Community-Based Health Promotion

Health is having quality of life in the physical, emotional, social, cognitive, and spiritual realms. The diseases that pose the most threat to achieving that quality of life are cardiovascular diseases, cancer, and diabetes. The factors that contribute to these diseases are integrally intertwined with the community and deeply connected to culture. Poverty, inadequate education, crime, and unemployment weaken the community, and these factors are associated with a higher prevalence of disease and higher mortality rates from diseases. The human and economic costs affect everyone, and these costs are soaring.

Yet, the factors that exacerbate disease are preventable or modifiable. Some factors are personal habits: smoking and chewing tobacco, overeating, sedentary lifestyles, and high consumption of polyunsaturated fats and sugars. Some factors are contextual: school-based soda vending machines, limited and overpriced healthy food choices in inner-city grocery stores or the lack of grocery stores in inner-city neighborhoods, unsafe streets that make walking dangerous, lack of adequate exercise facilities in rural areas, discriminatory practices toward minorities within the medical system, and the lack of insurance coverage for early detection of disease. Others emerge from culture-bound beliefs that inhibit health behavior change: language barriers, lack of engagement in preventive health practices, fatalism, use of emergency rooms as primary care facilities, inability to meld the medical system to the cultural beliefs of minorities, and attitudes toward certain behaviors, such as the link between smoking and status within a subculture.

Some community factors can be changed through advocacy efforts and community awareness. For example, many school systems in America are introducing higher nutrition standards for their lunch programs. The personal factors can be changed through personally engaging interventions and community support. Efforts, however, must be stepped up to develop and test culturally sensitive strategies for health promotion. Community health promotion is proceeding along two directions. One direction is toward more individualized interventions; the other toward reaching greater numbers of people, specifically, the underserved and minorities. The challenge we face today is their integration: accomplishing a wider reach while individualizing interventions to improve effectiveness.

The diseases that carry the highest costs are caused or exacerbated by poor diet, obesity, and smoking. Therefore, this entry synthesizes the research on those practices that are likely to have the greatest impact on health.