Culture Bound: The Intersection of CBPR, Health Disparities, and Child and Adolescent Mental Health

Forlorn, by Crystal Hubbard

A dear Georgetown professor took me under her wing and gave me an opportunity to write a short column about Community-Based Participatory Action Research (child and adolescent mental health) for the Journal of Child and Adolescent Psychiatric Nursing (JCAPN).

Three months after writing it, I might now approach the column’s argument’s differently. I’d adopt a “health equity” framework, and explore in greater depth the boundaries and limitations of  CBPR in the interest of social justice. Oh well.

I’m still proud to present it here.

Culture Bound: The Intersection of Community-Based Participatory Action Research, Health Disparities, and Child and Adolescent Mental Health

For more than a decade, communities and their academic partners have used community-based participatory action research (CBPR) to build knowledge and support social justice. CBPR has been referred to as a transformative approach to both qualitative and quantitative research that emphasizes co-learning (through which community and academic partners exchange knowledge and expertise), capacity building (in which partners commit to training community members in research processes and other skills), mutual benefit (through which knowledge produced by the research process benefits all partners), and a long-term commitment to eliminating health disparities. By exposing and addressing systemic factors influencing health behavior and tackling issues of concern to stakeholders in the community, CBPR is well suited for bridging gaps in health disparities research and addressing questions of interest to readers of the Journal of Child and Adolescent Psychiatric Nursing.

JCAPN Volume 23, Number 1, February, 2010 41

Mikhaila Richards, MS
(Formerly) Research Assistant
Georgetown University
O’Neill Institute for National and Global Health Law

Edilma L. Yearwood, PhD, PMHCNS, BC, FAAN
Associate Professor
Georgetown University
School of Nursing & Health Studies

New Developments

"Mr. Freire, say, how do you feel about the word, 'Skills'?"

So…how’s it going?

::silence::

<uncomfortable nod> Yeah…about my absence…</uncomfortable nod>

Making moves

Well, the least whiny and most appropriately public explanation for this blog’s stagnation is my transition to a new organization!

My new employer received funding from the National Center for Minority Health and Health Disparities at the National Institutes of Health to create a comprehensive, multi-media, Web-based educational resource that prepares public health practitioners to act on the root causes of inequity in the distribution disease and illness. This project, titled The Learning Collaborative for Health Equity and Social Justice, will function as a learning community for the current and future public health workforce. The  critical pedagogical strategy of Paulo Freire informs the program and will support the organizational and staff development of local health departments focusing on the root causes of health inequities.

It’s a huge project with conceptual challenges and opportunities that are as daunting as they are exciting.

An obvious issue is reconciling Freirian Pedagogy with use of the Intertubes–an apparently difficult task.[1] One explanation for the difficulty is that Freire is critical of the “banking” model of education,” which frames the student as “an empty account to be filled by the teacher.” Instead of prescribing information, students are encouraged–through a process of collective problem-posing and question-asking–to embark on an “educational journey.” The problem-posing and question-asking occur during a cycle of listening, dialogue, action, and reflection. Our aim is to reorient public health department towards social justice through a process of personal and organizational discovery. These aims and processes present challenges for sharing content online and necessarily pose challenges to interactive website curriculum design and development. The assumption is that the Internet best facilitates”bankable” knowledge, that websites are unable to cultivate a sense of “Place,” etc.

We’ll see!

[1] I say, “apparently” because I’m not yet convinced that, as I type, a sociology/technology/education/culture studies doctoral student somewhere isn’t piecing together an ambitious, but not altogether implausible, proposal to do just that.

Additional Resources

The Freire Project:

The Freire Project is dedicated to building an international critical community which works to promote social justice in a variety of cultural contexts. We are committed to conducting and sharing critical research in social, political, and educational locations.

The project promotes research in Critical Pedagogy, and brings together local and international educators. We are committed to continuing the global development of Critical Pedagogy and to highlighting its relevance with marginalized and indigenous peoples.

