Community-based Health Promotion

This chapter describes theories and methods underlying successful comprehensive community-based health promotion, and provides four examples. These studies represent well the field of experimental epidemiology, involving defined populations and often done following insights derived from observational epidemiology. Three of these were designed to reduce risk factors for cardiovascular disease (CVD), and relied heavily on locally available channels of mass communication in addition to community organizing and other education methods, relatively low-cost approaches with the potential to reach and change lifestyle behaviors of entire populations, in contrast to traditional individual or group counseling. One example, studying alcohol-involved trauma, used only community organizing to promote adherence to existing laws, rather than public education for behavior change. By community organizing we mean the process of enlisting community leaders in support of project goals, and also in insuring their continued support. The Stanford Prevention Research Center (SPRC), beginning in 1972, pioneered development of the intervention methods of comprehensive community-based CVD prevention and other methods of health promotion and chronic disease prevention. SPRC was connected to all four examples, either as initiator (for two studies) or collaborator (for two studies). This review also describes the theoretical background, methods of intervention, the past history of such studies, the cultural basis for barriers to change and lessons learned for the future.