Map of life expectancy at birth from Global Education Project.

Thursday, May 03, 2012

Town and Gown, cont.

One way universities can change is in how they do public health research, and other kinds of research with direct relevance to the communities in which they sit (and which they often dominate). As one review puts it:

Community-based participatory research in public health focuses on social, structural, and physical environmental inequities through active involvement of community members, organizational representatives, and researchers in all aspects of the research process. Partners contribute their expertise to enhance understanding of a given phenomenon and integrate the knowledge gained with action to benefit the community involved.
But . . .

Really doing CBPR is difficult. There are huge differences in resources, perspectives and interests between academic investigators and community representatives, whether they are professional staff of CBOs, patients or clients, community residents, people living with chronic diseases, or otherwise defined. Community based organizations are generally undercapitalized and have real difficulty investing the kinds of resources in speculative proposal development, with a potential payoff that we typically don’t see for two years or more, that we take for granted in the university. Unfortunately, despite the professed interest of NIH and the ICs in CBPR, NIH staff and proposal reviewers still have a long distance to travel  in adjusting their thinking to both the philosophical and practical demands of CBPR. The most straightforward practical mismatch between the NIH funding process and CBPR is that the specific aims and research strategy must be fully developed, with a high level of scientific rigor, before the proposal is submitted. But CBPR demands a planning and developmental process between the academy and the community during which the research problem and research strategy are shaped to meet the somewhat disparate needs of the two groups. Community representatives simply cannot engage in this process without financial support. The result is that putatively CBR projects are often actually completely developed and written before they are even presented to the community “partners.”

The philosophical difference between academic and community visions of research is complex.  Community representatives are typically interested in the specific problems and needs of their own community, obviously, but academic research, and certainly most NIH-funded research, cannot be satisfied with description of a particular instance but rather must create general knowledge which is broadly applicable. This is not usually an outright contradiction, but it can create tension. Most important, the ultimate goals of the two groups with respect to the uses of the research are different. Academic investigators have a personal interest in their careers – in publication, grants, tenure and promotion – and in the advance of science. Community representatives want their problems and needs to be understood, and addressed. Much research that is done in collaboration with community partners never results in any direct benefits to the community.

Rather than belabor these issues – and there are more -- I will just say that effective and, if I may presume, honorable, collaboration requires infrastructure. The community and the academy need ongoing institutional collaboration so they can grow to understand each other and benefit from mutual exchange of ideas, wisdom and resources to create the basis for truly equal partnership. This means an up-front investment. Which somebody with money has to make.

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