An 11th Essential Public Health Service- Strengthening Communities

Evidence is mounting on the role of community in influencing health.  The story of Roseto, PA is one example of how a strong community can result in good health outcomes.  This population of immigrants from Italy had reduced rates of chronic disease, cardiovascular disease, ulcers, and substance abuse because of their strong social structure and egalitarian culture. 

When looking at health disparities, data indicates that the health of community is strongly determined by the income gap between the richest and poorest members of the community- the greater the gap, the more unhealthy the community.  Dahlgreen and Whitehead’s illustration of the determinants of health depicts the overarching impact of socio-economic, culture, and the environment. 

Research has assisted in defining community and its key elements.  As identified by MacQueen et. al., a community has core elements including having a locus, shared interest and perspective, joint action, diversity and social ties.    Numerous evidence based public health practices and interventions are based on leveraging these community elements to improve health outcomes.

Public health has relied on the 10 Essential Public Health Services (EPHS) to direct its work in improving a community’s health. While the EPHS guide public health on how to work within the community using assessment, health education, policy, and mobilization of partners, it does not specifically address the identification, strengthening, and celebration of community’s core elements. The addition of an 11^th EPHS- to strengthen community core elements- would put community into community health by building upon its social capital and culture.