.

• A partnership between a university research center and a community coalition in Sumter County, South Carolina, launched the Step Up Step Out program to increase physical activity, particularly among middle-aged women. A media campaign and a behavior change program helped women triple their amount of exercise and lose an average of nearly 5 pounds if they were overweight. Visit www.sumtercountyActiveLifestyles.org/StepUpStepOut/.

By funding participatory research on community-based approaches to prevention, CDC hopes to put new knowledge quickly into the hands of people who need to make changes in health practices. More information on CDC's community-based participatory research projects is available at: www.cdc.gov/od/science/PHResearch/grants/community/.

Upcoming Meetings

National Conference on Health Communication, Marketing & Media, Atlanta GA. August 29–30, 2007. Visit www.blsmeetings.net/HCMM.

American Public Health Association 135th Annual Meeting and Exposition, Washington, DC. November 3–7, 2007. Visit www.apha.org/meetings.

National Prevention and Health Promotion Summit: Creating a Culture of Wellness, Washington, DC. November 27–29, 2007. Visit www.cdc.gov/cochp/conference/index.htm.

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Healthy People 2020

The Department of Health and Human Services is in the initial stages of planning for the next set of national disease prevention and health promotion objectives. As envisioned, Healthy People 2020 will continue and improve on the efforts of Healthy People 2010, by identifying and seeking to reduce the most significant preventable threats to health.

Initially, the development of Healthy People 2020 will use elements of a National Opinion Research Center report, "Assessment of the Healthy People Objectives-setting Framework and Process," that suggests Healthy People objectives support four overarching goals:

• Promote optimal health in order to end preventable death, illness, injury, and disability
• Eliminate health disparities
• Make wellness a way of life for individuals and their communities
• Promote healthy places and environments.
  

The establishment of a framework and objectives will be informed by a variety of sources—a Federal interagency workgroup, regional meetings across the country, and public comment periods—aimed at ensuring active input from public and private stakeholders.

The development of an overall framework for Healthy People 2020 is expected to be completed by January 2009, with the release of the objectives to follow in January 2010. More information about the Healthy People 2020 development process will be posted on the healthypeople.gov Web site in the coming weeks.

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Community Guide Informs Choices of Prevention Services

Community groups and other partners in community-based public health may benefit from a valuable and easily accessible resource, The Guide to Community Preventive Services, more commonly known as The Community Guide. The guide summarizes what is known about the efficacy, cost-effectiveness, and feasibility of interventions to promote health and prevent disease. The guide also presents evidence-based recommendations on how to use the interventions.

The Community Guide is developed by the Task Force on Community Preventive Services, which conducts rigorous and systematic scientific reviews of studies published in the scientific literature. The task force has published findings from more than 100 reviews in 16 topic areas, including cancer, diabetes, mental health, and violence.

Findings and recommendations distilled in The Community Guide help community-based organizations, public health professionals, healthcare providers, and policymakers make good choices among community health options for prevention services. The guide is available at www.thecommunityguide.org. The task force also publishes summaries of its findings in CDC's Morbidity and Mortality Weekly Report Recommendations and Reports series (www.cdc.gov/mmwr/mmwr_rr.html) and supplements to the American Journal of Preventive Medicine (www.elsevier.com/wps/find/journaldescription.cws_home/600644/ description#description).

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