communities at any one time When initiating community engagement efforts one must be. aware of these complex associations in deciding which individuals to work with in the targeted. From a sociological perspective the notion of community refers to a group of people united by. at least one common characteristic Such characteristics could include geography shared. interests values experiences or traditions John McKnight a sociologist once said that if one. were to go to a sociology department in search of a single simple definition of the word. community one would never leave To some people it s a feeling to some people it s. relationships to some people it s a place to some people it s an institution CBC 1994. Communities may be viewed as systems composed of individual members and sectors that. have a variety of distinct characteristics and interrelationships Thompson et al 1990 These. sectors are populated by groups of individuals who represent specialized functions activities or. interests within a community system Each sector operates within specific boundaries to meet. the needs of its members and those the sector is designed to benefit For example schools. focus on student education the transportation sector focuses on moving people and products. economic entities focus on enterprise and employment faith organizations focus on the spiritual. and physical well being of people and health care agencies focus on prevention and treatment. of diseases and injuries In reality these sectors are a few of the many elements that comprise. the overall community system, A community can be viewed as a living organism or well oiled machine For the community to. be successful each sector has its role and failure to perform that role in relationship to the. whole organism or machine will diminish success In a systems view healthy communities are. those that have well integrated interdependent sectors that share responsibility to resolve. problems and enhance the well being of the community It is increasingly recognized that to. successfully address a community s complex problems and quality of life issues it is necessary. to promote better integration collaboration and coordination of resources from these multiple. community sectors, One useful way to describe the community and its sectors is through a technique known as. mapping Kretzmann et al 1993 As shown in the following diagram someone interested in. describing the bounds of a community can map it by identifying primary secondary and. potential building blocks or human and material resources Each of these resources has assets. that can be identified mobilized and used to address issues of concern and bring about. Again from the systems perspective another way to understand and describe a community. might involve exploring factors related to, People socioeconomics and demographics health status and risk profiles cultural and ethnic. characteristics,Location geographic boundaries, Connectors shared values interests motivating forces. Power relationships communication patterns formal and informal lines of authority and. influence stake holder relationships resource flows. Adapted from VHA 1993, Similarly we can define the community from a broader sociological perspective by describing. the social and political networks that link individuals and community organizations and leaders. Understanding the nature and boundaries of these networks is critical to planning engagement. efforts For example tracing individuals social ties may help those who are initiating a. community engagement effort to identify leaders within a community understand community. patterns identify high risk groups within the community and strengthen networks within the. community Minkler 1997, Beyond the collective definitions of community that researchers and organizers can apply an. individual also has her or his own sense of community membership The presence or absence. of a sense of membership in a community may vary over time and is likely to influence. participation in community activities This variation is affected by a number of factors For. example persons at one time may feel an emotional cultural or experiential tie to one. community at another time they might believe they have a contribution to make within a. different group At yet another time they may see membership in a third distinct community as a. way to meet their own individual needs Chavis et al 1990 Of course they may also have this. sense of belonging to more than one community at the same time Before beginning an. engagement effort it is important to understand that all these potential variations and. perspectives may exist and influence the work within a given community. Concepts of Community Engagement, The CDC ATSDR Committee for Community Engagement developed a working definition of. community engagement Loosely defined community engagement is the process of working. collaboratively with and through groups of people affiliated by geographic proximity special. interest or similar situations to address issues affecting the well being of those people It is a. powerful vehicle for bringing about environmental and behavioral changes that will improve the. health of the community and its members It often involves partnerships and coalitions that help. mobilize resources and influence systems change relationships among partners and serve as. catalysts for changing policies programs and practices Fawcett et al 1995. In practice community engagement is a blend of social science and art The science comes. from sociology political science cultural anthropology organizational development psychology. social work and other disciplines with organizing concepts drawn from the literature on. community participation community mobilization constituency building community psychology. cultural influences and other sources Several of these concepts from the social science. literature are presented here The equally important artistic element necessary to the process. however involves using understanding skill and sensitivity to apply and adapt the science in. ways that fit the community and purposes of specific engagement efforts. Insights from the Literature, Studies of participation in voluntary and community organizations have allowed social scientists. and other researchers to develop organizing concepts about communities and the ways in. which they are mobilized Florin et al 1990 Fawcett et al 1995 Hanson 1988 89 Thompson. et al 1990 Findings in the literature have helped to shed light on why community engagement. is useful and how we can engage people to most effectively address public health issues What. follows are brief descriptions of some of the organizing concepts found in the literature that. guide approaches to successful community engagement Additional resources on these and. other concepts not included here may be found in the Bibligraphy. Social Ecology, Social ecological theories provide insight into elements of individuals lives that contribute to. health promotion Such theories seek to describe the concept of community in terms of a. dynamic interplay among individuals groups and their social and physical environments. Stokols 1996 p 286 Researchers in this area help to integrate approaches to disease. prevention and health promotion which focus on modifying individual health behaviors with. environmental approaches which focus on the physical and social environment From the. social ecology perspective the potential to change individual risk behavior is considered within. the social and cultural context in which it occurs Interventions that are informed by this. perspective are directed largely at social factors such as community norms and the structure of. community services including their comprehensiveness coordination and linkages in addition. to individual motivations and attitudes Goodman et al 1996 p 34. Social ecology theory as it informs health promotion suggests that community engagement. efforts need to be focused at multiple levels 1 individuals 2 social network and support. systems 3 the range of organizations that serve and influence individuals and the rules and. regulations that these organizations apply 4 the community including relationships among. organizations institutions and informal networks and 5 public policy regulations ordinances. and laws at the state and national levels Goodman et al 1996 p 35. Several core concepts summarize the contributions of social ecology theories to community. engagement efforts Stokols 1996 p 285 286, Health status emotional well being and social cohesion are influenced by the physical social. and cultural dimensions of the individual s or community s environment and personal attributes. e g behavior patterns psychological dispositions genetics. The same environment may have different effects on an individual s health depending on a. variety of factors including perceptions of ability to control the environment and financial. Individuals and groups operate in multiple environments e g workplace neighborhood larger. geographic communities that spill over and influence each other. There are personal and environmental leverage points that exert vital influences on health. and well being,Cultural Influences, The literature on cultural influences suggests that health behaviors are influenced directly by. elements of one s culture As a result social norms and other elements of community culture. provide a potential tool for disease prevention and health promotion Culture involves the. integrated pattern of human knowledge belief behavior and material traits characteristic of a. social group Braithwaite et al 1994 p 409 Another way to understand this concept is to. think of culture as the luggage we always carry with us the sum of beliefs practices. habits likes dislikes norms customs rituals that we have learned from our families. Spector 1985 p 60 Cultural identity influences the group s design for living the shared set. of socially transmitted perceptions about the nature of the physical social and spiritual world. particularly as it relates to achieving life s goals Airhihenbuwa 1995 p 5 Therefore those. who wish to work with community members should carefully examine the differences and. similarities in cultural perceptions so that engagement activities are appropriate for that. particular cultural context This appropriateness often referred to as cultural sensitivity means. that programs are developed in ways that are consistent with a people s and community s. cultural framework Airhihenbuwa 1995 p 7, An individual s culture influences his or her attitude toward various health issues including. perceptions of what is and is not a health problem methods of disease prevention treatments. for illness and use of health providers As Spector 1985 p 59 notes We learn from our own. cultural and ethnic backgrounds how to be healthy how to recognize illness and how to be ill. meanings attached to the notions of health and illness are related to basic culture bound. values by which we define a given experience and perceptions Individuals initiating community. engagement activities should understand belief systems held by community members. especially if they are different from their own Cultural experiences also can influence how. individuals and groups relate to each other and to people and institutions of other cultures. Efforts to address these elements of a community could concentrate on affecting the landscape. of information and ideas in which that community operates. Community Participation, Concepts concerning community participation offer one set of explanations as to why the. process of community engagement might be useful in addressing the physical interpersonal. and cultural aspects of individuals environments The real value of participation stems from the. finding that mobilizing the entire community rather than engaging people on an individualized. basis or not engaging them at all leads to more effective results Braithwaite et al 1994. Simply stated change is more likely to be successful and permanent when the people it. affects are involved in initiating and promoting it Thompson et al 1990 p 46 In other words. a crucial element of community engagement is participation by the individuals community. based organizations and institutions that will be affected by the effort. This participation is a major method for improving the quality of the physical environment. enhancing services preventing crime and improving social conditions Chavis et al 1990. p 56 There is evidence that participation can lead to improvements in neighborhood and. community and stronger interpersonal relationships and social fabric Florin et al 1990 Robert. Putnam notes that social scientists have recently unearthed a wide range of empirical. evidence that the quality of public life and the performance of social institutions are powerfully. influenced by norms and networks of civic engagement Moreover researchers in education. urban poverty and even health have discovered that successful outcomes are more likely in. civically engaged communities Putnam 1995 p 66 For example Steckler s CODAPT model. for Community Ownership through Diagnosis Participatory Planning Evaluation and Training. for Institutionalization suggests that when community participation is strong throughout a. program s development and implementation long term program viability i e institutionalization. is more likely assured Goodman et al 1987 88, The community participation literature suggests that. People who interact socially with neighbors are more likely to know about and join voluntary. organizations, A sense of community may increase an individual s feeling of control over the environment. and increases participation in the community and voluntary organizations. Perceptions of problems in the environment can motivate individuals and organizations to act. to improve the community Chavis et al 1990, When people share a strong sense of community they are motivated and empowered to. change problems they face and are better able to mediate the negative effects over things. which they have no control Chavis et al 1990 p 73 write Moreover a sense of community. is the glue that can hold together a community development effort Chavis et al 1990 p 73. 74 This concept suggests that programs that foster membership increase influence meet. needs and develop a shared emotional connection among community members Chavis et al. 1990 p 73 can serve as catalysts for change and for engaging individuals and the community. in health decision making and action,Community Empowerment. The literature suggests that a critical element of community engagement relates to. empowerment mobilizing and organizing individuals grass roots and community based. organizations and institutions and enabling them to take action influence and make decisions. on critical issues It is important to note however that no external entity should assume that it. can bestow on a community the power to act in its own self interest Rather those working to. engage the community can provide important tools and resources so that community members. can act to gain mastery over their lives, Empowerment takes place at three levels the 1 individual 2 organizational or group and 3. community levels Rich et al 1995 Fawcett et al 1995 Empowerment at one level can. influence empowerment at the other levels Fawcett et al 1995 At the individual level it is. generally referred to as psychological empowerment McMillan et al 1995 Rich et al 1995. Individual level empowerment can be described along three dimensions 1 intra personal an. individual s perceived personal capacity to influence social and political systems 2. interactional knowledge and skills to master the systems and 3 behavioral actions that. influence the systems Rich et al 1995 This concept of psychological empowerment has been. found to relate to an individual s participation in organizations the benefits of participation. organizational climate and the sense of community or perceived severity of problem. At the group or organizational level the literature distinguishes between 1 empowering. organizations which facilitate confidence and competencies of individuals and 2. empowered organizations which influence their environment Rich et al 1995 The degree to. which an organization is empowering for its members may be dependent upon the benefits. members receive and organizational climate as well as the levels of commitment and sense of. community among members McMillan et al 1995, Community level empowerment i e the capacity of communities to respond effectively to. collective problems occurs when both individuals and institutions have sufficient power to. achieve substantially satisfactory outcomes Rich et al 1995 Individuals and their. organizations gain power and influence by having information about problems and an open. process of accumulating and evaluating evidence and information Rich et al 1995 p 669. Empowerment involves the ability to reach decisions that solve problems or produce desired. outcomes requiring that citizens and formal institutions work together to reach decisions Rich. et al 1995,Capacity Building, Another set of organizing concepts that can help guide approaches to effective engagement. involves the process of capacity building In essence the literature on capacity building states. that before individuals and organizations can gain control and influence and become players. and partners in community health decision making and action they may need resources. knowledge and skills above and beyond those they already bring to a particular problem. Fawcett et al 1995 Participation in community engagement efforts can offer people the. possibility of developing these skills, The kind and intensity of capacity building that may be needed to sustain community. engagement efforts is not entirely known too often community leaders can be caught up in. selling the engagement effort without an accurate idea of the resources needed to actually. support it over the long term Florin et al 1993 For example people and organizations in the. community might need technical assistance and training related to developing an organization. securing resources organizing constituencies to work for change participating in partnerships. and coalitions conflict resolution and other technical knowledge necessary to address issues of. concern to the community,Coalitions, Engaging the community will very often involve building coalitions of diverse organizations A. community coalition can be defined as a formal alliance of organizations groups and agencies. that have come together to work for a common goal Florin et al 1993 p 417 Coalitions are. usually characterized as formal multi purpose and long term alliances that fulfill planning. coordinating and advocacy functions for their communities Butterfoss et al 1993 p 316. 