Community organizations to promote environmental health
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The Community Organizing Network for Environmental Health (CONEH), a project of Community Action Against Asthma, used a community health development approach to improve children’s asthma-related health through increasing the community’s capacity to reduce physical and social environmental triggers for asthma. Three community organizers were hired to work with community groups and residents in neighborhoods in Detroit on the priority areas of air quality, housing, and citizen involvement in the environmental project and policy decision-making. As part of the evaluation of the CONEH project, 20 one-on-one semi-structured, in-depth interviews were conducted between August and November 2005 involving steering committee members, staff members, and key community organization staff and/or community members. Using data from the evaluation of the CONEH project, this article identifies the dimensions of community capacity that were enhanced as part of a CBPR community health development approach to reducing physical and social environmental triggers associated with childhood asthma and the factors that facilitated or inhibited the enhancement of community capacity.
Keywords: Community-based participatory research, Community health development, Community capacity, Asthma, Environmental health
An extensive body of research acknowledges that stressors in the social and physical environment are associated with poor health outcomes and that these conditions contribute to ethnic, racial, and socioeconomic health disparities (Marmot and Wilkinson 2006; Parker et al. 2004; Schulz and Northridge 2004). Community-based participatory research (CBPR) has received growing recognition as a viable community health development approach for examining and addressing these health disparities (Israel et al. 2005, 1998; Minkler and Wallerstein 2008). CBPR is a collaborative approach to research that equitably involves community members, practitioners, and academic researchers in all aspects of the research process. By enabling all partners to provide their expertise and share responsibility and ownership, CBPR strives to enhance knowledge and integrate the knowledge gained with interventions and policies to improve health in the communities involved (Israel et al. 1998).
One of the strengths of a CBPR approach is its emphasis on building community capacity, which is a strategy that has shown promise for addressing the complex set of factors that contribute to overall community health (Freudenberg 2004; Minkler et al. 2008). The use of a CBPR approach is appropriate for enhancing community capacity given its emphasis on community identification of problems, engaging community members in participatory decision making, translating research into action, and mobilizing community members and organizations to advocate for change (Freudenberg 2004; Israel et al. 2008; Minkler et al. 2008). A number of CBPR partnerships are concerned with environmental public health and have recognized the crucial role of community capacity to address environmental exposures and health risks (Freudenberg 2004; Israel et al. 2005; Minkler et al. 2008; Minkler and Wallerstein 2008).
Freudenberg (2004) demonstrated how the conceptualization of community capacity by Goodman et al. (1998) can have utility as a framework to examine factors that contribute to a community’s ability to protect itself against environmental exposures harmful to human health. Community capacity is placed within a logic model in which determinants of community conditions (e.g., enduring political and economic systems, political dynamics, cultural and ideological beliefs) impact on both the dimensions of community capacity (e.g., participation, social support) and community characteristics (e.g., physical environment, social environment). These, in turn, influence behavioral manifestations of community capacity (e.g., leaders act to mobilize community members, residents participate in environmental action). Behavioral manifestations can then lead to increased citizen action to address environmental problems, resulting in improved environmental and health outcomes. Building off of Goodman’s and Freudenberg’s works, Minkler et al. (2008) used these conceptualizations of community capacity to develop a model to assess, in CBPR projects, what dimensions of community and partnership capacity affect health-promoting change in environmental health.
Given the contribution of physical and social environmental factors to health disparities and the potential role that CBPR efforts can play in community capacity enhancement, there is a need to understand better what dimensions of community capacity may be developed through CBPR efforts and what factors contribute to the development of these capacities. Such an improved understanding will contribute to the development of strategies aimed at enhancing a