Community and Aggregates
Prevention science provides a framework for community prevention planning that uses epidemiological data on empirically established predictors of health and behavior outcomes to identify specific short-term objectives for a community’s prevention efforts, and to select effective preventive or control interventions that have been shown to address these specific risk factors and enhance community level resilience.
An aggregate is a subgroup of the community population and is also referred to as a subpopulation. Any community consists of multiple aggregates. The manner in which the aggregate is identified determines the type of aggregate and eventually, the type of community interventions that are planned. Community members can be grouped into simple aggregates based on demographic or geographic location; this is the least common type of aggregate used in community health practice. The most common aggregate type is the high risk aggregate. A high-risk aggregate is a subgroup or subpopulation of the community that has a very high-risk commonality among its members. These may include risky lifestyle behaviors or high-risk conditions (e.g. adolescent pregnancy). The aggregate concept is widely used in public health practice to target and channel interventions to specific aggregates or subpopulations within a community (Garry, 2009).
At the planning level, the primary focus of community or public health practice is the maintenance health and wellbeing of an entire community. To affect and influence the health of an entire community, the public health nurses’ targets specific groups and designs specific interventions at multiple levels (individual, aggregate or group, family, and community). The manner in which the public health nurse identifies the target population, based on population-based data, determines the public health approach and strategy to the particular community: aggregate or community-based care. This approach offers promise to increase the effectiveness of community prevention systems.
The process of adoption of a science-based of prevention approach in the hypertension cases can be conceptualized as a process of diffusion of innovation. In our advocacy for the prevention mechanisms, the gap between prevention science and practice is that relatively little is known about the process of disseminating science-based prevention programming at the community level.
The concepts of aggregate and community-based approaches and community-based care are different in their intended focus. An aggregate approach targets a specific subpopulation within the community. The community-based approach focuses the intervention on the entire community, using population based data. In the community based data approach, interventions are designed to affect the health of the entire community at the same time, such as fluoridation of an entire community’s water supply.
Community based care is often confused with then community based approach. Community based care (also referred to as community based practice) is the delivery of health services outside the typical institutional setting, but these services do not necessarily focus on the entire community. Community based care is the delivery of health care services within the community environment, services that target individuals and families. For example, an ambulatory clinic that provides acute episodic care to individuals strategically located within a geographical community is delivering community based care. The services planned in the clinic may be based on the assessed health needs of individual community members, but they do not strive to affect then health of the community using community level interventions; rather, these services provide individual-level care. The differentiating factor is the implementation of interventions that affect the individual on family and community based levels.
Arguments linking community socioeconomic inequality to health through mechanisms of social cohesion or trust virtually ignore how community socioeconomic inequality may relate to individual or family level socioeconomic position to produce health outcomes. Yet, it is the very link between socioeconomic inequality at these aggregate and individual levels that helps to explain how and why socioeconomic position relates to health at both levels.
A number of authors, beginning with Preston (2008) and especially Rodgers (2006) and most recently Gravelle (1998), demonstrate that the relationship between community inequality and health is necessarily implied in the curvilinear relationship between income and health seen at individual level.
At the point of adoption, it is wise to engage the community affected by hypertension. This is critical to any interdisciplinary researcher as it helps them to understand the various effects the problem has to the community.
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