Community-Based Health Organizations: Advocating for Improved Health (review)

In Community-Based Health Organizations: Advocating for Improved Health, Marcia Bayne Smith, Yvonne J. Graham, and Sally Guttmacher provide a much needed and long awaited foundational text for anyone wishing to better understand the variety of issues pertaining to health care at the local level. The authors make their purpose for writing clear in the preface. Practical experience had shown them "that most CBHOs are so focused on providing services, advocating for funding, negotiating partnerships to improve community health, and advancing a policy agenda on behalf of their constituents that they often neglect to invest in activities that might build their capacity and help them become more competitive and sustainable [p. xv]." Thus the book was conceived as a how-to manual for CBHO managers and administrators seeking to establish a strong footing and thereby better serve their communities. Fortunately for the rest of us, it is also much more than that.

The book is outlined neatly in three parts, establishing some key concepts before progressing to more complex applications of those concepts. The first part establishes the context, providing both a historical and an organizational framework for understanding CBHOs. The second is descriptive, outlining the function of CBHOs, using a detailed case study. The third is prospective, suggesting how CBHOs might remain viable in the current economic and political climate and discussing what the future holds for CBHOs. The book has few illustrations (three tables and seven figures), but they add a lot at key points in the text.

In the opening section, CBHOs are defined (and distinguished from such local level health organizations as community health centers and local health departments) and placed in context. The authors elegantly recount the history of health delivery in the local community setting, allowing the reader to understand the evolutionary process that led to the emergence of CBHOs, from their roots in the 18th century to their flourishing in the 1960s through the present day. Special attention is given to the social determinants of health and their potential impact on health outcomes. The works of several renowned scholars in this area (R.G. Wilkinson, M. Marmot, I. Kawachi, and B. Kennedy) are reviewed succinctly but thoroughly. This part of the book concludes by exploring several different theoretical perspectives on community development, before segueing into the research and case study presented in Part Two.

The second section is certain to appeal to those in search of evidence-based practice. The authors present their own groundbreaking research, which, although in its infancy, offers a starting point for research on every facet of CBHOs, from financing and organizational structure to community involvement and outreach efforts. Chapter four is perhaps the defining piece. An intimate case study of the Caribbean Women's Health Association (a CBHO in New York City) is used to explore the Health Keepers model of service delivery. By putting a face on the issue, the authors effectively communicate the importance of community in health care, and cite several underlying assumptions upon which the Health Keepers model rests. Briefly, these three assumptions are "that health must be defined from a community perspective…that poor health is closely associated with low socioeconomic status and low levels of educational attainment…[and] that services to underserved and immigrant populations are more effective when they are neighborhood based; when community members are included in assessment of needs, design, development, implementation, and evaluation of programs; and when services are comprehensive in scope [155,156]." Language, culture, and religion are afforded the attention they deserve in culturally competent community based health care.

The final part of Community-Based Health Organizations reads like a roadmap for the future of CBHOs. The political and economic environments in which CBHOs must operate are discussed frankly, projections are made for the future, and strategies for success are provided to help CBHOs effectively fulfill their missions.

While Bayne Smith, Graham, and Guttmacher have written a very practical handbook for the administrator...