The impact of implementing selected CBPR strategies to address disparities in urban Atlanta: a retrospective case study.

In 2005, the Institute of Public Health at Georgia State University (GSU) received a 3-year community-based participatory research (CBPR) grant from the National Center for Minority Health and Health Disparities entitled Accountable Communities: Healthy Together (ACHT). Because urban health disparities result from complex interactions among social, economic and environmental factors, ACHT used specific CBPR strategies to engage residents, and promote the participation of community organizations serving, a low-income community in urban Atlanta to: (i) identify priority health and social or environmental problems and (ii) undertake actions to mitigate those problems. Three years after funding ended, a retrospective case study, using semi-structured, taped interviews was carried out to determine what impacts, if any, specific CBPR strategies had on: (i) eliciting resident input into the identification of priority problems and (ii) prompting actions by community organizations to address those problems. Results suggest that the CBPR strategies used were associated with changes that were supported and sustained after grant funding ended. Insights were also gained on the longer term impacts of ACHT on community health workers. Implications for future CBPR efforts, for researchers and for funders, are discussed.

Understanding wicked problems: a key to advancing environmental health promotion.

Complex environmental health problems--like air and water pollution, hazardous waste sites, and lead poisoning--are in reality a constellation of linked problems embedded in the fabric of the communities in which they occur. These kinds of complex problems have been characterized by some as "wicked problems" wherein stakeholders may have conflicting interpretations of the problem and the science behind it, as well as different values, goals, and life experiences. Accordingly, policy makers, public health professionals, and other stakeholders who grapple with these problems cannot expect to effectively resolve them by relying solely on expert-driven approaches to problem solving. Rather, they need to acknowledge that wicked environmental health problems are most likely to yield to (1) the application of effective community health promotion skills, (2) a sustained commitment to sound toxicological and epidemiological science, (3) the application of systems thinking, and (4) transparent communication among all stakeholders.