Partners in health disparities: Engaging communities with respect

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Despite technological enhancements in the U.S., serious health and healthcare inequities and excessive disease burdens for minorities including cancer and diabetes persist. For example, in the past 20 years, Blacks in San Bernardino County California have death rates much younger than their White counterparts and cancer death rates for breast and prostate cancer are among the highest in the Nation. Of approximately 1,600 people who die of diabetes or related complications in San Bernardino County every year, close to 25% are Latino, the highest ratio for any ethnic group. Awareness of this magnitude of variance in health outcomes among racial, ethnic, and cultural groups has increased. However, effective policies addressing health disparities remain elusive. Health planners have augmented their appreciation for active community participation in the identification of problems and in the definition, design, and implementation of integrated solutions. The Community Action Model (CAM) challenges traditional paradigms that concentrate on deficits and instead builds on asset-focused methods to empower and mobilize community members to address factors that perpetuate inequalities. Clearly, we must establish successful partnerships in the development of strategies to eliminate health disparities. It is in this context that we aim to collaborate with communities to translate and disseminate findings utilizing approaches and processes that respectfully seek to establish such partnerships.
 The presentation describes two separate community health planning processes, one with the Latino and the other with the African American community of San Bernardino County, CA. Both groups use a similar philosophy of engagement to address health disparities in the nation's largest county, where little research has been conducted to identify the reasons behind differences in health status between two minority communities and the White population.
 The African American Health Institute conducted a 3-year, countywide, community-based participatory research project. Data revealed that the mechanisms responsible for disparate death rates are complex. Qualitative and quantitative research found a consensus opinion that a variety of social as well as personal factors are associated with differential health and healthcare access and outcomes and an openness to engage with partners on research. Similarly, the Latino Health Collaborative organized a health planning effort to better understand health disparities for Latinos in the County. Steps include organizing and skill-based training Community Action Teams (CAT), followed by action research in which the CAT defines and conducts a community diagnosis and an analysis of the findings. Subsequent actions involve policy development and implementation of county-wide community-specific health empowerment initiatives.
 In both processes formative evaluation principles are integral to each phase in order to promote community capacity building and to ensure implementation of effective interventions and policies. After describing these unique community-driven partnerships, we will discuss how such efforts are important to the conduct and execution of health disparities related cancer research.