318 They can be helpful in a number of ways including maximizing the influence of individuals. and organizations exploiting new resources and reducing duplication of effort While the. literature reveals that coalitions have not been systematically studied and contains little data to. support their effectiveness funding sources have been giving serious commitment to. developing coalitions as an intervention to address health issues Butterfoss et al 1993. The concept of coalition has its roots in political science In parliamentary democracies for. example a coalition government is formed by two or more parties when no single party has a. sufficient mandate to represent the majority In addition in almost all kinds of governments. informal coalitions exist among factions that share general or specific policy or legislative. objectives The types of coalitions that might be necessary for engagement efforts can be. viewed the same way The experience of political theorists suggests that. Coalitions require a perception of interdependence each party must believe it needs help to. reach its goals, There must be sufficient common ground and a clearly articulated mission or purpose so the. parties can agree over time on a set of policies and strategies. At the same time coalition members typically have primary goals and perspectives that are. distinct if not conflicting they agree on some issues but disagree on others. Coalitions require continuous and often delicate negotiation among participants. The distribution of power and benefits among coalition members is a major focus of ongoing. concern each member needs to believe that over time he or she is receiving benefits that are. comparable to their contributions see discussion on Benefits and Costs below AED 1993. Benefits and Costs, A critical set of organizing concepts involves analysis of the benefits and costs of community. engagement The literature suggests that participants will invest their energy in an organization. only if the expected benefits outweigh the costs that are entailed Butterfoss et al 1993 p. 322 It appears that an individual s desire to join and continue a commitment to an engagement. effort depends more on this benefit cost ratio than on his or her demographic characteristics. Wandersman et al 1987 Potential benefits include networking opportunities access to. information and resources personal recognition skill enhancement and a sense of contribution. and helpfulness in solving community problems Costs can run the gamut from the contribution. of time required to lack of skills or resources needed for participation to basic burn out By. identifying the specific benefits and barriers to participation in the engagement effort community. leaders can put the appropriate incentives in place. The social exchange perspective investigates the benefits and costs of participation to help. explain who participates and why The literature has long discussed health related organizations. as being involved in an exchange system whereby they voluntarily share resources to meet. their respective goals or objectives Levine et al 1961 Similarly social exchange occurs. among community members organizations and others to overcome potential costs in an. engagement effort a social exchange takes place in organizations such that participants will. invest their energy into the organization only if they expect to receive some benefits. Wandersman et al 1987 p 538,Community Organization. The community organization literature provides insight on the kinds of engagement activities. that may prove useful This and related concepts offer a path to engagement through a process. by which community groups are helped to identify common problems or goals mobilize. resources and in other ways develop and implement strategies for reaching goals they have. set Minkler 1990 p 257 Organizing activities are a way of activating the community to. encourage or support social and behavioral change Bracht et al 1990 This approach to. bringing about change at the community level is based on principles of empowerment. community competence active participation and starting where the people are Minkler 1990. Labonte and Robertson support the particular importance of starting where the people are by. stating that if we fail to start with what is close to people s hearts by imposing our notions of. health concerns over theirs we risk several disabling effects Labonte et al 1996 p 441. These include being irrelevant to the community exacerbating the community s sense of. powerlessness further complicating individuals lives and possibly channeling local activism. away from broader challenges and into individual level changes. The community organization approach also reflects findings that individuals and communities. 1 must feel or see a need to change or learn and 2 are more likely to change attitudes and. practices when they are involved in group learning and decision making Minkler 1990 An. important element of community organizing is helping communities look at root causes of. problems while at the same time selecting issues that are winnable simple and specific can. unite members of the group involve them in achieving a solution and help build the community. or organization Minkler 1990, Community organizing can be an empowering process for individuals organizations and. communities At the individual level community organizing activities provide individuals with the. chance to feel an increased sense of control and self confidence and to improve their coping. capacities Minkler 1990 These have been shown to have physical health benefits Organizing. activities also strengthen the capacity of communities to respond effectively to collective. problems Individuals organizations and communities can be empowered by having. information about problems and an open process of accumulating and evaluating evidence and. information Rich et al 1995 p 669,Stages of Innovation. The concept of stages of innovation can be useful when dealing with the potential differences. that might exist within a community as it changes over time All individuals within a community. are not necessarily at the same stage of readiness to change behaviors This is an important. notion to understand before and during a community engagement effort Rogers offered one of. the earliest formulations of this idea with his 1962 work Diffusion of Innovations In this book he. states that all individuals do not adopt innovations at the same rate or with the same willingness. Stages of innovation in general can help implementors of engagement efforts to match. strategies to the readiness of a community to adopt them In applying these concepts to. community development for example desired outcomes are predicated upon the community. working through a number of phases including raising awareness of the severity of a health. problem transforming awareness into concern for the problem establishing a community wide. intervention initiative and developing the necessary infrastructure so that service provision. remains extensive and constant in reaching residents. General Conclusions about the,Power and Userfulness of Community Engagement. There is a consensus in the literature that engaging and supporting the empowerment of the. community for community health decision making and action is a critical element in health. promotion health protection and disease prevention The impact of programs that target. individual behavior change is often transient and diluted unless efforts are also undertaken to. bring about systematic change at multiple levels of society Braithwaite et al 1994. Scholars have described several trigger activities that might begin the community engagement. process Some of these trigger activities are tied to legislative or program mandates while. others involve special initiatives such as those of public health departments grant makers. health service providers or existing community groups and coalitions Once triggered the. community engagement process itself can take many forms It can range from cooperation. where relationships are informal and where there is not necessarily a commonly defined. structure to collaboration or partnerships where previously separated groups are brought. together with full commitment to a common mission Mattessich et al 1992. The organizational concepts from the literature discussed in this section of the document lead to. a number of general conclusions about what lies at the heart of successful community. engagement efforts These conclusions which follow here provide a useful segue to the. community engagement principles outlined in Part 2. Community engagement efforts should address multiple levels of the social environment. rather than only individual behaviors to bring about desired changes. Health behaviors are influenced by culture To ensure that engagement efforts are culturally. and linguistically appropriate they must be developed from a knowledge and respect for the. targeted community s culture, People participate when they feel a sense of community see their involvement and the issues. as relevant and worth their time and view the process and organizational climate of. participation as open and supportive of their right to have a voice in the process. While it cannot be externally imposed on a community a sense of empowerment the ability. to take action influence and make decisions on critical issues is crucial to successful. engagement efforts, Community mobilization and self determination frequently need nurturing Before individuals. and organizations can gain control and influence and become players and partners in. community health decision making and action they may need additional knowledge skills and. Coalitions when adequately supported can be useful vehicles for mobilizing and using. community assets for health decision making and action. Participation is influenced by whether community members believe that the benefits of. participation outweigh the costs Community leaders can use their understanding of perceived. costs to develop appropriate incentives for participation. The following table based on the social science literature and the above conclusions offers a. set of specific factors that can positively influence the success of community engagement. efforts Planners and organizers of these efforts may find it useful to keep the factors in mind as. they work through the engagement process and apply the principles detailed in Part 2. Factors Contributing to the Success of Community Engagement Efforts. Environmental, History of collaboration or cooperation in the community. Collaborating group and agencies in group seen as leader in community Favorable political. and social climate,Membership,Mutual respect understanding and trust. Appropriate cross section of members, Members see engagement in their self interest benefits of engagement as offsetting costs. Ability to compromise,Process Structure, Members feel ownership share stake in both process and outcome. Every level in each organization in collaborating groups participates in decision making. Flexibility of collaborating group,Clarity of roles and guidelines. Ability to sustain itself in midst of changing conditions. Communication, Open and frequent interaction information and discussion. Informal and formal channels of communications,Goals clear and realistic to all partners. Shared vision, Unique to the effort i e different at least in part from mission