Modelling the community as a determinant of health

Widespread recognition is given to the idea that an individual's health is influenced by the ways an individual works, rests and plays as well as genetic endowments. More recently, some researchers have suggested that the relationships between individual 'characteristics' and health are influenced by the context or community of the individual. Although the notion of the community as a determinant of health is not new, the incorporation of the community in empirical research on the determinants of health has been based on simple statistical models that fail to reflect the complex nature of the individual-community interface. In this paper we use the methods developed in educational research to show how separate statistical models for variations in health between communities and between individuals can be combined to provide a multi-level model for the determinants of health of populations.