Community Prevention: A
Key Component of a
Reforming Health System
Jeffrey Levi, PhD
Trust for America’s Health
February 8, 2010
Academy Health Conference
What is Community-Level Prevention?

Interventions that promote healthy environments and behaviors
– making it easier for people to make healthy choices, such as:
 Changing community norms and empowering communities
 Coalition and social network building
 Social marketing campaigns
 Changing the physical and social environments
 Organizational practices and governmental policies
 Facilities and programs
 Walkability – lighting, sidewalks, signs;
 Access to healthy foods
 Increasing individual knowledge and skills
Examples of community programs

Shape Up Somerville


Healthy Eating Active Communities (HEAC)


Schools, after school, neighborhoods, healthcare sector,
marketing changes
YMCA Pioneering Healthier Communities


School food, school activities, parent and community
outreach, restaurants, safe routes to school
Community coalitions, policy changes, leverage other
funding
Healthier Communities, Steps, REACH
American Recovery & Reinvestment
Act

$650 million in stimulus bill to “carry out evidence-based
clinical and community-based prevention and wellness
strategies…that deliver specific, measurable health outcomes
that address chronic disease rates.”


Grants targeting smoking, physical activity, nutrition and obesity –
emphasis on structure and policy change
“a historic commitment to wellness initiatives will keep
millions of Americans from setting foot in the doctor's office
in the first place -- because these are preventable diseases and
we're going to invest in prevention.” – President Barack
Obama, Feb. 17, 2009
The new “conventional wisdom”

“Prevention encompasses health promotion activities that
encourage healthy living and limit the initial onset of chronic
diseases. These activities include behavioral strategies as
well as policy or environmental strategies to improve health
outcomes. Widespread use of effective, population-based
approaches to increase physical activity and consumption of
fruits and vegetables reduce obesity and tobacco use, and
promote recommended screenings can reduce the incidence
of various associated chronic conditions, prevent some
disabilities and reduce the severity of others.”


CDC Congressional Justification, FY 2011 Budget
NOT limited to chronic conditions
Health reform: Real money for
prevention (mandatory appropriation)

Senate Prevention and Public Health Investment Fund: $15
billion over 10 years (permanent authorization at $2 billion a
year)



House Prevention and Wellness Trust: $15.4 billion over 5
years




Supports new and existing prevention and public health programs,
including Community Transformation Grants
Separate fund for Community Health Centers (5 years)
Community Prevention rises to $1.6 billion in 2014
Core public health rises to $1.265 billion in 2014
Research rises to $300 million in 2014
Both bills also support investment in US Preventive Services
Task Force and Community Guide
True community-based prevention

Senate Community Transformation Grants

Requires detailed plan for policy, environmental,
programmatic and infrastructure changes to
promote healthy living and reduce disparities



Create healthier school environments, including healthy
food options, physical activity opportunities, promotion of
healthy lifestyles
Develop and promote programs targeting increased access
to nutrition, physical activity, smoking cessation and safety
Highlight healthy options at restaurants and food venues
Community prevention (2)

House Community-Based Prevention and
Wellness Services


Evidence-based community prevention and
wellness services in priority areas identified by
the Secretary in the national prevention strategy
Health Empowerment Zones – targeting
interventions where multiple issues are at stake
How did prevention become so
important?

Framed in the context of chronic diseases



Chronic care costs are the drivers of increases in
premiums (and costs to the public programs)
Most are driven by smoking and obesity – and
these require non-clinical interventions
Where do infectious diseases fit in?

Place-based strategies need to think across
traditional disease groupings
If comprehensive health reform stalls?


Stand alone legislation
Reassess existing programs to fit this new
vision of the focus of publicly funded
prevention activities


See Major Cities Initiative in the President’s
Budget
Train public health officials to use “soft
power” to bring about policy and
environmental change