1. The Sociocultural Environment and Health: Systematic Reviews of Community Interventions

2. Sociocultural Review Team Laurie Anderson CDC Community Guide Mindy Fullilove Columbia University Susan Scrimshaw University of Illinois Chicago Jonathan Fielding Los Angeles County DHS Jacques Normand National Institutes of Health Ruth Sanchez-Way Substance Abuse and Mental Health Services Administration

3. A Tool for Informed Decision-Making The Community Guide provides a set of evidence-based recommendations for public health action to improve community health. The Community Guide summarizes what is known about the effectiveness and feasibility of community-based health interventions by conducting systematic reviews of the intervention literature.

4. Community Guide Reviews Environmental Influences Sociocultural Environment Physical Environment Risk BehaviorsSpecific Conditions Tobacco Use Alcohol Abuse/Misuse Other Substance Abuse Poor Nutrition Inadequate Physical Activity Unhealthy Sexual Behaviors Vaccine Preventable Disease Pregnancy Outcomes Violence Motor Vehicle Injuries Depression Cancer Diabetes Oral Health www.thecommunityguide.org

5. Community Interventions to Promote Health-Enhancing Social Environments The sociocultural environment exerts a fundamental influence on health at the neighborhood, community, and societal level. The Sociocultural Environment reviews in the Guide will include evaluations and recommendations on interventions to reduce health inequalities through modifying the social environment.

6. Social Resources Standard of living Culture and history Social institutions Built environments Political structures Economic systems Technology Physical Environment COMMUNITY HEALTH Equity & Social Justice SOCIOCULTURAL DETERMINANTS: SOCIAL RESOURCES AND THEIR DISTRIBUTION IMPACT HEALTH (Resource Distribution)

7. Social Resources and their Distribution Adequate social resources are prerequisite to maintaining a supportive social environment for health. Equity and social justice are quintessential to health. They are conditions that characterize the distribution of resources among the population.

8. Neighborhood Living Conditions Community Development and Employment Opportunities Opportunities for Learning and Developing Capacity Community Customs, Norms and Processes Civic Engagement & Participation in Decision-Making Health Promotion, Prevention and Care Opportunities INTERMEDIATEOUTCOMESINTERMEDIATEOUTCOMES COMMUNITY HEALTH OUTCOME

9. Intermediate Outcomes Between root social determinants and health outcomes are observable community conditions amenable to intervention programs: neighborhood living conditions, school and work opportunities, community norms, neighborhood cohesion, available health and social services These are quantifiable conditions and thus offer a means to account for why communities with few social resources experience poorer health.

10. SOCIOCULTURAL ENVIRONMENT FRAMEWORK Determinants SOCIAL RESOURCES Standard of living Culture and history Social institutions Built environments Political structures Economic systems Technology Neighborhood Living Conditions Community Development and Employment Opportunities Opportunities for Learning and Developing Capacity Community Customs, Norms and Processes Civic Engagement & Participation in Decision-Making Intermediate Outcomes Health Outcome Health Promotion, Prevention and Care Opportunities PHYSICAL ENVIRONMENT Natural Resources EQUITY AND SOCIAL JUSTICE. HEALTHIER COMMUNITIES

11. RANKED BY POTENTIAL IMPACT ON IMPROVING COMMUNITY HEALTH 1Child development programs (Head Start, Healthy Start, etc.). 2Adequate public investment in education. 3“Living wages” to move working families above poverty. 4Access to quality health care for all ages. 5Mixed income housing to decrease segregation by socioeconomic status. 6Programs to reintegrate stigmatized populations. 7Parenting classes in schools, churches, health agencies, etc. 8Neighborhood schools as site of numerous community support programs. 9Family-focused, one-stop health and human services centers. 10Adequate health benefits with employment. Priority Interventions for Health Enhancing Social Environments

12. Completed Systematic Reviews TOPICTOPIC Neighborhood Living Conditions Opportunities for Learning and Developing Capacity Health Promotion Prevention and Care Opportunities INTERVENTIONINTERVENTION Mixed-income housing developments. Rental voucher subsidies which allow families choice in residential location. Publicly funded, center-based, comprehensive early childhood development programs for low-income children, 3-5 years of age. Culturally competent health care systems: -interpreters and bilingual staff -cultural diversity training for providers -linguistically and culturally appropriate health information -ethnic specific services

13. Early Childhood Development Programs

14. Affordable Housing in Mixed-SES Neighborhoods

15. Access to Culturally Competent Health Care Access to culturally competent health care Diversity training Culturally accommodating settings Interpreter services Culturally appropriate health education materials Diverse staffing Insufficient number of evaluation studies to draw conclusions about intervention effectiveness

16. For Further Information Morbidity and Mortality Weekly Report on Community Guide Sociocultural Environment reviews coming in November 2001 Reviews will be published in the American Journal of Preventive Medicine in Fall 2002 Community Guide website: www.thecommunityguide.org