Three Paths Community Assessment Worksheet PUBLIC VERSION.xlsx

	A	B	C	D	E	F	G	H	I
1	Three Paths Community Health Program
2	Community Assessment Worksheet
3	Copyrighted Material - All Rights Reserved
4
5		Community Name
6		Province or State
7		Country
8		Assessor or Group Name
9		Completion Date
10
11		Instructions:
12		Instructions for use of this worksheet are provided in the Three Paths Community Health Program guide, which is published in the appendix of Our Three Natural Paths by Mark Lundegren
13
14		Community Status For Health Factor:		Score
15		Strongly true of community or >90% achievement of goal		2
16		Moderately true community or 30-90% achievement of goal		1
17		Untrue or marginally true of community or <30% achievement of goal		0
18		Initially unsure or unclear		No score
19
20		Section	Health Factor	Input Areas for Individual Assessor or Assessment Team			Factor Rationale	Optional Assessor or Assessment Team Input Areas
21		Section	Health Factor	Score	Evidence	Potential Actions	Factor Rationale	Evidence Notes	Action Notes
22	1	Security	There are no significant military or terror threats to or in the community				Physical and personal security is a natural foundation of both human community and modern community health. Security is essential to sustained collectivity and cooperation, future-oriented investment in the community, and progression to more advanced states of health, health awareness, and health promotion.
23	2	Security	Criminal and civil legal or judicial systems are in place, either by or for the community, and laws are applied equally to all people				Fair, impartial, and effective criminal and civil legal or judicial systems, encompassing the entire community are essential to community cohesion, engagement, civility, and health. These systems provide an independent, impartial, and consistent arbiter of social transgressions and disputes. They in turn ensure adequate social justice, typically lead to substantial reductions in both proactive and retributional interpersonal violence and contention, greatly reduce social costs and friction, and thereby aid the emergence of healthy future-mindedness and elevated personal and community self-investment.
24	3	Security	Community policing and criminal detention systems are established either by or for the community, there is no ex-judicial police punishment or sentencing, and all policing and detention facilities are safe and humane				Governmental policing and detention systems - treating all people accused and convicted of crimes fairly and humanely, and subordinated to an effective criminal judicial system - is essential to community health. These systems provide a common, efficient, and transparent process for responding to community crime and ensuring criminal punishment and deterrence. They promote security and social justice, encourage civic affiliation and engagement, and reduce both proactive and retributional community violence. They also help to increase community predictability, future-mindedness, and thus the probability of progressive health investment.
25	4	Security	Community policing and criminal detention systems are operating effectively and efficiently according to written, transparent, reasonable, and consistently applied policies and procedures				Effective, efficient, transparent, and consistent policing and detention systems are promote civic support and engagement, increase civility and equanimity between the people of a community, and can greatly aid both immediate community health and long-term progressive health investment.
26	5	Security	The community or its larger area's police force is actively and amicably engaged with the community and specifically in "community policing" - defined as working interactively, effectively, and proactively with the community to target and eliminate the sources and causes of crime				Police engagement with the community and community policing and crime prevention programs - which seek to promote civic engagement and community involvement to both minimize crime and ensure effective law enforcement when crime does occur - have been shown in research generally to be more effective at promoting both community security and civility than traditional or more autonomous law enforcement approaches.
27	6	Security	Crime against people, including robbery, is absent or rare in the community				A marked absence or minimality of crime against people is an indicator of advancing community civility, cooperation, cohesion, health and self-awareness, and thus health potential. It also is a condition likely to naturally and circularly promote further civic engagement, reductions in the likelihood of crime, and resulting increases in a community's health potential.
28	7	Security	Crime against property, including theft, is absent or rare in the community				A marked absence or minimality of crime against property is another indicator of advancing community civility, cooperation, cohesion, health and self-awareness, and thus health potential. As with limited crime against people, it too is likely to naturally and circularly promote further civic engagement, reductions in the likelihood of crime, and resulting increases in a community's health potential.
29	8	Security	A system for small and large-scale emergency responses is established by or for the community, reasonably addressing and prepared for all foreseeable natural and human-created emergencies and disasters the community may face				The ability to respond in coordinated and effective ways to foreseeable emergencies, from smaller-scale events to disasters affecting the entire community and beyond, is a natural foundation of human community and essential to modern community health. As with other aspects of community security, emergency response systems help to enable community stability and predictability in time, promote sustained future-mindedness and investment in the community, and thus aid the progression to more advanced states of community health and health promotion.
30	9	Security	The community's emergency response system is tested for readiness regularly against varying possible emergency and disaster scenarios, and incidents of sustained community disruptions from emergencies and disasters are rare or absent				The effectiveness and reliability of a community's emergency response system is essential to ensure community stability and confidence, and to encourage active involvement in planning for the future and more advanced health promotion efforts. Emergency system effectiveness and reliability in turn normally require regular testing to ensure preparedness, and also testing that is based on careful assessment of foreseeable community emergency risks or threats. These actions, and system effectiveness and reliability overall, in turn normally will result in conditions where the community is substantially free of disruptions from emergencies and disasters of all kinds over time.
31	10	Security	There is a comprehensive system, operated either by or for the community, to identify and eliminate or control all large-scale public health hazards or endemic threats to normal daily life in the community and its surrounding environment				Pre-emptive elimination or control of large-scale public health hazards and threats is essential to long-term community health and sustained progressive health investment. This owes to the fact that the natural alternative is the regular emergence of public health threats in time, including outbreaks of infectious diseases, food supply contamination, community-limiting impacts from unhealthy lifestyle norms, and other threats within and to normal daily life. The presence of unaddressed and unmitigated public health threats in turn makes more advanced health promotion efforts more difficult to implement and sustain, and even an unrealistic or low-priority goal to consider in the face of unmanaged basic public health risks impacting a community.
32	11	Security	There are no uncontrolled public health hazards in or affecting the community and surrounding area, and incidents of public health threats or emergencies are rare or absent				The effective and reliable control public health hazards, risks, and threats is essential to ensure freedom from disruptions to regular daily life in a community and larger area, and thereby to encourage active planning for the future and more advanced health promotion efforts. As in other areas, these public health actions, and system effectiveness and reliability overall, in turn will result in conditions where the community is substantially free of disruptions from public health emergencies and threats of all kinds over time.
33	12	Infrastructure	A system is in place, operated either by or for the community, for the reliable delivery of safe water for drinking and other household and community uses				A standard focus area of traditional public health efforts, safe drinking water is essential to immediate personal health and therefore community health in any timeframe.
34	13	Infrastructure	The community's water supply system is regularly tested for hygiene and evaluated for reliability, and incidents of either water supply contamination or disruption are rare or absent in the community				A safe and reliable water supply system is essential to immediate personal and community health, and thus to future-oriented community planning and effort toward more advanced sates of health and health promotion. If a community's water supply is safe and reliable, instances of water supply contamination and disruption should be rare or absent in the community.
35	14	Infrastructure	The community's water supply system is fully sustainable, able to meet the needs of the community indefinitely at projected population and water-use levels without depletion of reserve levels or environmental harm in an average year				Water system sustainability is essential to the long-term health of any modern community and its natural environment, and therefore to progressive states of community health and health promotion. The reserve levels and environmental effects of water supply systems naturally vary annually, based on weather and others factors, and are normally evaluated on an average-year basis.
36	15	Infrastructure	A system is in place, operated either by or for the community and whether centralized or decentralized, for the capture, treatment, and safe recycling of all household and other community sewerage				A standard focus area of traditional public health efforts, safe sewerage control is essential to immediate personal health and therefore community health in any timeframe.
37	16	Infrastructure	The community's sewerage management system is regularly tested for hygiene and evaluated for reliability, and incidents of either external sewerage contamination or system disruption are rare or absent in the community				A safe and reliable sewerage management system is essential to immediate personal and community health, and thus to future-oriented community planning and effort toward more advanced sates of health and health promotion. If a community's sewerage management system is safe and reliable, instances of external sewerage contamination and system disruption should be rare or absent in the community.
38	17	Infrastructure	The community's sewerage management system is fully sustainable, able to meet the needs of the community indefinitely at projected population and sewerage-production levels without human or environmental harm in any year				Sewerage system sustainability is essential to the long-term health of any modern community and its natural environment, and therefore to progressive states of community health and health promotion.
39	18	Infrastructure	A system is in place, operated either by or for the community, for the safe collection, management, and recycling of all household, commercial, and industrial solid waste				A standard focus area of traditional public health efforts, safe solid waste control is essential to immediate personal health and therefore community health in any timeframe.
40	19	Infrastructure	The community's solid waste management system is regularly tested for hygiene and evaluated for reliability, and incidents of either external solid waste contamination or system disruption are rare or absent in the community				A safe and reliable solid waste management system is essential to immediate personal and community health, and thus to future-oriented community planning and effort toward more advanced sates of health and health promotion. If a community's solid waste management system is safe and reliable, instances of external solid waste contamination and system disruption should be rare or absent in the community.
41	20	Infrastructure	The community's solid waste management system is fully sustainable, able to meet the needs of the community indefinitely at projected population and waste-production levels without human or environmental harm in any year				Solid waste system sustainability is essential to the long-term health of any modern community and its natural environment, and therefore to progressive states of community health and health promotion.
42	21	Infrastructure	A system is in place, operated either by or for the community, for monitoring and managing airborne pollutants and air quality threats, and daily air quality is very high on average throughout the community				A standard focus area of traditional public health efforts, air quality control is essential to immediate personal health and therefore community health in any timeframe.
43	22	Infrastructure	The air around the community is regularly tested for quality, either by or for the community, and incidents of elevated industrial and other forms of human air pollution or contamination are rare or absent in the community				A reliable and effective air quality management system is essential to immediate personal and community health, and thus to future-oriented community planning and effort toward more advanced sates of health and health promotion. If a community's air quality management system is reliable and effective, instances of aid pollution and contamination should be rare or absent in the community.
44	23	Infrastructure	The community's air quality management system is fully sustainable, able to ensure high air quality for the community and prevent environmental harm indefinitely at projected population and activity levels in any year				Air quality system sustainability is essential to the long-term health of any modern community and its natural environment, and therefore to progressive states of community health and health promotion.
45	24	Infrastructure	The community has a neutral footprint with respect to carbon dioxide and other greenhouse gasses, and emits no other household, commercial, industrial, or other gasses that harm the global atmosphere				Carbon neutrality and elimination of other harmful gas emissions have been shown in research to be essential for global environmental and economic sustainability, and thus for the long-term health of all local communities.
46	25	Infrastructure	A system is in place, operated either by or for the community, to ensure food safety and hygienic quality in all public markets, eating places, and home, as well as their food supply chains or sources				A standard focus area of traditional public health efforts, food safety control is essential to immediate personal health and therefore community health in any timeframe.
47	26	Infrastructure	The community's food supply system is regularly tested for hygiene and evaluated for reliability, and incidents of either external food contamination or system disruption are rare or absent in the community				A safe and reliable food management system is essential to immediate personal and community health, and thus to future-oriented community planning and effort toward more advanced sates of health and health promotion. If a community's food system is safe and reliable, instances of food contamination and disruption should be rare or absent in the community.
48	27	Infrastructure	All agricultural operations serving the community are regularly tested for hygiene and evaluated for reliability, and incidents of either agricultural contamination or system disruption are rare or absent				A safe and reliable food system normally depends on adequate testing, evacuation, and control of all sources of food entering the community, including all agricultural operations.
49	28	Infrastructure	All agricultural operations serving the community are subject to soil and water level preservation requirements, as well as fair labor standards, and further are either fully sustainable or have a plan in place to achieve full sustainability within twenty years - allowing these operations to meet the food needs of the community indefinitely at projected population levels without human suffering in any year and environmental harm in an average year				Agricultural sustainability is essential to environmental and food supply sustainability, to the long-term health of any modern community, and therefore to progressive states of community health and health promotion. Soil and water level preservation are essential to agricultural sustainability. The environmental effects of agriculture naturally vary annually, based on weather and others factors, and are normally evaluated on an average-year basis.
50	29	Infrastructure	A system is in place, operated either by or for the community and whether centralized or decentralized, to ensure safe, affordable, and reliable electricity for all people, households, and other enterprises or activities in the community				Safe and affordable access to electricity is a foundation of many dimensions of modern life and community, notably including a variety of new modern opportunities for progressive human health, quality of life, and natural and self-understanding. In this way, universal electrification can be a strong enabler or catalyst for new modern progression to more advanced states of health, health awareness, health opportunity, and health promotion.
51	30	Infrastructure	The community's electrical supply system is regularly tested for safety and evaluated for reliability, and incidents of either electrical injury and damage or system disruption are rare or absent				A standard focus area of traditional public health efforts, safe and reliable electrical systems are essential to immediate personal health in modern life and therefore community health in any timeframe. If a community's electrical system is safe and reliable, instances of injury or damage and system disruption should be rare or absent in the community.
52	31	Infrastructure	The community's electrical supply system and sources are fully sustainable, able to meet the needs of the community indefinitely at projected population and electricity-use levels without human or environmental harm in any year				Just as electricity is an enabler of many positive or progressive health opportunities in modern life, electrical system and supply sustainability are essential to the long-term health of any modern community in its natural environment, and therefore to progressive states of community health, health understanding, and health promotion.
53	32	Infrastructure	A system is in place, operated either by or for the community and whether centralized or decentralized, to ensure reliable, affordable, and secure high-speed internet access for all people, households, and other enterprises or activities in the community				Much as with universal electricity, secure, affordable, and reliable access to high-speed internet is a foundation of many positive and health progressive dimensions of modern life and community, notably including superior information access overall, increased education and economic opportunities, greater civic and social transparency, and less encumbered or resource-intensive life on multiple fronts. In this way, universal high-speed internet access can be a strong enabler or catalyst for new modern progression to more advanced states of health, health awareness, health opportunity, and health promotion.
54	33	Infrastructure	The community's internet system is regularly tested for security from identifiable threats, whether moral or technical, and evaluated for reliability, and incidents of either harm from internet use or system disruption are rare or absent in the community				A new area of focus area for public health efforts, reliable, affordable, and secure high-speed internet systems often are essential to immediate personal health and quality of life in modern life and therefore community health in any timeframe. If a community's internet system is secure and reliable, instances of injury and system disruption should be rare or absent in the community.
55	34	Infrastructure	The community's internet system is fully sustainable, able to meet the needs of the community indefinitely at projected population and information-use levels without human or environmental harm in any year				Just as high-speed internet access is an enabler of many positive or progressive health opportunities in modern life, internet system sustainability can be essential to the long-term health of any modern community, and therefore to progressive states of community health, health understanding, and health promotion.
56	35	Medical Care	High-quality primary medical care - defined as treatment of simple injuries & medical conditions - is readily available and affordable to all members of the community, and both untreated and unknown primary medical conditions are rare or absent in the community				Effective primary medical care is essential to treat basic illnesses and injuries, when these conditions cannot be prevented, and to reduce their severity via the risk of inattention. Primary medical care services also can be an important means of identifying both personal and common community health trends, conditions, and shortfalls. Ready and universal availability and affordability of primary medical care thereby promotes greater personal health, community understanding of personal health levels, and often personal engagement in both health and the community overall. In all, these developments typically lead to increased community health, health understanding. and health promotion. If a community has high-quality, readily-available, and affordable primary medical care, instances of both untreated and unknown primary medical conditions should be rare or absent in the community.
57	36	Medical Care	High-quality advanced medical care - defined as treatment of severe injuries & medical conditions - is readily available and affordable to all members of the community, and both untreated and unknown advanced medical conditions are rare or absent in the community				Effective secondary medical care is essential to treat severe illnesses and injuries, when these conditions cannot be prevented, and to reduce death and disability via the risk of inattention or inadequate treatment of these conditions. Ready and universal availability and affordability of secondary medical care promotes these benefits, increases community health understanding and information, and also fosters greater personal engagement in both health and the community, all potentially increasing community health and health promotion. If a community has high-quality, readily-available, and affordable secondary medical care, instances of both untreated and unknown secondary medical conditions should be rare or absent in the community.
58	37	Medical Care	Quality dental and optometric care, including regular screening and identification of treatment needs, is readily available and affordable to all members of the community, and both untreated and unknown dental and optometric conditions are rare or absent in the community				Effective and timely care in these areas is essential to individual health and autonomy, and to reduce personal impairment and limitations associated with dental and optometric inattention. Universal availability and affordability of these forms of care thereby promotes personal health, increases community health understanding and information, and also fosters greater personal engagement in both health and the community, all potentially increasing community health and health promotion. If a community has high-quality, readily-available, and affordable dental and optometric care services, instances of both untreated and unknown conditions in these areas should be rare or absent in the community.
59	38	Medical Care	An oversight system is in place, operated either by or for the community and that is independent of medical care providers, for quality assurance of all primary, secondary, and ancillary medical care organizations and practitioners, and injury or death caused in the course of medical care is rare or absent in the community				An effective medical care system is essential for personal and community health, community health information, and community health promotion. Independent quality assurance of the community's medical care system improves its functioning overall, aids the above goals, and challenges and drives progressive improvement in medical practices that are less than optimal. If the medical quality assurance system is functioning correctly, injury or death caused in the course of medical care should rare or absent in the community.
60	39	Medical Care	Medical and other health care providers are compensated either on a fixed basis, based on community health metrics, or a combination of the two approaches, rather than for or in proportion to the delivery or quantity of medical and allied services.				Ensuring alignment of financial and other incentives for medical and health care professionals and institutions with community health goals and outcomes is essential to promote optimal amounts and types of medical and health care. Misalignment of incentives - for example via fee for service models or omitting incentives for care quality and health outcomes - has been shown to reduce community health and/or increase care delivery costs without corresponding improvements in health outcomes.
61	40	Medical Care	A program is in place, operated either by or for the community, to screen for and prevent maternal and child health risks and conditions, and the program reaches all mothers and children in the community				A newer focus area of traditional public health efforts, specifically targeting maternal and child health risks and conditions can greatly improve both immediate and long-term personal and community health outcomes. This includes reducing often readily-preventable community risks of suffering and disability in this area, preventing a variety of unhealthy norms and conditions from forming and enduring in a community, increasing personal and overall community health awareness, improving community health information, and aiding community health promotion efforts over time.
62	41	Medical Care	Death or disability during pregnancy, childbirth, child-rearing, and childhood is rare or absent in the community				If a community's maternal and child health program is functioning properly, incidences of death and disability during child-bearing, child-rearing, and childhood should be rare or absent in the community.
63	42	Medical Care	A program is in place, operated either by or for the community, to screen for and prevent childhood and adult obesity and related health risks and conditions, and the program reaches all members of the community				Childhood and adult obesity of course are now common, growing, and already severe personal and community health conditions associated with industrial affluence, more sedentary living, and greater consumption of calorie-rich foods and beverages. In both children and adults, even modest levels of obesity can engender a variety of lifelong health risks, including diabetes, cardiovascular disease, cancer, other chronic diseases, lifestyle impairment and disempowerment, social disability and estrangement, and psychological disaffection. Given the common prevalence and often severe negative health consequences of obesity, a series of targeted, integrated, and robust steps to prevent both child and adult obesity are often essential to modern personal and community health, and typically are best implemented in the form of coordinated community interventions on several fronts. Wide and strong obesity reduction efforts can reduce the risk and community presence of obesity, substantially improving health, health awareness, and health norms - and notably via both direct personal impacts and increasingly well-understood network or social effects that influence the overall behavior, expectations, and norms of a group. Together, these steps can greatly increase not only immediate community health outcomes, but also longer-term community member loyalty and engagement, community cohesiveness, personal and community future-mindedness and tendencies toward self-investment, and thus community health promotion.
64	43	Medical Care	No members of the community are overweight, and death or disability from obesity and related health conditions is rare or absent in the community				If a community's obesity-reduction program is functioning properly, both the presence of obesity and incidents of death and disability from obesity and related disease conditions should be rare or absent in the community.
65	44	Medical Care	A program is in place, operated either by or for the community, to screen for and prevent sexual health risks and conditions, and the program reaches all members of the community				A common focus area of traditional public health efforts, specifically targeting sexual health risks and conditions can greatly improve both immediate and long-term personal and community health outcomes. This includes reducing often readily-preventable community risks of suffering and disability in this area, preventing a variety of unhealthy norms and conditions from forming and enduring in a community, increasing personal and overall community health awareness, improving community health information, and aiding community health promotion efforts over time.
66	45	Medical Care	Death or disability from sexual health conditions is rare or absent in the community				If a community's sexual health program is functioning properly, incidents of death and disability from sexually-transmitted diseases and other sexually-related health hazards should be rare or absent in the community.
67	46	Medical Care	A program is in place, operated either by or for the community, to screen for and prevent mental health risks and conditions, and the program reaches all members of the community				A more recent focus area of traditional public health efforts, specifically targeting mental health risks and conditions can greatly improve both immediate and long-term personal and community health outcomes. This includes reducing often readily-preventable community risks of suffering and disability in this area, preventing a variety of unhealthy norms and conditions from forming and enduring in a community, increasing personal and overall community health awareness, improving community health information, and aiding community health promotion efforts over time. Signs of mental illness, just as with physical illness, are symptoms or signals of compromised health in the community overall, and in this case perhaps of unexamined, unmitigated, and unhealthy chronic stress, disaffection, alienation, and estrangement among community members.
68	47	Medical Care	The presence of mental illness and death or disability from mental health conditions are rare or absent in the community				If a community's mental health program is functioning properly, both the presence of mental illness and incidents of death and disability from mental illness and other mental health hazards should be rare or absent in the community.
69	48	Safety	A program is in place, operated either by or for the community, to identify and mitigate common and preventable risks of injury and property damage from natural disasters and climate change, and has achieved substantial protection of the community against these risks				Natural disaster control is standard focus area of traditional public health efforts, while climate change control is a newer but related or overlapping one. The first of these often is essential to short-term personal health, and today both generally are needed to assure long-term community health and health promotion.
70	49	Safety	Death, disability, and significant property damage from natural disasters and extreme weather is rare or absent in the community				If a community's natural disaster and climate change control program is functioning properly, incidents of death, disability, and significant property damage from natural disasters and extreme weather should be rare or absent in the community.
71	50	Safety	A program is in place, operated either by or for the community, to identify and mitigate common and preventable infectious disease threats, and has achieved full vaccination of the community or an alternative control measure against these diseases (excepting members with medical exemptions)				A standard focus area of traditional public health efforts, infectious disease control - including pre-emptive identification and widely-provided immunization against major infectious disease threats - often is essential to short-term personal health, as well as long-term community health and health promotion.
72	51	Safety	Death or disability from common and preventable infectious diseases is rare or absent in the community				If a community's infectious disease control program is functioning properly, incidents of death and disability from common and preventable infectious diseases should be rare or absent in the community.
73	52	Safety	A program is in place, operated either by or for the community, to identify and mitigate occupational health risks and conditions, and the program reaches all members of the community				A standard focus area of traditional public health efforts, occupational safety or workplace health programs often are essential to immediate personal and community health, reduce common sources of modern death and injury, indirectly promote family integrity and childhood health by protecting working parents, raise personal and community health awareness, provide community health information, encourage both greater attentiveness and future-mindedness, and thus aid or enable more advanced community health promotion efforts and investments. As in other areas, wide or universal reach of effort promotes community inclusiveness and cohesion.
74	53	Safety	Death or disability from occupational health conditions is rare or absent in the community				If a community's occupational health program is functioning properly, incidents of death and disability from occupational hazards should be rare or absent in the community.
75	54	Safety	A program is in place, operated either by or for the community, to identify and mitigate excessive occupational and non-occupational stress, and the program reaches all members of the community				Much as with obesity resulting from general and often health-indifferent modern wealth, chronic stress stemming from excessive modern work and wealth-related goals now is a pervasive, often less appreciated, and significantly unmitigated health limiter in many communities today. Severe and chronic stress, and the unexamined and unmanaged states of life and mind that stress circularly can stem from and promote in modern conditions, can lead to increased levels of personal illness, disaffection, self-preoccupation, narrowness in the framing of life issues and goals, and civic withdrawal. All of these outcomes of course are likely to reduce a community's immediate health, along with its opportunity and capacity for progressive health promotion in time. In practice, widespread and effective stress reduction programs tend to substantially alter both the tempo and content of personal and community life, can broadly and often rapidly increase community health and health awareness, and steadily promote substantially higher levels of community cohesion and health investment. As in other areas, wide or universal reach of efforts in the management of common community stressors and member stress levels promotes community inclusiveness and cohesion.
76	55	Safety	The presence of severe and chronic stress, and death or disability from occupational and non-occupational stress, are rare or absent in the community				If a community's stress reduction program is functioning properly, both the presence of severe and chronic stress, and incidents of death and disability from occupational and non-occupation stress, should be rare or absent in the community.
77	56	Safety	A program is in place, operated either by or for the community, to identify and mitigate home and transportation injury risks, and the program reaches all members of the community				A standard focus area of traditional public health efforts, and a natural complement or counterpart to occupational or workplace safety and health programs, home and transportation safety and health programs often are essential to immediate personal and community health, reduce common sources of modern death and injury, directly promote family integrity and health, raise personal and community health awareness, provide community health information, encourage both greater attentiveness and future-mindedness, and thus aid or enable more advanced community health promotion efforts and investments. As in other areas, wide or universal reach of effort promotes community inclusiveness and cohesion.
78	57	Safety	Death or disability from home and transportation injury risks is rare or absent in the community				If a community's home and transportation safety program is functioning properly, incidents of death and disability from home and transportation hazards should be rare or absent in the community.
79	58	Safety	A program is in place, operated either by or for the community, to discourage tobacco and alcohol consumption, and avoidance of these drugs is the community norm				A standard focus area of traditional public health efforts, programs and accompanying community norms leading to the avoidance of tobacco and alcohol use can greatly increase both immediate and long-term personal and community health outcomes. Even modest levels of tobacco and alcohol consumption are associated with significant increases in disease, disability, and death. Their use also can be a telling symptom or signal of unmitigated community member stress, disaffection, presentism, civic withdrawal, and health indifference as well. These various effects, alone and in total, of course can greatly limit a community's potential for progressive health awareness, focus, promotion, and investment. If a community's tobacco and alcohol avoidance program is functioning properly, avoidance of these common modern drugs should be the community norm.
80	59	Safety	A program is in place, operated either by or for the community, to discourage other recreational or non-medical drug consumption, and avoidance of these drugs is the community norm				A more recent focus area of traditional public health efforts, but building on programs seeking to discourage tobacco and alcohol use, programs and accompanying community norms leading to the avoidance of recreational or non-medical drug use overall can greatly increase both immediate and long-term personal and community health outcomes. Even modest levels of recreational or non-medical drug consumption are associated with significant increases in disease, disability, and death. Their use also can be a telling symptom or signal of unmitigated community member stress, disaffection, presentism, civic withdrawal, and health indifference as well. These various effects, alone and in total, of course can greatly limit a community's potential for progressive health awareness, focus, promotion, and investment. If a community's recreational or non-medical drug avoidance program is functioning properly, avoidance of all recreational drugs should be the community norm.
81	60	Safety	There is a program, operated either by or for the community, for training, certifying, and monitoring governmental public health officials - or all officials working either within or in ways overlapping with traditional areas of public health promotion and risk control - all such officials working in or for the community are certified by the program, and all members of the community view these officials, their public health efforts, and any larger community or collective health initiatives they engage in as highly valuable to the community overall				Traditional public health functions and some aspects of broader efforts at holistic community health promotion require detailed knowledge and skilled action, and thus essential training in specific areas. The Three Paths Community Health Program guide may provide sufficient information and procedures for generalist health promotion leadership and activism in communities, but the program is intended to be aided or supplemented by public health and other professional activities conducted for the community and within its health promotion agenda. Therefore, in addition to the medical and allied health care training and oversight discussed above, as well as training and oversight of other professionals who may be enlisted in a community's health promotion efforts, it normally is essential to have all governmental officials acting in traditional public health capacities and areas within or for a community similarly trained, certified, and monitored. Importantly, public health official training may be most beneficial if it requires fluency in both essential technical topics and also community relations or outreach techniques. As in other areas, if a community's public health official training, certification, and oversight program and its certified professionals are effective, operating transparently and communicatively, widely interactive with and thus visible in the community, and aiding highly valuable community health promotion activities, each should be viewed as such by the community.
82	61	Nutrition	A science-based model of optimal daily eating, created either by or for the community, has been adopted by the community's governing body, and the community has a program to promote and gauge use of the dietary model that reaches all members of the community				Nutritional health is essential to personal health, and wide research underscores that poor nutrition can lead both to lower-quality or less healthy immediate personal functioning, and premature disease, disability, and death in time. While this linkage is well understood, given the wide, often commercially-inspired, and frequently health-indifferent mix of foods now available, and unlike ancestral life, optimal personal and community nutrition is unlikely today without a clear dietary model and memorable set of goals, along with compelling promotion of the importance of the model. Importantly, dietary science in our time includes areas of high consensus and substantial controversy. Thus, your community's dietary model is likely to be most effective and accepted if it is responsive to these areas of debate, while emphasizing nutritional principles that are understood and personally testable with high confidence. The remaining nutritional factors are derived from the science-based OurPlate dietary model, one of several available, and use this model to provide a framework for promoting nutritional and overall health in your community. Whatever nutritional model your community selects, an effective program to promote and gauge its use can increase not only the personal health of your community members, but also overall community health, health awareness or understanding, available health information, future and goal-mindedness, interest and participation in health promotion, and capacity and willingness to pursue progressive health investments.
83	62	Nutrition	The community's dietary model advocates avoidance of refined and other concentrated sugars in all forms - including sugar-rich meals, snacks, desserts, beverages, and condiments - and use of these foods is rare or infrequent in the community				The nutritional health importance of avoiding refined and other concentrated sugars, in all forms and where they are included in foods and beverages, is an area of high scientific consensus. Eliminating use of these foods reliably improves modern nutritional quality and personal health. By contrast, the regular use of refined and concentrated sugars and sugar-rich foods commonly leads to lower-quality or less healthy personal functioning, socializes health indifference and normalizes lower states of health in your community, and increases both personal and community risks of premature disease, disability, and death. If your dietary model and promotion program are effective, use of these foods should be rare or absent in the community.
84	63	Nutrition	The community's dietary model advocates avoidance of processed, manufactured, or heavily-modified foods in all forms - including processed meals, snacks, desserts, beverages, condiments, and seed oils - and use of these foods is rare or infrequent in the community, with whole-food diets being the dominant community norm				The nutritional health importance of avoiding processed, manufactured, or heavily-modified foods, in all forms and where they are included in or comprise foods and beverages, is an area of high scientific consensus. Eliminating use of these foods reliably improves modern nutritional quality and personal health. By contrast, the regular use of processed, manufactured, or heavily-modified foods commonly leads to lower-quality or less healthy personal functioning, socializes health indifference and normalizes lower states of health in your community, and increases both personal and community risks of premature disease, disability, and death. If your dietary model and promotion program are effective, use of these foods should be rare or absent in the community.
85	64	Nutrition	The community's dietary model encourages exploration of low grain and legume diets - including all foods containing these ingredients - especially among community members who experience chronic, ongoing, or regular bodily inflammation, digestive upset, digestive bloating, general fatigue, head and body aches, difficulty reasoning, emotional instability or irritability, skin and other allergies, skin rashes and irritations, swelling and other signs of reduced tissue health, asthma and difficulty breathing, high or low body weight, and other signs of reduced personal health and vitality or failure to thrive				Diets rich in agricultural grains and legumes appear to have given rise to and in any case proliferated historically with the rise of fixed human civilization, and today are widely and significantly consumed modern foods. However, the naturalness of these foods for our species, their advisability for optimal modern nutrition, and their ability to be grown sustainably all are areas of strong and growing modern scientific and practical controversy. In addition, and both reflecting and driving this controversy, many report greatly improving their personal health, and notably freeing themselves from chronic and even lifelong health complaints, via the elimination of agricultural grains and/or legumes from their diets, including foods containing grains and legumes as ingredients. Given this set of facts, your community's dietary model is likely to be most effective and accepted if it takes no sides in the current grain and legume desirability nutritional debate, but also encourages exploration of the avoidance of these foods - as a potential source of increased personal health, on ecological health or sustainability grounds, and to increase community health understanding and engagement. If your dietary model and promotion program are effective, these symptoms should be rare or absent in the community.
86	65	Nutrition	The community's dietary model encourages exploration of high and low carbohydrate diets - reducing or increasing natural fats and proteins to maintain calorie levels - and also high and low plant diets - reducing or increasing animal foods to maintain calorie levels - to gauge which mix of foods works best individually for community members in general and especially ones experiencing chronic, ongoing, or regular symptoms of reduced health and vitality or failure to thrive				Partly overlapping with modern technical and popular debates about the desirability of dietary grains and legumes, questions regarding the naturalness of both high carbohydrate and high plant diets for our species, their advisability for optimal modern nutrition, and their ability to be produced sustainably all are areas of strong and growing modern scientific and practical controversy. Once more, and both reflecting and driving this controversy, many report greatly improving their personal health, and notably freeing themselves from chronic and even lifelong health complaints, via the elimination of significant carbohydrate and/or plant foods from their diets, including foods containing carbohydrates and plants as ingredients. Given this set of facts, your community's dietary model is likely to be most effective and accepted if it takes no sides in the current carbohydrate and plant desirability nutritional debate, but also encourages exploration of reductions in and the avoidance of these foods - again as a potential source of increased personal health, potentially on ecological health or sustainability grounds (where foods are not from perennial or sustainable sources), and to increase community health understanding and engagement. If your dietary model and promotion program are effective, these symptoms should be rare or absent in the community.
87	66	Nutrition	The community's dietary model encourages avoidance of foods whose production is ecologically damaging, and steady movement toward diets based 100% on ecologically sustainable foods and agriculture is the dominant community norm and goal				The nutritional, ecological, and species health importance of 100% ecologically sustainable modern agriculture and eating is an area of high scientific consensus. That said, and as with modern economic systems more generally, significant technical debate remains regarding how this outcome is best achieved and the speed with which modern people can and should move to conditions of agricultural and dietary sustainability. Given this mix of consensus and debate, as well as the need for but still limited popular appreciation of this issue, your community's dietary model is likely to be most effective and accepted if it encourages awareness of and steady action toward our natural need for dietary and agricultural sustainability, takes no sides in current technical debates regarding how this outcome is best achieved and at what pace, and notably emphasizes that sustainable agriculture, as scientists currently understand it, generally involves moving to perennial and polycultural food systems modeled on natural ecology. To the extent this last point proves true in time, this implies needed dietary movement away from foods derived from traditional annual and monocultural agriculture, in favor of animal foods raised on or in perennial pasture and forest, wild and naturally-raised fish, and perennially-grown fruits, nuts, and other edible plants. With this approach - which notably aligns or overlaps with the exploration of low grain, legume, carbohydrate, and plant diets - consideration of increased personal, community, ecological, and species health can be fostered, increasing community health understanding and engagement over time.
88	67	Exercise	A science-based model of optimal daily exercise, created either by or for the community, has been adopted by the community's governing body, and the community has a program to promote and gauge use of the exercise model that reaches all members of the community				Regular exercise or natural physical conditioning is essential to personal health, and wide research underscores that limited exercise can lead both to lower-quality or less healthy immediate personal functioning, and premature disease, disability, and death in time. While this linkage is well-known, given the wide, commonly commercially-inspired, and often health-indifferent lifestyles available, and unlike ancestral life, optimal natural conditioning is unlikely today without a clear exercise model and memorable set of goals, along with compelling promotion of the importance of the model. Importantly, unlike dietary science in our time, exercise science is marked by high consensus regarding essential goals and practices, with only peripheral controversy. Thus, your community's exercise model is likely to be most effective and accepted by emphasizing principles that are understood and personally testable with high confidence, while remaining flexible regarding areas of debate. The remaining exercise factors are derived from the science-based natural exercise model in Our Three Natural Paths, one of several available, and use this model to provide a framework for promoting optimal exercise and overall health in your community. Whatever exercise model your community selects, an effective program to promote and gauge its use can increase not only the personal health of your members, but also overall community health, health understanding, available health information, future and goal-mindedness, interest and participation in health promotion, and capacity and willingness to pursue progressive health investments.
89	68	Exercise	The community's exercise model begins with the related ideas that health-essential exercise should be an integral part of community life and concern in the community's design and norms - with the exercise model: 1) foundationally promoting essential natural conditioning via the norms of daily member walking and active life overall, 2) specifically encouraging at least 8 km (5 miles) of daily walking in the course of life or as dedicated exercise, 3) further promoting longer periodic walks around the community and hikes or bivouacs in nearby wild nature to increase conditioning, renewal, and perspective, 4) broadly encouraging 'natural conditioning' or forms exercise that can be accomplished without significant expense or equipment, 5) relatedly advocating naturally efficient 'whole body' exercise, and 6) flexibly accommodating alternatives to daily walking and other exercise norms, as long as the alternatives are not disruptive to the community - overall with daily walking at the above level or alternative exercise and physically active life the dominant community norm for all members over the age of seven (with exercise norms subject to safety considerations and medical advisability)				This factor is multi-part and has a number of interrelated scientific and practical concepts providing its rationale. These include the ideas that both health-essential and optimal lifelong exercise are now well-understood and characterized, adequate and optimal exercise is often best and most reliably assured by building exercise and conditioning activities into daily life itself, effective social promotion and norming of exercise and active life is likely to increase exercise and activity overall, walking is the most effective, complete, and naturally central form of exercise or conditioning for humans, daily walking of roughly 8km (or 10,000 steps) is often essential for basic natural conditioning, daily walking may increase community interaction and cohesion, periodic longer walks and walking in wild nature (each if safe) may have additional and important physiological and psychological benefits, replication of natural or ancestral activity patterns and emphasis of whole body exercise or activities each often aids optimal and maximally efficient lifelong conditioning, related emphasis of accessible or low-cost exercises similarly encourages at once elevated and more natural modern exercise, and accommodating healthy alternatives around a core focus on daily walking may increase both community exercise levels and community norming of exercise overall. As in other areas, the factor further assumes that if a community exercise model and promotion program are effective, daily walking or alternative exercises at the indicated levels should be common and a dominant norm in the community.
90	69	Exercise	In addition to its core emphasis of daily walking and periodic extended walks or hikes, but consistent with emphasis of both integral and natural conditioning and whole body exercise, the community's exercise model encourages regular calisthenics or other forms of 'total-body conditioning' exercises or activities - ones that naturally promote flexibility, strengthening, agility, stress reduction, and improved cognition - and the regular practice of calisthenics or alternative total-body exercises is the dominant community norm for all members over the age of seven (with exercise norms subject to safety considerations and medical advisability)				Exercise research suggests that personal health, fitness, vitality or efficacy, and cognitive functioning overall all can be improved by regular resistance and range of motion exercises, especially building on a base of daily walking or another aerobic exercise, in all promoting more complete natural conditioning and superior personal health. As before, these measures in turn can increase overall community health, health awareness or understanding, available health information, future and goal-mindedness, interest and participation in health promotion, and capacity and willingness to pursue progressive health investments. Once again, the factor further assumes that if a community exercise model and promotion program are effective, regular calisthenics or alternative total-body exercises should be common and a dominant norm in the community.
91	70	Exercise	As part of but extending beyond its core emphasis of daily walking, the community's exercise model encourages community members to ensure sufficient daily sun exposure for natural Vitamin D production and general hormonal regulation - roughly 30 minutes on at least half of the body for members with a light complexion, 90 minutes with a medium complexion, 180 minutes with a dark complexion, always without burning - and these levels of daily sun exposure are the dominant community norm				Growing physiological research suggests that this level of sun exposure is essential to adequate Vitamin D production, natural metabolic regulation, and reducing risks of a variety of chronic diseases and forms of dysfunction. Additionally, adequate sun exposure promotes health-enhancing time outdoors and often community social interaction. As in other areas, these personal health benefits can provide the community health benefits listed above, and if a community exercise model and promotion program - and health efforts overall - are effective, adequate sun exposure should be common and a dominant norm in the community.
92	71	Exercise	To aid and encourage not only daily exercise, but also community safety, cohesion, and intimacy, one or more walking and walkable gathering areas that are safe, planted with shady trees or other attractive plants, and naturally pleasant to be in or pass through are readily available to all community members and widely used by the community				The availability and quality of walking and walkable gathering areas has been shown in research to affect the extent of their use and thus contribution to personal health. These personal impacts once again in turn influence overall community health, and a community's ability and willingness to engage in more advanced health promotion efforts.
93	72	Exercise	To aid and encourage not only daily exercise, but also community safety, cohesion, and intimacy, one or more walking and walkable gathering areas that are separated from and generally not intruded by motor vehicle traffic, and no more than moderately noisy, are readily available to all community members and widely used by the community				Motor vehicle intrusion into pedestrian and gathering areas has been shown in research to reduce their use, perceived environmental quality, level of stress reduction and psychological benefit, and thus contribution to personal health. These personal impacts once again in turn influence overall community health, and a community's ability and willingness to engage in more advanced health promotion efforts.
94	73	Exercise	To aid and encourage not only daily exercise, but also community safety, cohesion, and intimacy, there is a central and walkable gathering area in the community, one that is readily accessible via walking or cycling by all community members, large enough to hold the entire community, free of vehicular traffic and normally no more than moderately noisy, and widely used by the community for both informal gatherings and whole community events				Walkable and highly accessible central gathering areas of this type, whether in the form of a park, commons, or civic meeting area, have been shown in research to increase community gathering, interaction, satisfaction, engagement, and cohesion - and thus likely both community health overall, and ability and willingness to engage in more advanced health promotion efforts in particular.
95	74	Exercise	Consistent with but extending beyond the community's exercise model, and promoting natural community cohesion, intimacy, and sustainability in addition to natural conditioning, the community's governing body has adopted a master plan for community development that favors community design and building practices which enable and promote daily walking and/or cycling for normal life activities, personal errands, work and leisure, social activities, and community events				Unplanned, haphazard, car-dependent, and sprawling community development - notably where natural forms and levels of human activity are neither required or favored - has been shown in research to greatly reduce both personal exercise levels and community interaction, increase sedentary living and personal isolation, lower community identification and engagement and reduce both personal and community health overall. By contrast, community design and norms encouraging walking and cycling for daily life activities has been shown to have the reverse of these effects and a renaturalizing effect overall, increasing personal and community health, health and self-awareness, and health information and transparency - and thereby a community's ability and willingness to engage in more advanced health promotion efforts.
96	75	Exercise	Consistent with but extending beyond the community's exercise model, and promoting natural community cohesion, intimacy, and sustainability in addition to natural conditioning, the community's master plan for development further encourages a fairly compact community footprint overall, significantly limits so-called sprawl or sprawling development, and either preserves or steadily restores a buffer of undeveloped natural or agricultural land around the community				Building on the important personal and community health benefits of reducing car-dependency and sprawl, emphasis of a fairly compact community design or footprint has been shown in research to improve personal and community health further in many cases (understanding that maximizing a community's compactness may not optimize its health). Importantly, these effects appear to owe from at least four sources: 1) the increased ease of walking and active daily life that can come with relatively compact communities, 2) the increased social interaction and community cohesion that a relatively compact community footprint can foster, 3) the elevated community transparency and health information that community compactness can afford, and 4) the more ready access to wild nature that compact communities can provide, especially when communities are surrounded by a buffer of wilderness or undeveloped area. Once more, these community features can have a renaturalizing effect overall, increasing personal and community health, health and self-awareness, and health information and focus - and thereby a community's ability and willingness to engage in more advanced health promotion efforts.
97	76	Exercise	It is possible to walk or cycle at least 20 km (12 miles ) in a non-repeating route within or around the community, without significant interruption, risk to safety, interaction with motor vehicles, or exposure to industrial and commercial development				Depending a community's size and population, a minimal walking and cycling route of this distance and possessing these general qualities may be essential to promote safe walking or cycling and natural conditioning overall, optimize community member fitness and health, thereby elevate overall community health awareness and understanding, and ensure a community's long-term ability and willingness to engage in more advanced health promotion efforts.
98	77	Exercise	There are five or more different ways to walk or cycle at least 20 km (12 miles) in a non-repeating route within or around the community, without significant interruption, risk to safety, interaction with motor vehicles, or exposure to industrial and commercial development				Depending a community's size and population, walking and cycling routes of this number and distance, and possessing these general qualities, may substantially increase walking or cycling and natural conditioning overall, improve community member fitness and health, thereby elevate overall community health awareness and understanding, increase community satisfaction and civic engagement, and improve a community's long-term ability and willingness to engage in more advanced health promotion efforts.
99	78	Exercise	Consistent with but extending beyond the community's exercise model, and specifically promoting personal development and perceptual intimacy in addition to natural exercise or conditioning, it is possible to walk directly from anywhere in the community into either wild nature or an undeveloped an agricultural area, and then to hike or bivouac at least 100 km (60 miles) in wild nature or undeveloped agricultural areas without significant interruption, risk to safety, interaction with motor vehicles, or exposure to human development				Ready and substantial access to wild nature often increases time in nature, and time in nature has been shown in research to increase personal fitness, reduce stress and foster positive emotion, provide extrapersonal perspective and insight, foster creativity, and in total set the stage for increased individual health. As before, these personal effects in turn tend to elevate overall community health levels, raise community health awareness and understanding, increase community satisfaction and civic engagement, and thus improve a community's long-term ability and willingness to engage in more advanced health promotion efforts Depending a community's size and population, walking and hiking routes of this type and general quality may be essential to create or realize these health effects. Importantly, this level of natural access also will tend to promote or require a compact community footprint overall and the substantial avoidance or reduction of unhealthy community car-dependency and sprawl, with the potential for numerous additional community health effects, as discussed above.
100	79	Exercise	Consistent with but extending beyond the community's exercise model, and again specifically promoting natural community cohesion, intimacy, and sustainability, the land immediately surrounding the community today either is or soon will be entirely natural or agricultural, with sprawling development by and around the community prevented or eliminated				As outlined above, and in this case perhaps regardless of community size and population, naturally buffered or nature-ringed community development naturally tends to increase community compactness, overall walkability and resulting physical activity levels, avoidance of unhealthy community car-dependency and sprawl, and ease of access to wild or at least undeveloped nature - distinct and potentially synergistic community attributes that can have multiple positive personal and community health effects. As a recap of relevant rationale discussions in this section, this includes greater restorative time in nature, increased natural exercise and conditioning, reduced personal stress and elevated positive emotion, extrapersonal perspective and insight, elevated community health overall, greater community health awareness and understanding, increased community satisfaction and civic engagement, and improved community ability and willingness to engage in progressive health promotion in time.