Map of life expectancy at birth from Global Education Project.

Thursday, December 15, 2005


That's not an acronym because you can't pronounce it (KaBopper?), it's the abbreviation for Community Based Participatory Research. This is an increasingly popular concept intended to address the power imbalances and exploitation that many people perceive in the way public health research is typically done.

Conventionally, a learned professor ensonced among ivy-covered walls deems some environmental hazard or social pathology worthy of study, and wangles a major chunk of change out of the taxpayers on that basis. The money pays a portion of the learned one's upper middle class salary, plus chump change for a bunch of graduate students who go out and collect a lot of information about the endangered or pathologized people, which they all then process into an article about odds ratios or beta coefficients which is published in a journal that costs $300 a year. The publication then becomes evidence in the learned professor's case for tenure or promotion, and for further grants.

CBPR principles include involving "the community" in defining the problem and the methods for studying it, benefiting in some way materially from the major chunk of change, and interpreting the results. "The community" also gets to actually learn what the results are, and if we're really cooking with gas, converting the new knowledge into some sort of action to solve problems. Of course there are multiple problems here, not the least of which is how to define, and then to represent, "the community," since the best you can actually hope for is some small group of actual real people who are intended to stand for the whole. And of course, it is extremely challenging to eliminate, or even substantially reduce, the power imbalances that will still exist within whatever participatory structure you create.

CBPR advocates generally recognize the problems and wrestle with them honorably. Nevertheless, in what I saw of the representation of CBPR at the APHA meeting, the medium is the message. We had learned professors standing on podiums addressing an audience three feet below, describing how they were empowering a lot of people who weren't there. Sometimes we had, speaking for the community side, a director of non-profit organization whose list of degrees might stop short of bestowing the magic word "doctor" -- somebody with an MSW or a Master of Public Administration, say. One presentation I heard, entitled "Being the community in community based research," described the speaker's travails confronting the power, insularity and self-absorption of academic scientists and their institutions. Fair enough, but the speaker is the director of an independent but university-based institute with millions of dollars in grant funding, who has been an executive for more than twenty years.

One place the community definitely wasn't was at the APHA meeting. Of course, the $300 registration fee and the $170/night downtown hotel rates might contribute to that.

No comments: