Improving population health through area-based social interventions: generating evidence in a complex world

Targeted interventions to improve population health have long been a feature of public health practice in high-income nations. Area-based interventions focused on improving the health of deprived communities have been a particularly important part of government policy since 1997. Such an approach has coincided with an increasing recognition of the role of 'context' in shaping individual health outcomes. The idea that risk factors for poor health and health inequality are not just properties of the individual but are also properties of neighbourhoods, schools, workplaces, and other environmental settings, is a welcome one. However, the challenge for researchers, practitioners, and policy makers is to populate a sparse evidence base for the effectiveness of environmental interventions targeted at specific communities. Drawing on the evaluation of a 'natural' community experiment to improve diet in Glasgow - the Glasgow Superstore Project - this chapter outlines some of the challenges of generating evidence for the effectiveness of areabased strategies for heath improvement.