goals or approach of member. organizations,Sufficient funds,Skilled convener, Based on a review of the literature and excerpted from Mattessich and Monsey 1992. References, Academy for Educational Development AED Porter Novelli Johns Hopkins University. Coalitions and public health a program manager s guide to the issues Washington DC. Academy for Educational Development 1993 April Contract No 200 91 0906 Prepared for the. National AIDS Information and Education Program Centers for Disease Control and Prevention. Airhihenbuwa CO Health and culture beyond the western paradigm Thousand Oaks CA. Sage Publications 1995, Bracht N Kingsbury L Community organization principles in health promotion a five stage. model In Bracht N editor Health promotion at the community level Newbury Park CA Sage. Publications 1990, Braithwaite RL Bianchi C Taylor SE Ethnographic approach to community organization and. health empowerment Health Education Quarterly 1994 21 3 407 416. Butterfoss FD Goodman RM Wandersman A Community coalitions for prevention and health. promotion Health Education Research 1993 8 3 315 330. Canadian Broadcasting Corporation CBC Ideas community and its counterfeits transcript. Toronto Canada CBC RadioWorks 1994 January, Chavis DM Wandersman A Sense of community in the urban environment a catalyst for. participation and community development American Journal of Community Psychology. 1990 18 1 55 81, Fawcett SB Paine Andrews A Francisco VT Schultz JA Richter KP Lewis RK Williams EL. Harris KJ Berkley JY Fisher JL Lopez CM Using empowerment theory in collaborative. partnership for community health and development American Journal of Community. Psychology 1995 23 5 677 697, Fawcett SB Paine Andrews A Francisco VT Vliet M Promoting health through community. development In Glenwick DS Jason LA editors Promoting health and mental health in. children youth and families New York Springer Publishing Company 1993. Florin P Mitchell R Stevenson J Identifying training and technical assistance needs in. community coalitions a developmental approach Health Education Research 1993 8 3 417. Florin P Wandersman A An introduction to citizen participation voluntary organizations and. community development insights for empowerment through research American Journal of. Community Psychology 1990 18 1 41 55, Goodman RM Steckler AB The life and death of a health promotion program an. institutionalization case study International Quarterly of Community Health Education 1987. 1988 8 1 5 21, Goodman RM Wandersman A Chinman M Imm P Morrissey E An ecological assessment of. community based interventions for prevention and health promotion approaches to measuring. community coalitions American Journal of Community Psychology 1996 24 1 33 61. Hanson P Citizen involvement in community health promotion a role application of CDC s. PATCH model International Quarterly of Community Health Education 1988 89 9 3 177 186. Institute of Medicine The future of public health Washington DC National Academy Press. Institute of Medicine National Academy of Sciences Assessing the social and behavioral. science base for HIV AIDS prevention and intervention workshop summary and background. papers Washington DC National Academy Press 1995, Kretzmann JP McKnight JL Center for Urban Affairs and Policy Research Neighborhood. Innovations Network Northwestern University Building communities from the inside out a path. toward finding and mobilizing a community s assets Chicago IL ACTA Publications 1993. Labonte R Robertson A Delivering the goods showing our stuff the case for a constructivist. paradigm for health promotion research and practice Health Education Quarterly. 1996 23 4 431 447, Levine S White PE Exchange as a conceptual framework for the study of interorganizational. relationships Administrative Science Quarterly 1961 5 4 583 601. Mattessich PW Monsey BR Collaboration what makes it work a review of research literature. on factors influencing successful collaboration St Paul MN Amherst H Wilder Foundation. McKnight JL Kretzmann J Mapping community capacity Evanston IL Center for Urban. Affairs and Policy Research Northwestern University 1990. McMillan B Florin P Stevenson J Kerman B Mitchell RE Empowerment praxis in community. coalitions American Journal of Community Psychology 1995 23 5 699 728. Minkler M Improving health through community organization In Glanz K Lewis FM Rimer BK. editors Health behavior and health education theory research and practice San Francisco. Jossey Bass Publishers 1990, Putnam RD Bowling alone America s declining social capital Journal of Democracy. 1995 6 1 65 78, Rich RC Edlestein M Hallman WK Wandersman AH Citizen participation and empowerment. the case of local environmental hazards American Journal of Community Psychology. 1995 23 5 657 676, Rogers EM Diffusion of innovations New York Free Press 1962. Spector RE Cultural diversity in health and illness East Norwalk CT Appleton Century. Crofts 1985, Stokols D Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion 1996 10 4 282 298. Thompson B Kinne S Social change theory applications to community health In Bracht N. editor Health promotion at the community level Newbury Park CA Sage Publications 1990. Voluntary Hospitals of America Inc VHA Community partnerships taking charge of change. through partnership Irving TX Voluntary Hospitals of America Inc 1993. Wandersman A Florin P Friedmann R Meier R Who participates who does not and why an. analysis of voluntary neighborhood organizations in the United States and Israel Sociological. Forum 1987 2 3 534 555, World Health Organization WHO Health and Welfare Canada Canadian Public Health. Association Ottawa charter for health promotion an international conference on health. promotion Ottawa Ontario Canada November 17 21 1986. For further information on community collaboration visit the Public Health Practice Program. Office Internet site at www cdc gov phppo or contact Michael Hatcher at Mail Stop K39 4770. Buford Highway N E Atlanta GA 30341 3724 or email mth1 cdc gov.
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