Tackling Health Inequities Through Public Health Practice: A Handbook for Action:

Health practitioners in local health departments face many dilemmas and struggles in seeking to protect and improve the public’s health. As the front line of the public health response in local communities, they often must cope with immediate crises and chronic issues with limited resources, restrictive statutory mandates, categorical funding, and political pressures from state and local officials. Addressing the root causes of inequities in the distribution of disease and illness might seem like a luxury. But it is not.

It’s All “Health Policy”

Teamwork!

“Housing policy is health policy. Educational policy is health policy. Antiviolence policy is health policy. Neighborhood improvement policies are health policies,” says David Williams in Unnatural Causes.

Last week my professional life converged on “health equity”—a more empowering and assertive approach to understanding the differences in health status we see across social groups. It’s a necessary response to those who would throw up their hands and overemphasize biology and behavior as major explanatory factors.

“People tended to attribute health differences to behaviors, genes or nature and inevitability: “That’s just the way things are.” True, some outcomes are random or result from accidents of nature or individual pathology.

But health equity concerns those differences in population health that can be traced to unequal economic and social conditions and are systemic and avoidable – and thus inherently unjust and unfair.” What is Health Equity? (Excerpted from “Unnatural Causes” toolkit).

At its core, the health equity frame recognizes complex and simple links between many social ills. This alternate framing moves discussions of the social determinants of health towards actionable, creative, and innovative strategies for change. We can hack away at the inherently unjust and unfair by forging connections across disciplines and interests, while putting historically disenfranchised communities in the driver’s seat. We need community members and experts in labor, education, housing, transportation, urban planning, social policy, and public health to form teams seldom seen outside of the DC Universe.

Keeping it local and focused, organizations, communities, and academic disciplines have successfully bridged differences in language, theory, and perspective that encourage silos and alienate communities. The programs below are just a few examples of how our understanding of health disparities has informed our understanding of how to achieve health equity.

The South Bronx Greenway: Public Health, Urban Planning, and Environmental Justice

Released in November 2006, the South Bronx Greenway is one of the primary goals of a comprehensive planning process for the South Bronx that began with the Hunts Point Vision Plan, issued in March 2005.

The proposed Greenway will vastly improve access to the waterfront, provide much-needed recreational opportunities, improve transportation safety, and enhance the network of bike and pedestrian paths on the South Bronx peninsula while providing opportunities for compatible economic development. More info. Even more info.

Building Green to Combat Asthma: Public Health and Housing

One of the Sonoma County Asthma Coalition’s first big wins came in 2005 with the passage of a County Board of Supervisors Resolution highlighting the links between indoor air quality and asthma and calling upon the Department of Health to educate both property owners and tenants on improving poor indoor air quality. Building off this momentum, the coalition successfully advocated with Burbank Housing Development Corporation, the largest low-income housing developer in the county, to implement three new green building practices — improved ventilation systems in units, use of no- or low-volatile organic compound indoor paints, and landscaping with low-allergen plants. Burbank Housing continues these healthier practices in all new developments. More info.

Citywide Colon Cancer Coalition: Public Health, Hospital administration, Community Members, and Foundations

According to a presentation by the Department of Health and Mental Hygiene, NY, New York City was successful in eliminating disparities on colorectal cancer screening through community interventions such as direct colonoscopy referral systems, a system which ensures that the primary care provider follows up a colonoscopy referral directly with a colonoscopy center. The Department of Health and Mental Hygiene also established a task force and a clear policy goal to increase numbers of people getting screened, and eliminate disparities. Recent numbers in New York City show screening rates up by 66 percent, indicating the progress of this intervention. Outside organizations also deserve credit for this progress, including the American Cancer Society which covered 2,000 colonoscopies through this program. More info.

Additional information:

UnnaturalCauses.org. What is Health Equity?

Whitehead M. The concepts and principles of equity in health. Int J Health Serv 1992;22:429–445. (first published with the same title from: Copenhagen: World Health Organisation Regional Office for Europe, 1990 (EUR/ICP/RPD 414).)

CDC. Promoting Equity in Health: A Resource to Help Communities Address the Social Determinants of Health.