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Three domains define major challenges facing U.S. health care. Although engagement in the clinical and service domains directly impacts health, integrative engagement operates at the community level to address social determinants of health. Relying on examples from the Rodham Institute, an academically-based community organization, the authors describe principles and practices for promoting community self-efficacy and capacity-building to improve health. These include effective listening, allowing the self-identified needs of the community to drive engagement, and facilitating physician learning involving community education. If social determinants are to be effectively addressed, such approaches provide valuable insight.