When academic researchers and community partners work together, CBPR is an effective way to promote greater equity in healthcare access and alleviate health disparities. Community-based participatory research approaches are useful for addressing health disparities in communities that have been marginalized, oppressed, discriminated against, and stigmatized, or have otherwise experienced historical or contemporary injustices. Several chapters included in this volume highlight the important role of CBPR in addressing health disparities in diverse communities. As discussed by Coughlin et al. in chapter 1, pronounced health disparities exist in the United States and many other countries across population groups defined by race, ethnicity, sexual orientation, sexual identity, socioeconomic status, geographic locality, and other factors.53 Many immigrant populations also experience health disparities, a topic dealt with by Vaughn and Jacquez in chapter 8. Racial minorities in the United States are more likely than their White counterparts to die from many common diseases including breast cancer, cardiovascular disease, diabetes, HIV/AIDS, and infant mortality.53 Racial and ethnic minority populations are also more likely to be exposed to environmental toxicants, as discussed by Kim and Haynes in chapter 13. Despite the complexity and intractability of many public health problems (for example, interpersonal violence, substance abuse, and mental illness), evidence-based solutions do exist. Innovative CBPR studies, such as the one discussed by Akintobi et al. in chapter 9, are addressing multiple priority health concerns. The integrative approach employed by Akintobi et al. is examining mental and behavioral health practices in at-risk African American neighborhoods in Atlanta, Georgia, specifically as those practices relate to eating habits and access to nutritional foods; physical activity and environmental impact; and access to and use of primary care services for mental and behavioral health needs.
Continued efforts are needed to ensure that CBPR studies and evaluation projects are sustainable over time, and that adequate resources are available. To an increasing extent, major funding agencies such as the Centers for Disease Control, the National Institutes of Health (NIH), and the Patient-Centered Outcomes Research Institute require grant applicants to provide a plan for sustainability of the health intervention. Israel et al.32 suggested that the endpoint of action research should be the establishment of sustainability mechanisms for the project such as searching for additional sources of funding and training community partners on how to secure additional funding. As noted by Kitzman-Ulrich and Holt in chapter 6, the sustainability of evidence-based health promotion in faith- based organizations depends on the extent to which it is institutionalized into the routine operations of the organizations.
Health needs assessments and pilot studies that are completed to lay the ground work for larger-scale CBPR studies of important public health problems often do not achieve their longer-term goals due to a lack of funding or other resources. Several factors can contribute to this problem, including the highly competitive nature of funding from agencies such as the National Institutes of Health, conflicting institutional priorities, turnover in academic researchers, and the challenges that many CBPR researchers have in obtaining tenure or promotion after devoting years to studies that require patience and substantial time spent engaging community partners.
Progress in science includes the gradual accumulation of knowledge within disciplines (e.g., the acquisition of evidence from community-engaged studies about effective interventions for promoting healthy behaviors in diverse populations) and nonlinear progress resulting from scientific breakthroughs or new scientific methods, resources, or strategies.54 One example of this is the NIH Clinical and Translational Science Award program, which is increasing the efficiency and impact of biomedical research and furthering community-engaged, translational research aimed at improving health and well-being in communi- ties.31-55 The incorporation of CBPR approaches into the translational sciences is a paradigm-shifting event that is likely to result in major advances in our understanding of the causes of and solutions to complex health challenges in diverse communities.