全球智库信息集成服务系统

• Community environments influence the allostatic load of individuals but also influence how a community collectively responds to stress.
• Community resilience frameworks that deal with chronic stress are also useful in understanding community-level allostasis.
• Issues of segregation and marginalization affect community allostatic load.
• Persistent policies that may exacerbate discrimination (or perceived discrimination across race or ethnicity, culture, social status, or economic status) and inequity, as well as changes in demography, can influence the level of community allostasis.
• Community perception of stress is an important factor in the accumulation of community allostatic load.
• Trust and the role of civil society are important factors in understanding community allostatic load.

Understanding extant stress levels within a community can help inform how it responds to acute or traumatic events. This report presents a concept of community allostatic load based on that of individual allostatic load — how stress, trauma, and adverse experiences can significantly affect individual health. The framework outlined in this report could be used to develop a concept for determining the allostatic load level of a community.

The goal is to use such a framework to help public health practitioners and other community leaders better explain, support, and mitigate stress levels community-wide and to work to create conditions that promote health and well-being. To push forward this new way of thinking about communities and stress, researchers at the RAND Corporation working with the Robert Wood Johnson Foundation developed an initial framework conceptualizing community allostatic load. While this work is formative and principally a proof of concept, the framework can help build a general appreciation of community stress for use by practitioners and policy leaders; offer new ways to measure community health and well-being; and support efforts by the Robert Wood Johnson Foundation to better consider community stress in the context of health equity and to create a framework that contains drivers to build a healthier nation, known as the Culture of Health.

• Chapter One

  Introduction

• Chapter Two

  Literature Review: Part One

• Chapter Three

  Literature Review: Part Two

• Chapter Four

  Key Themes from Community Analyses

• Chapter Five

  Initial Conceptual Framework for Community Allostatic Load

• Chapter Six

  Summary and Next Steps

• Appendix A

  Key Informant Protocol

• Appendix B

  Potential Community Allostatic Load Measure Areas