Addressing Health Disparities Is a Place-Based Issue

Collaborative place-based approaches to improving population health and addressing health disparities are gaining momentum. There is strong rationale for prioritizing the premise that addressing health disparities is a placed-based issue, where improving community conditions could make a difference in improving health outcomes.1,2 An equitable approach to building healthy communities requires place-based approaches that involve the community and stakeholders. Place is characterized by structural resources such as schools, hospitals, recreational facilities, retail outlets, and housing. Healthier places have health-promoting environments such as parks, safe walking spaces, maintained homes, full-service food stores, and environmental protection. Based on the strength of available evidence, there are policy initiatives that are feasible and sustainable for improving health in a community setting. Such initiatives could lead to

1. improved economic opportunity with better access to good jobs;

2. higher quality schools at the kindergarten through to 12th grade level that enhance access to college;

3. more open green space, maintained sidewalks, and effective community policing;

4. local businesses promoting healthier food options; and

5. available health care that addresses risk behaviors, acute illness, preventive measures, and management of chronic diseases.

Place-based interventions take time to become established, implemented, and sustained. Even though the research is still in a nascent stage, gaps in our knowledge demonstrate that it is currently impossible to provide a single model for powerful, feasible, and sustainable placebased initiatives that guarantees improved community health outcomes with any certainty. Part of the challenge is the varied planning and evaluation processes, and limited studies with long-term evaluation outcomes tied to improved health conditions. We can say that certain key elements play an important role in successful approaches. On the strength of the available evidence, we suggest that placebased initiatives should incorporate the approaches listed in Table 1.

STRATEGIES

Various terms have been offered to characterize and define place-based interventions for addressing health disparities and improving population health. These include community health development, sustainable community initiatives, collective impact programs, and neighborhood revitalization initiatives.3,4 In place-based approaches, community and stakeholder agencies collaborate to address health and contextual factors influencing social well-being of a population within a de fi ned geographic location. We use the term placed-based interventions to refer to approaches for improving health in a geographic location that aligns the community...