Submitted by: Andrew Foell
Differential access to social, economic, and environmental supports puts community members at greater risk for numerous adverse outcomes.
A lack of access leads to disparities in health and well‐being.
CBPR is a promising approach to address the social determinants of health.
Social determinants of health – including economic instability, housing insecurity, insufficient neighborhood resources, and inadequate access to high quality educational opportunities – disproportionately affect African American communities in U.S. cities. These social determinants influence a variety of health outcomes leading to widespread health disparities, or systematic differences in health outcomes across social groups. In many places these disparities are quite stark. For instance, in some U.S. cities average life expectancies may differ by as many as 30 years between neighborhoods that are just miles apart. While these realities are tragic, the good news is that they are preventable.
The 2014 release of the For the Sake of All report highlighted persistent health disparities for African Americans in St. Louis, Missouri, and their social and economic impacts on the St. Louis region. This study extended this work by developing partnerships with community organizations and neighborhood residents to address health disparities. Community members selected 14 vacant lots to implement their action plan, which included visions for repurposing the land into a community park, produced a report for dissemination, and organized a community action forum to communicate their findings.
“Individual effort and medical care are necessary but not sufficient to eliminate persistent disparities in health. Communities armed with knowledge of the contextual factors that contribute to disparate health outcomes are better equipped to respond.”
We utilized Community-Based Participatory Research (CBPR) methods to engage community partners and neighborhood residents. CBPR is an approach to research that prioritizes equitable involvement of community members, organizational representatives, and other project partners in the research and social action process. Seven community members, neighborhood researchers, engaged in a 10-month research and community engagement process that included neighborhood observations, community member interviews, participant photography, action planning, and reporting findings and recommendations to the community.
How Did A Community Psychology Perspective Inform Your Work?
We drew from empowerment theories and socioecological models of health to inform our work. Socioecological models of health behavior focus on the importance of social and environmental contexts that support and undermine health and recognize that individual health problems are largely driven by systems, institutions, and environmental factors. Meanwhile, empowerment theories suggest that health disparities arise from limited power to exert control over these factors. We utilize these perspectives to shift understanding of health disparities as arising solely from individual decisions and behaviors or as the result of medical care alone to examine the role of social and structural conditions that promote or constrain health behaviors and health outcomes in a specific local community.
- Social, environmental, and economic community conditions are major concerns for residents living in low-income urban neighborhoods due to their influence on health and well-being.
- CBPR is a promising approach to address the social determinants of health by merging academic and community expertise, and integrating education with social action to enhance community interventions.
- The co-learning process resulted in a plan for a community park and included general policy recommendations as well as context-specific action strategies to address local health disparities.
- Neighborhood researchers gained knowledge of tools and methods to gather information to support their goals and built capacity to respond to health concerns using data-driven, evidence-based strategies.
What Does This Mean For?
Research and Evaluation: Community members hold immense knowledge and expertise about their lived experiences, a form of knowledge that is often diminished or ignored in research and evaluation studies. Yet, this expertise is invaluable to understanding and addressing health disparities. When implemented with genuine care and compassion, community-engaged research has the potential to empower communities and inform concrete strategies for change.
Practice: Participatory processes that combine local knowledge with professional expertise and techniques can improve decision-making in the design and implementation of community programs, policies, and interventions.
Social Action: The goal across many community-engaged approaches to research, including CBPR, is to leverage the research process toward social action. Our work suggests that CBPR is an effective approach to identify social determinants of health in local communities and develop strategies to address them through social action.
Similar Settings: Community-engaged research approaches have been utilized across a diverse range of communities to address social, economic, and health-related concerns. Our study adds to the promising potential of CBPR as an effective strategy for change in low-income urban neighborhoods.
Original Citation: Foell, A., Purnell, J. Q., Barth, R., Witthaus, M., Murphy-Watson, T., Martinez, S., & Foley, M. (2020). Resident-led Neighborhood Development to Support Health: Identifying Strategies using CBPR, American Journal of Community Psychology, DOI: 10.1002/ajcp.12441
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To learn more about the CBPR effort described here, please watch this short video: