Toward an Epidemiological Definition of Community

By Nathaniel Counts

With the coordination and additional funding afforded by the National Prevention, Health Promotion, and Public Health Council and the Prevention and Public Health Fund under the Affordable Care Act, scholars may have a unique opportunity to work toward an epidemiological definition of community.  The evaluation and record-keeping components of the different interventions will inevitably lead to a great deal of additional information about individuals, including their beliefs, behaviors, and health, over time.  If one’s behaviors, and in particular the Leading Health Indicators (ten factors chosen by Health and Human Services that contribute to health, including substance abuse, exercise levels, condom use, etc.) and health status are determined in part by social signaling, it may be possible to use this data to determine which individuals seem to be part of a community.  Various environmental, and possibly even genetic, factors could be controlled for to find groups of individuals whose Leading Health Indicators affect one another’s, and whose health statuses are linked.  This grouping would be a functional “community,” a group of people who influence one another, whether they realize it or not. Currently, the notion of community is usually defined geographically – your community are those that are close to you, unless it is a city, in which case your community are those who are nearby of similar socioeconomic class.  This method would allow for greater precision in determining groups that influence another.

A more precise understanding of community would be useful for assessing the impact of interventions, public health or otherwise.  If you can see the initial community structures at the beginning of an intervention, you could target the individual communities for change and see how their Leading Health Indicators and health statuses evolve.  You could also, and more importantly, see how an intervention changes the make-up of a community.  A new basketball program in a local gymnasium will bring together different arrangements of individuals, who may in turn influence one another, joining them into a community and linking their health statuses.  This could determine choices of programs – a youth basketball league will shape communities differently than a family program or an adult program, and conscious choices could be made about how to bin people based on their current risk behaviors.  This type of information could also provide caution to those planning any sort of intervention – any interaction could reshape communities, subtly changing individual’s values and even their health in ways unbeknownst to them and unintended by the intervener.


Nathaniel Counts was a Student Fellow during the 2013-2014 academic year. At the time, he was in his third year at Harvard Law School. He was interested in the role of law and lawyers in the treatment of mental health issues, with a focus on behavioral disorders, including intersections with the criminal justice system. He was also interested in the use of a right to health care in human rights lawyering and international development. Nathaniel graduated from Johns Hopkins with a major in biology and a minor in entrepreneurship and management. Prior to law school, he studied creative writing at Bar-Ilan University in Israel. His past research focused on the federal government’s response to marijuana legalization, including recommendations for public health initiatives; he published an article on this subject in the Gonzaga Law Review in 2014.

2 thoughts to “Toward an Epidemiological Definition of Community”

  1. Fascinating. But what if groups of people “objectively” defined as a community because they influence each other’s health status(es) do not self-identify as a discrete, cohesive community?

    After all, the epidemiologic evidence shows quite profound links between a number of demographic variables that in many cases correlatively and in some cases even causally link health status of widely different groups of people. But I doubt very seriously that in many cases people at the top of the social gradient see themselves as members of communities of people belonging to the least well-off groups. Indeed, the paucity of linking social capital suggests the difficulty of crossing class boundaries even where the acts that facilitate concentration of wealth undeniably improve the health of the affluent at the expense of the materially deprived.

    So how to forge a sense of community when people do not feel it or recognize it? I’m not sure how much better epidemiology will help with that, although it is surely a good regardless.

    1. That is an interesting question. I imagine individuals would rarely correctly identify their own communities if asked. The catch-22 in forging a sense of community using the epidemiologically-determined community is that it is likely that any intervention to create a sense of community would likely change the community make-up as individuals change their patterns of behavior. The epidemiologically-defined community may only be useful for studying without direct intervention, or in planning how to diffuse information or shape behaviors in an intervention, or evaluating how an intervention affected a community make-up. I imagine this definition would not be particularly useful for promoting an ideal of social inclusiveness in individual communities.

      If the epidemiologically-defined community discovered broader, but as of yet unacknowledged, inclusiveness in communities, I do not have a framework yet for evaluating if the community is “good” – which could mean free from discrimination as to its elements.

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