Community-Based Public Health: A Partnership Model

Journal of Public Health Policy,  2001  by Addiss, Susan S

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Thomas A. Bruce and Steven Uranga McKane, eds. CommunityBased Public Health: A Partnership Model. Washington, D.C.: American Public Health Association, 2000. x+129 pp. $22.00 paper.

"Partnership" seems to have become the latest buzz word of public health gurus. Not that there have been no partnerships in public health practice until recently, but the word itself is now put before us constantly as a guiding principle for our initiatives at all levels of government. In the minds of some, it has been overused and has taken on an "oh! that!" quality, engendering a "been there, done that" reaction when it appears before our eyes.

So it is refreshing and welcome to see a book that does more than just repeat the word again like a mantra, a book that explores the concept in its varied facets, that presents advantages and disadvantages of the partnership approach, that puzzles over the thorny issues that don't always get resolved when partnerships are formed, and that provides much helpful information and advice to academic, public health, and community groups contemplating adopting this approach.

The book recapitulates and evaluates the W. K. Kellogg Foundation's Community-Based Public Health (CBPH) Initiative, launched in 1991, the goal of which was to "strengthen the practice and teaching of public health by creating partnerships with an informed and involved public." Believing that to be truly effective teachers of future public health professionals, academics must become intensely involved with community groups embodying community culture, speaking for community needs, and showing the way to community implementation of public health programs, the Foundation funded seven consortia in seven different states. Each consortium had to consist of four categories of partners: public health schools, local health departments, community organizations, and health professions schools other than public health. The chief expected outcome was the reorientation of public health teaching, service, and research to better reflect community priorities and the diversity of community cultures.

In eleven chapters written by different authors, this initiative is examined from its inception at the Kellogg Foundation to its evaluation after the end of the four-year funding period. There are separate chapters that present the educational, research and community perspectives. There is a fine theoretical treatment by John McKnight titled "Rationale for a Community Approach to Health Improvement." A separate discussion of public health in the 21st century sets a context for the initiative. Finally, there are the three chapters by Foundation staff that evaluate the project from several viewpoints.

Throughout the book, one finds guidelines, principles, and recommendations that should be valuable for others launching similar initiatives. Particularly useful from the viewpoint of reorienting public health education is a matrix entitled "A Continuum of `CommunityBased' Learning Experiences," page 48. Unlike many books consisting of chapters written by different authors, this one flows quite smoothly, without the disjunctions and stylistic clashes so common to this approach. (A possible exception is the McKnight chapter, which seems somewhat to be "plunked down," but it is so valuable that one can't really object.) Because the topic is examined so thoroughly from so many different perspectives, one feels upon finishing the last page that one has a good grasp of the model: its advantages and disadvantages, the policy issues it presents, and the lessons to be learned.

With respect to the lessons learned, the Foundation takes a welcome and completely open attitude (too infrequent in many other reports of this nature), generously sharing with the reader, along with the successes of the projects, descriptions of pitfalls, unexpected "glitches," and mistakes made because of poor communication or lack of understanding of the community culture and desires for the project. We learn that identification of community assets is a much more effective approach than dwelling on gaps and needs. We come to understand the different meanings of "policy" to academia, public health agencies, and community groups, and the implications of these meanings for the operations of the consortia. We feel the pressures that community involvement can bring to bear on academic research and faculty status and promotion. We see that, as is so often the case, there was not enough time allocated to fully carry out all the activities necessary for fulfillment of the projects. Finally, we note the importance of leadership to these seven consortia. So in one sense the circle is completed. The need for community-oriented leadership makes clear the importance of reorientation of public health training. This book is a valuable resource for those who also see this need and want to act to meet it.

SUSAN S. ADDISS

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