Editorial: Every Effect Has Its Cause

Abstract

It is with great pleasure that we launch the journal Progress in Community Health Partnerships: Research, Education, and Action (PCHP) as part of a new and hopefully expanding effort to improve the health of our communities. The Johns Hopkins University Urban Health Institute, the home of this new journal, was established six years ago with just this charge from Johns Hopkins leader­ ship. By providing a grant to the Institute to fund this new journal, the W. K. Kellogg Foundation recognized the importance of community­based participatory research (CBPR) and its great potential benefit to community health. There is much to do to achieve the goal of true CBPR, and we believe PCHP will be a significant step forward. In examining how research and program implementa­ tion in community health have been carried out, we almost always find that academic centers and communities find themselves at either one end or the other of a spectrum. On the one end is research with little or no community involvement; on the other are health projects or inter­ ventions in communities, divorced from academic insti­ tutions or with such late or peripheral involvement that they add little or nothing to our evidence­based knowledge. In addition, government agencies often are not involved despite the expertise and resources they could offer. The landscape of my own career has been littered with admirable commu­ nity healthcare projects involving numerous nongovern­ mental organizations and community groups usually with the afterthought that we should have worked with our local academic or government partner. This failure to collaborate dooms us to “continue asking the same question and wonder why we are getting the same answer.” As we go forward, it is our hope that PCHP will act as a bridge for us to better understand and work with one another. Effective community–academic partnerships are possible and productive, as many have already demon­ strated. Unfortunately, they are often not initiated due to “academic conceit,” which still exists in more quarters than most of us in these settings would care to admit. Conversely, communities are often unwilling to let go of their belief that they are “being used” and that “we are just part of another experiment.” We must learn to talk with each other and find new ways to work together or risk failure to improve the health of our communities. We must be frank and honest with ourselves and with each other and face the following questions with open minds and in a spirit of cooperation: What are the incentives for an academic institution to involve community in an early and continuous way in its business? Who is the community and how do we make sure we are engaging a broad enough constituency? Is an egalitarian relationship really possible? Can academic institutions make training new and existing faculty in CBPR principles a priority? How can academic institutions really be accountable to communities when they “hold so many of the cards”? What is the incentive for local groups to trust and be willing to allow themselves to be vulnerable in their academic relations? How can we mini­ mize the either perceived or actual devaluation of the community by the academics? How can we ensure that in the process of CBPR the community becomes less the community and more the academic? What is the most effective way to involve community in research without controlling the process through the intimidation of the “degree?” We must answer these and other questions, and expand the inventory of effective models of cooperation. As the editors of PCHP indicate in their “Vision for Progress in Editorial