AMERICAN JOURNAL OF PUBLIC HEALTH EDITOR-IN-CHIEF ASSISTANT EDITOR DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS
EDITOR’S CHOICE The Action Is Upstream: Place-Based Approaches for Achieving Population Health and Health Equity Life opportunities, including a healthy life, are largely determined either directly or indirectly by the contextual qualities of where we live. The last three decades have produced a large and rich body of research documenting that where we live, grow, work, and play determine not only life opportunities, but also determine risk of illness and individual actions taken to prevent or treat illness. Shaped by the distribution of resources and power, whether at the global, national, or local level, social determinants of health are internationally recognized as major drivers of health and health inequities (see http://www.who.int/social_determinants/en). As a result, at the forefront of contemporary public health discourse are complex questions of how to move upstream in community- and population-level interventions to improve health. Yet, progress on how to move upstream in our actions has developed more slowly than progress in our ability to describe the role of context and community-level factors that shape major causes of morbidity, mortality, and well-being. Now, research is needed to guide upstream approaches, including place-based interventions, which address contextual factors that shape major public health problems such as obesity, interpersonal violence, infant and maternal health, cardiovascular diseases, infectious diseases, substance use, and mental health. A number of efforts supported by both private foundations and state and federal agencies have created an impetus for placed-based interventions. But fundamental questions remain. Through which modifiable mechanisms do community-level factors impact health directly and indirectly? Which policy levers are the most powerful, feasible, and sustainable for improving health in varied community settings— and for what health conditions? Recent efforts based on the role of place and health are revisiting the important roles of social capital, collective efficacy, community organizing, and empowerment of community residents as agents of change for improving community conditions that impact health. Most commonly, placebased initiatives such as those addressing obesity have targeted changes in public systems and policies that negatively affect the health of disenfranchised communities, using community-building principles and strategies. However, our research tools and methods developed for individual-level approaches are often not a good fit for isolating and evaluating the
964 | Editor's Choice
impacts of place-based interventions. New, community-level methodological approaches are needed. Furthermore, we would do well to learn from place-based interventions outside of the United States, where creative strategies such as microfinancing and community-level strategies to change gender norms have been employed to address underlying conditions that shape health and opportunity. We have witnessed powerful impacts of policy interventions in population health in such areas as motor vehicle fatalities and smoking, and more recently in school-based interventions for prevention of obesity among youths. Place-based interventions are also being implemented to improve access and quality of affordable food in low-income communities and to address environmental hazards that have been documented to be disproportionately prevalent in low-income and minority communities. Some universities are exploring or implementing approaches for academic-community partnerships to improve health-related conditions in neighboring communities in the face of development that often has led to gentrification and displacement of low-income residents. My interest in place-based interventions to address health inequities arose from years of my work’s focus on individual level interventions. A nagging frustration with the negative impacts of toxic environments on individual-level intervention effects has led me to a new focus on place-based interventions. This I believe is the “new” frontier of public health that is solidly grounded in our field’s early history. In my new role of Associate Editor, I will be leading a determined effort within the Journal to highlight cutting-edge and innovative theoretical perspectives on mechanisms of action, strategies and studies of place-based interventions, and methods that focus on improving health and eliminating health inequities in communities within and outside the United States. My goal is to facilitate the sharing of creative ideas, promising practices, and sound research that advance sustainable population-level public health efforts to implement action upstream. j Hortensia Amaro, PhD AJPH Associate Editor
Mary E. Northridge, PhD, MPH Cynthia Golembeski, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Mary T. Bassett, MD, MPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Ferney-Voltaire, France) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MD, MPH (2015) Caroline Bergeron, MSc (2016) Eric R. Buhi, PhD (2016) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Jeffrey Hallam, PhD (2014) Dio Kavalieratos, PhD (2016) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) Joan Reede, MD, MPH (2014) Helena Temkin-Greener, PhD, MPH (2014) David H. Wegman, MD, MSc (2014) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Jamie Smith, Production Coordinator Michael Henry, Associate Production Editor (Sr) Aisha Jamil, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Manager FREELANCE STAFF Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Sarah Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
doi:10.2105/AJPH.2014.302032
