The community organizing process has been widely used in developed and developing countries to assist communities to recognize and address local health and social problems. In public health work, many disease prevention and health promotion goals can only be realized through the active involvement of community citizens, leaders, and organizations. Community organization is "a planned process to activate a community to use its own social structures and any available resources to accomplish community goals decided primarily by community representatives and generally consistent with local attitudes and values. Strategically planned interventions are organized by local groups or organizations to bring about intended social or health changes" (Bracht 1999, p. 86). It is sometimes referred to as community empowerment, capacity building, and partnership development.
An important outcome of this dynamic process is community ownership (i.e., by community leaders and institutions), which allows citizens to build skills and resources to effect community health change and to sustain such efforts over time. Experienced public health facilitators or community organizers often assist in this process, but control remains with local groups. The use of community organization strategies is not new in public health. In the early 1900s, for example, the National Citizens Committee on the Prevention of Tuberculosis worked closely with public health professionals and communities to control this infectious disease. In the twenty-first century, hundreds of community partnership groups are working locally to reduce the incidence of HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), heart disease, child and spouse abuse, and other threats to community health. T. Lasater et al. (1984) have described the use of church groups in mobilizing interventions for heart health. S. Verblen-Mortensen et al. (1999) illustrated a multistage process of community organizing to empower citizens to enforce alcohol sale ordinances for minors in rural communities. Community participation requirements are often mandated by both public and private health-funding agencies.
COMMUNITYWIDE CHANGE
One helpful way to think about effecting change at the community level is to consider the community as a dynamic system composed of several major sectors (business, government, schools, media). The people within each of these sectors interact with and influence each other, and when a change or alteration occurs in one sector it will have an impact on other sectors. A prohibition against secondhand smoke in public buildings, for example, may lead to a ban on smoking in restaurants. When health-oriented interventions are incorporated into many sectors of the community, the likelihood of a positive change increases. This focus on the total community system and its population is the hallmark of modern health-promotion programs. Mittelmark (1999) has summarized the results of diverse international community health-improvement programs and has found that community organization strategies are commonly utilized. Such techniques work regardless of whether the goal is behavioral in nature (e.g., to increase daily exercise among special groups) or whether the goal is to achieve health-policy changes (e.g., to eliminate tobacco billboard advertising near schools).
THE FIVE STAGES OF COMMUNITY ORGANIZATION
In many community organization strategies, a five-stage process can be identified. What follows is a summary of the key factors and tasks in each stage. It should be noted that these stages are dynamic and overlapping. In addition, some tasks from an early stage may need to be repeated in later stages (e.g., updating a community resources inventory).
Stage One: Conducting Community Analysis. A commitment to community participation in health campaigns requires above all else a knowledge of the assets, capacity, and history of a local community. This is accomplished by a careful "mapping" of the community to document its unique qualities, issues, and modes of decision making. This will provide the basis of an informed approach that realistically matches health goals with citizen readiness, expectations, and resources. Analysis is a critical first step in shaping the design of campaign interventions, and it is important to involve members of the community at this stage. The product of community analysis is an accurate profile that blends health and illness statistics with demographic, political, and sociocultural factors.
Stage Two: Design and Initiation of a Campaign. Following a community analysis and the identification of local priorities, the design aspects for a collaborative community campaign begin to emerge. A core group of citizens and professionals (with both public and private sectors represented) will usually begin the process of establishing a permanent organizational structure and making preliminary decisions about campaign objectives and interventions. This group may also write a mission statement and select a project coordinator. In organizing community partnerships, several structural forms (e.g., coalition, lead agency, citizen network) can be considered. B. Thompson (1999) provides a helpful discussion of the pros and cons of using various structures.
Stage Three: Campaign Implementation. Implementation turns theory and ideas into action, translating a mission into an effectively operating program. At this stage, organizations and citizens are mobilized and involved in the planning of a sequential set of activities aimed at accomplishing campaign objectives. Written plans with specific timelines have been shown to be a critical forerunner of success. Cost estimates should be included in the plan, along with monitoring and feedback strategies to measure progress. The key element in this stage is the careful determination and selection of priority intervention activities that can achieve maximum impact.
Stage Four: Program Refinement and Consolidation. During this stage both successes and problems in implementation are reviewed. Task forces of the local citizen organization need to determine any new directions or modifications for the program, including activities to maintain high levels of volunteer involvement. Efforts of organizers to have health program elements and interventions become more fully incorporated into the established structures of the community (e.g., exercise programs becoming a regular part of worksite culture) should continue in this phase as well.
Stage Five: Dissemination and Durability. In this last stage the strategic dissemination of information on project results and the finalization of plans for the durability of intervention efforts are the key considerations. Communities and citizens need to receive clear, succinct messages describing what has been accomplished and what continuing effort may be required. Such messages are reinforced when community leaders and local advocates are involved in their presentation. The local durability plan should include a vision for future health and social improvements and lay out a strategy to identify, recruit, and involve new people in current or future projects and community activities.
A common set of essential planning and organizing tasks has emerged from the many community mobilization and health promotion experiences of recent decades. These tasks include selecting broadly representative community participants and clearly identifying their decisionmaking authority, establishing an effective organizational structure, achieving mission clarity and realistic objectives, identifying community assets as well as resistance factors, establishing evaluation and tracking mechanisms early, managing and reinforcing volunteer involvement, conducting ongoing training for citizen intervention skills, recruiting a community organizer/facilitator with appropriate competencies and experience, and securing the necessary resources for the durability of program results.
Bracht, N.; Kingsbury, L.; and Rissel, C. (1999). "A Five Stage Community Organization Model for Health Promotion: Empowerment and Partnership Strategies." In Health Promotion at the Community Level: New Advances, ed. N. Bracht. Thousand Oaks, CA: Sage Publications.
Brownson, R.; Baker, E.; and Novick, L. (1999). Community Based Prevention: Programs that Work. Gaithersburg, MD: Aspen Publications.
Lasater, T.; Abrams, D.; Artz, L. et al. (1984). "Lay Volunteer Delivery of a Community-Based Cardiovascular Risk Factor Change Program: The Pawtucket Experiment." In Behavioral Health: A Handbook of Health Enhancement and Disease Prevention, ed. J. D. Matarazzo et al. New York: Wiley.
Minkler, M. (1997). Community Organizing & Community Building for Health. New Brunswick, NJ: Rutgers University Press.
Mittlemark, M. (1999). "Health Promotion At The Community Level: Lessons from Diverse Perspectives." In Health Promotions at the Community Level: New Advances, ed. N. Bracht. Thousand Oaks, CA: Sage Publications.
National Cancer Institute (1995). Community Based Interventions for Smokers; The COMMIT Field Experience. National Cancer Institute Monograph No, 6. NIH Publication No. 95–4028.
Thompson, B; and Winner, C. (1999). "Durability of Community Intervention Programs: Definitions, Empirical Studies, and Strategic Planning." In Health Promotion at the Community Level: New Advances, ed. N. Bracht. Thousand Oaks, CA: Sage Publications.
Veblen-Mortenson, S.; Rissel, C.; Perry, S. et al. (1999). "Lessons Learned from Project Northland: Community Organization in Rural Communities." In Health Promotion at the Community Level: New Advances, ed. N. Bracht. Thousand Oaks, CA: Sage Publications.
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