Community Based Coalitions

Community coalitions (also discussed in Chapter 12) involving official health agencies, academic health centers, places of worship, and other community-based organizations have emerged as an essential part of any community-wide effort to improve health in many parts of the world including the United States (Green and Kreuter 1991). Levine and co-workers have described an ongoing community-based partnership in East Baltimore, Maryland, a community of 150,000 whose residents are predominantly African-American (Levine et al. 1994). The partnership involves a coalition of churches which have organized into an umbrella organization known as Clergy United for Renewal of East Baltimore (CURE), the Johns Hopkins Academic Health Center (the schools of medicine, nursing, and public health, and the Johns Hopkins Hospital), the Baltimore City Health Department and school system, and Health Care for the Homeless.

The appeal of places of worship as settings for health promotion and disease prevention is based on experience suggesting that such settings are receptive to health-related programs, have access to large numbers of persons from all socioeconomic and ethnic groups, have effective communication and meeting facilities, and are oriented to volunteerism (Lasater et al. 1990; 1991; DePue et al. 1990). Since its creation in 1989, the Heart, Body, and Soul Program has evolved in scope to include programs targeted against heart disease, smoking, obesity, violence, crime, substance abuse, and tuberculosis, as well as the promotion of youth education, completion of schooling, and career development. Examples of the effectiveness of this approach include significantly improved rates of identification, care, and control of hypertension, as well as concomitant decreases in related morbidity and mortality and significant improvement in smoking cessation (Levine et al. 1979, 1990; Morisky et al. 1983; Stillman et al. 1993).

Opportunities. Levine sees the replication of partnerships like the East Baltimore coalition in similar communities across the country as an oppor tunity to make substantial progress in decreasing the gap in the health status between underserved, minority populations and the majority of Americans. He points out that about 75% of the 126 academic health centers in the nation are located in communities of underserved minority populations similar to East Baltimore (Pew Health Professions Commission 1993); the mission of such centers is to gain new knowledge through research to enhance the health of the public, as well as to train health professionals to provide the best quality care to all citizens; and with federal and state government help and local leadership much more can be accomplished (Levine et al. 1994).

Challenges. Achieving long-term success in East Baltimore and elsewhere is a substantial challenge because of the difficulty of maintaining high levels of enthusiasm and effort among participants of demonstration projects over time and competition for philanthropic resources among potential coalition partners to address a long list of intractable problems (e.g., smoking, hypertension, hyperlipidemia, substance abuse, violence, and various cancers).

Essential characteristics of this model of coalitions that are likely to meet those challenges include community-based leadership and ownership of specific programs, training and utilization of indigenous community health workers, joint planning for a sequenced strategy of addressing various health problems, interdisciplinary community practice and training opportunities for faculty and students, built-in evaluation, and broad community development and long-term maintenance of effective strategies.

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