A new 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, chronic diseases.

The 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.

Second, 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.

Third, the framework must take into account differ­ences among communities that can affect the link between interventions and outcomes.

Because 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.