The Utility of Large Coalitions for Community Health Programs

Abstract

his commentary makes the argument and advocates for large-scale community engagement coalitions to address community health issues. Taking this position, one must consider the goal of enhanced citizen participation, ideal size, and member- ship make-up of community coalition partnerships for addressing health conditions at the county level. For many years, community organizers and coalition conveners have pondered the question of the appropriate mix of individuals and organizations for inclusion in coalition membership and the size of coalition partnerships to be efficient and effective. 1 This commentary takes the position that large and representative coalition partnerships facilitate community-wide health interventions and support services for families within a county. In this context, large is defined as 40 or more participating organizations and or individuals. While 40 is not a magic number or a silver bullet, the magnitude of 40 gives the latitude for a broad base of inclusion. Both macro agencies, community-based organizations, and local citizens should be included and have a pivotal role in governance and decision-making for improving the quality-of-life among the citizenry. In this context, improved quality-of-life can be measured by lifestyle changes (e.g., dietary habits, routine exercise, knowing the importance of drinking water and hydration, behavior modification related to smoking, alcohol consumption, use of illicit drugs, and engagement of pre-natal health education for pregnant mothers). Some of the key tenets central to building and sustaining a successful coalition include appropriate and comprehensive orientation of new members, clarity of coalition mission, advocacy for a shared leadership approach, ongoing training and technical assistance for coalition members, transparency of coalition resources, processes for conflict management and resolution, credible leadership and use of memoranda of understanding. The ideal size and membership mix of community coalition partnerships for health promotion continues to be discussed among public health practitioners. 1,2 Some coali- tions are as small as 10 members while others may have 40 or more. Some coalitions are dominated by health providers where professionals make major decisions about programs and then politely inform community members about the nature, scope, and implementation plans. Other coalitions include a mix of health practitioners and consumers, while consumers are the majority and have the controlling vote in event that a decision is based on membership category. Consumer-dominated coali- tion partnerships represent a more genuine engagement and acknowledgement that