report from the Institute of Medicine (IOM) proposes a framework to
assess the value of community-based, nonclinical prevention policies and
wellness strategies, especially those targeting the prevention of long-term,
report's authors conclude that a comprehensive framework for valuing
community-based prevention programs and policies should meet 3 major criteria. First, the framework should
account for benefits 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 disease, declines in
mortality, and increases in health-related quality of life.
the framework should consider the resources used and compare the benefits and
harms associated with those resources. To effectively compare interventions,
it is essential to quantify the magnitude of benefits in relation to the
associated cost for each intervention.
the framework must take into account differences among communities that can
affect the link between interventions and outcomes.
selecting 1 community-based prevention policy or program over another can be
difficult, the report recommends that decision
makers weigh the benefits and harms to health, community well-being, and
community process as they assign value to specific interventions.
The authors caution that although a community-based prevention
action may improve the overall health of a community, it 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, they say.
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