Community trials.

Community-wide or population approaches are essential in most health promotion and prevention strategies. However, much less is known about these methods compared with traditional clinical approaches. Why is the community approach essential? Most common health problems amenable to prevention have strong environmental, cultural, lifestyle, and behavioral components. People, communities, whole countries make choices about whether or not to consume alcohol, and drive, smoke cigarettes, exercise, or have their children immunized. All of these involve individual choices but also involve societal or cultural barriers and enticements, access, and availability, monetary and opportunity costs, laws, and other community-wide factors. While some prevention issues respond to traditional clinical or health care approaches, most do not. They require a coordinated community approach to support the preventive efforts of the health care sector and develop an environment and an educated population which makes prevention possible. If we are to approach true primary prevention or elimination of major health impairing conditions, the population approach is a necessary element.