American Journal of Public Health | June 2014, Vol 104, No. 6
EDITOR’S CHOICE The Action Is Upstream: Place-Based Approaches for Achieving Population Health and Health Equity Life opportunities, including a healthy life, are largely determined either directly or indirectly by the contextual qualities of where we live. The last three decades have produced a large and rich body of research documenting that where we live, grow, work, and play determine not only life opportunities, but also determine risk of illness and individual actions taken to prevent or treat illness. Shaped by the distribution of resources and power, whether at the global, national, or local level, social determinants of health are internationally recognized as major drivers of health and health inequities (see http://www.who.int/social_determinants/en). As a result, at the forefront of contemporary public health discourse are complex questions of how to move upstream in community- and population-level interventions to improve health. Yet, progress on how to move upstream in our actions has developed more slowly than progress in our ability to describe the role of context and community-level factors that shape major causes of morbidity, mortality, and well-being. Now, research is needed to guide upstream approaches, including place-based interventions, which address contextual factors that shape major public health problems such as obesity, interpersonal violence, infant and maternal health, cardiovascular diseases, infectious diseases, substance use, and mental health. A number of efforts supported by both private foundations and state and federal agencies have created an impetus for placed-based interventions. But fundamental questions remain. Through which modifiable mechanisms do community-level factors impact health directly and indirectly? Which policy levers are the most powerful, feasible, and sustainable for improving health in varied community settings— and for what health conditions? Recent efforts based on the role of place and health are revisiting the important roles of social capital, collective efficacy, community organizing, and empowerment of community residents as agents of change for improving community conditions that impact health. Most commonly, placebased initiatives such as those addressing obesity have targeted changes in public systems and policies that negatively affect the health of disenfranchised communities, using community-building principles and strategies. However, our research tools and methods developed for individual-level approaches are often not a good fit for isolating and evaluating the
964 | Editor's Choice
impacts of place-based interventions. New, community-level methodological approaches are needed. Furthermore, we would do well to learn from place-based interventions outside of the United States, where creative strategies such as microfinancing and community-level strategies to change gender norms have been employed to address underlying conditions that shape health and opportunity. We have witnessed powerful impacts of policy interventions in population health in such areas as motor vehicle fatalities and smoking, and more recently in school-based interventions for prevention of obesity among youths. Place-based interventions are also being implemented to improve access and quality of affordable food in low-income communities and to address environmental hazards that have been documented to be disproportionately prevalent in low-income and minority communities. Some universities are exploring or implementing approaches for academic-community partnerships to improve health-related conditions in neighboring communities in the face of development that often has led to gentrification and displacement of low-income residents. My interest in place-based interventions to address health inequities arose from years of my work’s focus on individual level interventions. A nagging frustration with the negative impacts of toxic environments on individual-level intervention effects has led me to a new focus on place-based interventions. This I believe is the “new” frontier of public health that is solidly grounded in our field’s early history. In my new role of Associate Editor, I will be leading a determined effort within the Journal to highlight cutting-edge and innovative theoretical perspectives on mechanisms of action, strategies and studies of place-based interventions, and methods that focus on improving health and eliminating health inequities in communities within and outside the United States. My goal is to facilitate the sharing of creative ideas, promising practices, and sound research that advance sustainable population-level public health efforts to implement action upstream. j Hortensia Amaro, PhD AJPH Associate Editor
Mary E. Northridge, PhD, MPH Cynthia Golembeski, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Mary T. Bassett, MD, MPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Ferney-Voltaire, France) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MD, MPH (2015) Caroline Bergeron, MSc (2016) Eric R. Buhi, PhD (2016) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Jeffrey Hallam, PhD (2014) Dio Kavalieratos, PhD (2016) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) Joan Reede, MD, MPH (2014) Helena Temkin-Greener, PhD, MPH (2014) David H. Wegman, MD, MSc (2014) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Jamie Smith, Production Coordinator Michael Henry, Associate Production Editor (Sr) Aisha Jamil, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Manager FREELANCE STAFF Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Sarah Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
doi:10.2105/AJPH.2014.302032
American Journal of Public Health | June 2014, Vol 104, No. 6
