Commentary: challenges for the field in overcoming disparities through a CBPR approach.

Within the last decade, community-based participatory research (CBPR) has gained momentum with the recognition that community engagement is necessary for community interventions to effectively address seemingly intractable social problems and health disparities. Philanthropic foundations, in response to increasing community demands, have led the way in supporting health disparities research that is collaborative and community ‘‘based,’’ rather than community ‘‘placed’’ or community ‘‘targeted.’’ Academia has responded with new academic-community centers and re-examination of tenure and promotion criteria; with participatory research tools for judging the extent of collaboration; with CBPR as a new recommended competency for education; and with special theme issues of medical and public health journals, such as the American Journal of Public Health, Environmental Health Perspectives, Health Education and Behavior, and the Journal of General Internal Medicine, among others. The Campus Community Partnerships for Health has created a CBPR listserve for university and community partners nationwide (mailman1.u.washington. edu). The Centers for Disease Control and Prevention (CDC) has led CBPR-oriented governmental funding with their Urban Research Centers, their CBPR emphasis in the Prevention Research Centers, and recent investigator-driven CBPR initiatives, with the National Institutes of Health (NIH) responding more slowly. The National Institute of Environmental Health Sciences took an early lead with its environmental justice funding; yet increasingly other NIH institutes are releasing individual CBPR-based requests for applications (RFAs), and last year, two major RFAs were released with multiple institutes. Despite this apparent and increasing support for CBPR, the field is still learning how best to implement authentic participatory research partnerships; how best to address the scientific questions that arise through using participatory processes; and how best to reduce the predominant skepticism within the academy in adopting CBPR, as opposed to more traditional research. This issue of Ethnicity & Disease goes a long way to providing grounded examples of an evolving, multicenter university-community partnership and to exploring the science of the added value of community participation to improving clinical and community practice and health outcomes. The Los Angeles Community Health Improvement Collaborative (CHIC) has taken the idea of partnerships to a new level by bringing together multiple academic centers (rather than creating a single new center) to collectively work on distinct diseases and to identify and share resources for priority domains for action. The CHIC started with both a short-term practical approach, to identify potential practice sites for pilot projects, and a long-term vision, to build community research capacity, to sustain the academic-community partnerships, and to improve community health status over time, across the life span, and across health conditions. The articles in this special issue provide a window into several core issues that need to be addressed to create a stronger science of CBPR. The two that I want to focus on are, first, the meaning and reality of ‘‘partnership,’’ with our social context of institutional and structural racism; the inherent dilemma of partners who have different expertise and self-perceptions of the value of their knowledge (ie, the academy versus the community); and the concern of representation, who represents the community or the academy, and which voices are being heard and which are still silenced. Second, we need to better understand how to adapt intervention research designs in the context of fluid and dynamic participation both in the intervention and in the research process. We must develop strategies to test the hypothesis, or at least to better understand, how participation in community intervention research may promote greater effects on health status and health disparities. While partnership and collaboration are guiding values of CBPR, the work of creating partnership remains challenging. Most collaboratives start with principles drafted by the partners; yet partnerships range across a continuum, from those driven by communities to those controlled by universities. These dynamics are not static but unfold and change over time. From the Masters in Public Health Program, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico.