Summary
The episode works through the distinction between a community intervention and an intervention in a community, sorting invented programs into universal, selected and indicated prevention and explaining why a bridge group can justify a targeted program. A harder invented example applies Geoffrey Rose's population strategy to stroke in a health region, showing that most cases come from the large group at moderate or usual risk and that a universal program can prevent more cases while offering each person a benefit too small to notice. The hosts then examine why COMMIT and the Minnesota Heart Health Program produced small effects, with attention to secular trends, dose, missed target groups and the small number of communities such trials can randomize. A worked worksite assessment shows how the setting points to theories of norms, networks and organizational change, and the hosts review randomized trials of workplace wellness programs that found no significant effect on health care spending. The episode closes with a discussion of how far an evidence-based program can be adapted, ending with a practical rule that separates core components from surface features.