The Community Guide—A National Health Success Story

What works to improve the health of populations? This is a fundamental question asked by local public health officials, government and business leaders, city planners, health care professionals and others who make decisions that affect entire communities. In the United States we may count ourselves lucky that myriad options exist claiming to enhance health and well-being, but this makes it all the more difficult to identify which ones actually work and choose the ones most likely to improve population health in specific communities. 

Fortunately, the Guide to Community Preventive Services (The Community Guide) is here to help. The Guide is a collection of evidence-based findings of the Community Preventive Services Task Force (CPSTF), a group of experts established by the U.S. Centers for Disease Control and Prevention (CDC) in 1996 to help decision makers select interventions that improve health and prevent disease. In 23 years of existence, the CPSTF has been part of monumental changes occurring in public health, making a difference in the lives of Americans of all stages of life.
 
When the first CPSTF meeting took place in August 1996, the idea that prevention at the population level was an opportunity to improve health was not yet widely embraced. At that time, the U.S. Preventive Services Task Force (USPSTF), which began in 1984, focused on developing recommendations for what “prudent clinicians should provide their patients as part of routine clinical care.”

As important as that guidance was and continues to be, it did not address the effectiveness of preventive approaches aimed at populations in communities, states, nationally, or in subpopulations defined by gender, risk factors or health status. Nor did the guidance address interventions that target patients as a group.

It was becoming clear that many of the things that made the greatest difference in people’s health happened outside of clinical settings—in schools, worksites, homes, streets and neighborhoods. Thus, CDC launched the CPSTF as a population-targeted complement to the USPSTF.  

Since its creation, several developments have influenced how the CPSTF conceives and pursues its mission. There has been a growing recognition of the large contribution of social determinants such as education, job opportunities, housing stock, and income and assets to health, disease, injury and well-being. There has also been a growing concern about the glaring health inequities that exist, arising in part from discrimination and structural racism. Both of these issues—social determinants and health inequities—are now systematically addressed in The Community Guide’s choices of interventions to review.

The Guide started to address social determinants by reviewing education interventions that could have long-term health consequences and also help to achieve health equity. The reviewed interventions that have led to recommendations include early childhood education, school-based health centers, full-day kindergarten and high-school completion programs. The Guide has also expanded its scope to include housing policies and programs, with early reviews in this area looking at mixed-income housing developments, tenant-based rental assistance programs (aimed at increasing access to affordable housing to reduce racial and income segregation) and, most recently, interventions aimed at reducing homelessness. 

car seatThere are many success stories based on the work of the Task Force.

For example, infants and toddlers are kept safe and healthy through the CPSTF’s work to identify the most effective ways to boost immunization rates among communities. 

In addition, Community Guide recommendations, based on rigorous systematic reviews of the scientific literature, have provided the basis for child safety seat laws and smoke-free policies that reduce everyone’s exposure to secondhand smoke, especially young children. 

The Guide’s findings related to alcohol use and impaired driving have also been influential, providing the basis for state laws limiting hours of alcohol sale and the Department of Transportation’s 2001 Appropriations Act, which required states to implement 0.08 blood alcohol content laws. Additionally, we have seen great reductions in tobacco use following implementation of CPSTF-recommended programs and policies. 

Comprising nearly 250 evidence-based recommendations and findings across 21 topic areas, the Community Guide has been the work of 47 CPSTF members volunteering more than 55,000 hours over 23 years, along with untold time by CDC Community Guide staff and 32 liaisons representing state and local health departments, the U.S. Armed Forces, federal agencies, health care professionals and other national organizations invested in America’s health. The Guide includes 160 economic reviews among its 335 publications, based on the understanding that policy makers, funders and program planners often need evidence regarding the economic merits of different intervention approaches in order to make their decisions. 

It has been my honor to serve as a member of the CPSTF since its founding. In its third decade and beyond, I feel confident the Task Force will continue to push the boundaries of research on social determinants, which we know is critical to public health.

Everyone interested in improving population health owes a huge debt of gratitude to CDC leadership for their consistent support, including during the times when the Guide’s very existence was in doubt. It is my hope that CDC, under whose auspices all our work has occurred, can both increase its support and successfully solicit contributions from other federal agencies that benefit from the Guide, starting with Centers for Medicare and Medicaid Services and the National Institutes of Health.

Additional funds are essential to sufficiently cover additional priority review topics and to re-review topics at a frequency that gives all audiences confidence that our recommendations are comprehensive and current.  With greater monetary support, the enormous benefits that our nation has garnered from the pioneering work to date can be multiplied and make all Americans healthier. 
 



Jonathan Fielding, MD, MPH, MBA, MA, chairs the U.S. Community Preventive Services Task Force. Dr. Fielding is a Distinguished Professor of Health Policy and Management at the University of California Los Angeles (UCLA) Fielding School of Public Health and a Distinguished Professor of Pediatrics at the UCLA Geffen School of Medicine.