Perspectives

Common Grounds

Cultivating the Field of Community-Based Participatory Research

As the world confronts massive environmental problems such as global warming, it’s easy to forget that many environmental issues reside in our own backyards. According to the latest data, well over ten million Americans live within a mile of a federal Superfund site — an uncontrolled or abandoned place where hazardous waste is located — that threatens their health and that of their children.

Figuring out the health effects of such sites is the purview of research, but spurring policymakers to take action often goes beyond the mandate of researchers. In these cases, it is often left to the communities themselves to advocate for change. Thus has arisen the field of community-based participatory research, or CBPR, involving partnerships between researchers and the communities affected by health problems, with the ultimate goal of effecting policy change and making tangible improvements in people’s lives.

Do these collaborations work? Meredith Minkler, a professor of health and social behavior at the University of California, Berkeley, School of Public Health, sought to answer that question in a talk at RAND, sharing some CBPR success stories and challenges. Minkler has more than 25 years of experience working with underserved communities in this still-emerging field.

Beyond the Ivory Tower

Those living in communities plagued by health concerns are often frustrated with researchers because of an apparent disconnection between academia and the real world when it comes to analyzing a problem and actually working to solve it, stressed Minkler. In such cases, the field of CBPR can help to bridge the gap.

AP IMAGES/PAT SULLIVAN A chemical plant is the backdrop for a swing set in Houston, Texas.

Those living in communities plagued by health concerns are often frustrated with researchers because of an apparent disconnection between academia and the real world.

But for a project to qualify as CBPR, she argued, “The research question must come from, or be important to, the community, and there must be an interplay between the professional and the community’s ways of knowing.” She outlined five examples that fit these criteria. Each one involves environmental justice, ranging from air pollution and asthma in Harlem, New York, to children’s lead exposure in rural Oklahoma to water and air pollution from massive industrial hog operations in North Carolina.

Minkler pointed to West Harlem Environment Action (WE ACT) as a textbook case in community-driven research. With an estimated one in four kids in Harlem now suffering from asthma, WE ACT had been convinced for years that the high prevalence was related to the fact that six of New York’s eight diesel bus depots, one-third of the city’s 4,200 buses, and 650 Port Authority buses were stationed in their Northern Manhattan community.

WE ACT sought the scientific evidence by working with the Columbia Center for Children’s Environmental Health. “Kids were trained in how to use and calibrate backpack air monitors,” said Minkler, “and they also did traffic and pedestrian counts at key intersections for five eight-hour days.” The research, showing fine particulate matter rates at more than 200 times the Environmental Protection Agency threshold, was instrumental in spurring the Metropolitan Transit Authority to convert its entire fleet to “clean diesel” and the state legislature to adopt a New York State Environmental Justice Policy.

Barefoot Epidemiology

“Industrialized hog operations are big business in North Carolina,” said Minkler. “But they come at the expense of local rural communities, with massive runoff from the operations forming in open cesspools and contaminating well water.”

Noticing an increased incidence of chronic conditions such as sore throats and asthma, residents of the small town of Tilley, North Carolina, formed the Concerned Citizens of Tilley and began conducting what Minkler called “barefoot epidemiology.” On their own, they studied the dates of well construction, the depth of wells, and their proximity to the hog operations.

The residents formed a partnership with researchers from the University of North Carolina to help do the hard science. This research involved both water sampling to measure contamination levels and spatial analysis mapping so that citizens could document whether and to what extent there was racial discrimination in where the large hog operations were located.

AP IMAGES/NEWS & OBSERVER, JIM BOUNDS A hole the size of a semitruck is shored up after the berm of a hog waste storage lagoon collapsed in Onslow County, North Carolina, sending millions of gallons of wastewater into fields and streams.

“Citizens used the findings of the research in advocacy, working through the mass media and in public hearings,” said Minkler. The partnership was widely credited with helping make the county in which Tilley resides the first in the state to have a public health permitting process for hog operations as well as a moratorium on both the construction of new operations and the expansion of existing ones.

Administering Good CBPR

In looking across all five examples, Minkler cited a number of factors for success in CBPR partnerships, including a commitment to rigorous scientific inquiry, an aptitude for building collaborations and alliances with diverse stakeholders beyond the formal partnership, and a willingness to do the “homework.” Homework includes understanding what other communities have done, who holds the decisionmaking authority, and what the key leverage points are for changing policy.

Just as important, success requires that research partners show real respect for lay knowledge. Minkler described a situation in which researchers wanted to put air monitors on school roofs but were convinced by the community to put them near the windows where the children were. “From a scientific point of view, it made no difference where the monitors were, but from a policy point of view, putting them near the kids was critical for advocacy,” Minkler said. “Seeing the monitors so close to the kids who were being affected made it easier for policymakers to appreciate the connection,” she explained.

There are challenges and tensions that go hand in hand with CBPR. “There is an inevitable balancing act between the necessary skepticism of science and the action-imperative of the community,” said Minkler. Researchers want to get the “science right,” which can mean waiting until the research is published, while community partners want to use the research immediately to effect change in their communities.

Even when researchers themselves want to push ahead with policy change, she said, they are often confounded by the constraints of research funding. The need to obtain future funding can deter researchers from speaking openly about policy implications, and the discussion of such implications is sometimes restricted by the editorial review boards of professional journals.

Yet academics involved in CBPR must “take seriously one’s commitments to the community,” Minkler said. “And that includes helping to ensure that action to address the study findings is part of the CBPR process itself — not simply something left for others to worry about after the papers get published.”