Daniel S. Blumenthal, MD, MPH
When I was in medical school, back in the mid-1960s, some other students and I started the first free clinic in Chicago. It was located in a Salvation Army building in the Englewood neighborhood on Chicago’s South Side and was staffed by med students from the University of Chicago, dental students from Loyola University, and all the volunteer faculty members we could recruit from both universities. It was open two evenings per week.
We had an Advisory Committee that we hoped would help us understand how to operate a clinic for low-income people. We figured that the right people for the committee would be practicing physicians and dentists from the surrounding neighborhoods. I can’t recall if they gave us any good advice, but I do recall thinking – once the committee was assembled – that it wasn’t really the right group of people. Why weren’t most of the committee members patients instead of doctors?
A couple of years later, I found myself in a rural east Arkansas county as the country’s only physician in AmeriCorps VISTA (Volunteers in Service to America, part of the War on Poverty). Again, I was involved, with many collaborators, in starting a clinic to serve the poor. But this time, we took a different approach. We organized a board that was no longer an “advisory” board but was rather, a board of directors comprised entirely of lay people elected by the clinic’s patients. Thus, the Lee County Cooperative Clinic was established as a cooperative in an era when a popular slogan was “Power to the people!” The board was a governing board rather than one that could only give “take-it-or-ignore-it” advice. Thus empowered, the clinic and its board played a major role in bringing the Civil Rights Movement to Lee County.
Fast-forward to the early 21st Century and community boards are once again drawing attention. Not that they had ever really disappeared because the remnants of the War on Poverty — Community Health Centers and Head Start Programs – still have community-majority boards. But now, the community had been discovered by academia, and even some of the nation’s most elite universities were undertaking something called “Community-Based Participatory Research.” In this approach to research, the community is to be involved from the beginning to the end of the research project. What better way to promote “community involvement” or “community engagement” than a community advisory board?
When a group of us at Morehouse School of Medicine started a research center dedicated to community-based participatory research, my first instinct was to emulate the Lee County Cooperative Clinic model: an all-community board of directors that would govern the center and deliver Power to the People! But cooler heads convinced me that times had changed. Newer models were about partnership: the university as the community’s partner, not its adversary. So the board of the Morehouse Prevention Research Center was organized as the Community Coalition Board – a coalition of neighborhood people, agency representatives, and academics, with neighborhood people always in the majority. The board is considered a policy-making board rather than an advisory board, but it’s not really a board of directors. Legally, the medical school’s Board of Trustees has that authority.
However, the goal of empowering people who have had little or no power in the past persists, and the model does too. Neighborhood people who have gained some measure of control over a research center can go on to act on the social determinants of health, such as education, environment, and housing.
Since the Center is now about 12 years old, enough time has passed so that some measure of evaluation is in order. In fact, the neighborhoods served by the center have improved in many ways: decrepit housing has come down and has been replaced by better housing. Industrial pollution has been cleaned up. Drug-dealing, prostitution, and other undesirable activities have been reduced. Members of the Community Coalition Board have been involved in addressing these ills and persuading government authorities to act.
Would these improvements have taken place had the Prevention Research Center never come into being? It is impossible to say. But I doubt that the improvements would have taken place without the neighborhood activism that is represented on the Community Coalition Board. Power to the people is not dead. And community-based participatory research is helping it along.
Dr. Blumenthal is the co-editor of the second edition of Community-Based Participatory Health Research, Second Edition. This text discusses the unique challenges of conducting CBPR and addresses ways to build and sustain community partnerships. It explores ethical issues regarding health care research, includes input from community stakeholders, and describes national and international support for CBPR. Research methods covered include qualitative studies, surveys, and intervention trials. Applications of CBPR illustrate how to translate research into practice and community-based participatory approaches to service, education, and evaluation.