Toward an Initial Conceptual Framework to Assess Community Allostatic Load

Early Themes from Literature Review and Community Analyses on the Role of Cumulative Community Stress

by Anita Chandra, Meagan Cahill, Douglas Yeung, Rachel Ross

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Research Questions

  1. Is the concept of individual allostatic load applicable to the community level?
  2. Can community allostatic load be measured to inform community health and resilience planning?

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.

Key Findings

  • 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.

Recommendations

  • Community leaders can use measures to describe the current stress level in a community and sense challenges before a triggering event.
  • The framework can be used to elevate the role of different drivers in influencing community allostatic load. For instance, one could imagine a community narrative that discusses how a community did or did not handle a stressful event and how that experience is now influencing future ability to address or improve community health.
  • The framework could be used in an assessment tool, using each element of the framework to measure and assess different elements of community health and well-being. Programs seeking grant funding or community support could use this framework as part of the assessment regarding the likelihood that an intervention would be successful or sustainable or to determine whether additional community supports were needed because of this history of community stress.
  • Future avenues for related work might include examining how community stress interacts with individual stress experiences generationally and across the community, exploring to what extent community design can facilitate the mitigating factors that help with stress experience and community narrative, and informing conversations about facilitators of and barriers to population health improvement and guiding prioritization of interventions.

Table of Contents

  • 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

The research described in this report was supported by the Robert Wood Johnson Foundation (RWJF) and conducted within RAND Health.

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