Building community capacity to promote social and public health: challenges for universities.

There is a sudden renewal of interest in community capacity building to achieve broad social and public health goals. Part of it stems from the healthy cities movement launched in the late 1980s (Hancock, 1993), from more recent innovations in public health and primary care (Human Resources and Services Administration [HRSA], 1996; Suen, Christenson, Cooper, & Taylor, 1995), and from the need to replace fragmented systems with coordinated community networks of managed care (Berkman, 1996). Cutbacks in federal spending for scores of social programs have sparked interest as well, along with the "new federalism" that gives states and communities greater control over and responsibility for these programs through block grants (Weil, 1997). Another source of renewal is civic distrust of large public institutions and, with it, popular outcry for localism, decentralization, and greater reliance on local mediating structures in the provision of community care (McKnight, 1995). Although many policy analysts (for example, Davis, 1997; Jansson & Smith, 1997; Keigher, 1996; Lehman & Danzinger, 1994; Poole, 1996) fear that a return to the "lost world of community" could harm people of color and other politically vulnerable groups, few question the urgent need for community capacity building in social and health services. Earlier we discussed the need for community capacity building in primary care and prevention (Poole & Van Hook, 1997). After examining several successful projects in the national Models That Work campaign (HRSA, 1996), we concluded that some retooling in our field will be necessary for social workers to build and participate in community health partnerships. Specifically, social workers need to enlarge their professional tool kit to include a repertoire of skills in community practice. Here the discussion continues, this time focusing on the need for universities to become effective participants in the community capacity-building movement. At this stage of the movement, there appears to be a great divide between what faculty are teaching students in academia and what practitioners are doing in the field. COMMUNITY CAPACITY BUILDING McLeroy (1996) defined community capacity as the characteristics of communities that affect their ability to identify, mobilize, and address social and public health problems. The purpose of capacity building, therefore, is to foster conditions that strengthen the characteristics of communities that enable them to plan, develop, implement, and maintain effective community programs (for example, Cottrell, 1977; Fawcett et al., 1996). Critics (for example, Funiciello, 1993; Illich, 1975; Lasch, 1977, 1995; McKnight, 1995) argued that professionals, and the programs they administer, often weaken community potential to address local needs - hence, their call for community capacity building in the provision of social and health services. In December 1995 the Centers for Disease Control and Prevention, Division of Chronic Disease Control and Community Intervention convened a symposium on community capacity. On the basis of the findings of the symposium, an expert panel (Speers et al., 1997) reached initial agreement on the dimensions of community capacity. These include participation and leadership, access to and prudent application of resources, social and interorganizational networks, sense of community, community history of collective action, community power, shared core values, and capacity to engage in critical reflection. Numerous examples of community capacity building for health promotion can be found in the literature. Some of the most frequently cited ones are the Pennsylvania County Health Improvement Project (Stunkard, Felix, Yopp, & Cohen, 1985), the Minnesota Heart Health Program (Carlaw, Mittelmark, Bracht, & Leupker, 1984), the Stanford Five-City Projects (Farquhar et al., 1985), and the Planned Approach to Community Health (PATCH) programs (Steckler, Orville, Eng, & Dawson, 1989). …