Strategies for community health intervention: promises, paradoxes, pitfalls.

This paper provides a rationale for intervening on shared determinants of health at the community level of analysis, presents strategies for intervening on shared determinant risks at the community-level of analysis, and illustrates through a case study of a youth program how a small-scale community intervention on shared determinants might work in practice. Although there is a long history of community intervention to improve health, high quality research on these interventions has been conducted only recently. In evaluating the usefulness of a community intervention, the distinction between relative risk and population-attributable risk is not always made clear. These two distinct types of risk are reviewed considering their implications for what risk factors are targeted by community interventions and what criteria are reasonable to apply in evaluating the utility of these interventions. A role for linking root cause analysis with attributable risk and interventions to reduce risk is presented.