Hill Anne, De Zapien Jill Guernsey, Staten Lisa K, McClelland Deborah Jean, Garza Rebecca, Moore-Monroy Martha, Elenes JoJean, Steinfelt Victoria, Tittelbaugh Ila, Whitmer Evelyn, Meister Joel S
Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, P.O. Box 245163, Tucson, AZ 85724, USA.
Prev Chronic Dis. 2007 Oct;4(4):A103. Epub 2007 Sep 15.
Diabetes mortality at the United States-Mexico border is twice the national average. Type 2 diabetes mellitus is increasingly diagnosed among children and adolescents. Fragmented services and scarce resources further restrict access to health care. Increased awareness of the incidence of disease and poor health outcomes became a catalyst for creating community-based coalitions and partnerships with the University of Arizona that focused on diabetes.
Five partnerships between the communities and the University of Arizona were formed to address these health issues. They began with health promotion as their goal and were challenged to add policy and environmental change to their objectives. Understanding the meaning of policy in the community context is the first step in the transition from program to policy. Policy participation brings different groups together, strengthening ties and building trust among community members and community organizations.
Data on progress and outcomes were collected from multiple sources. We used the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health (REACH) 2010 Community Change Model as the capacity-building and analytic framework for supporting and documenting the transition of coalitions from program to policy.
Over 5 years, the coalitions made the transition, in varying degrees, from a programmatic focus to a policy planning and advocacy focus. The coalitions raised community awareness, built community capacity, encouraged a process of "change in change agents," and advocated for community environmental and policy shifts to improve health behaviors.
The five coalitions made environmental and policy impacts by engaging in policy advocacy. These outcomes indicate the successful, if not consistently sustained, transition from program to policy. Whether and how these "changes in change agents" are transferable to the larger community over the long term remains to be seen.
美国与墨西哥边境地区的糖尿病死亡率是全国平均水平的两倍。2型糖尿病在儿童和青少年中的诊断率日益上升。服务分散且资源稀缺，进一步限制了医疗保健的可及性。对疾病发病率和不良健康结果的认识不断提高，成为创建以社区为基础的联盟以及与亚利桑那大学建立专注于糖尿病的合作伙伴关系的催化剂。
社区与亚利桑那大学建立了五个合作伙伴关系，以解决这些健康问题。它们最初以健康促进为目标，并面临着将政策和环境变革纳入目标的挑战。理解社区背景下政策的含义是从项目向政策转变的第一步。政策参与使不同群体聚集在一起，加强了社区成员与社区组织之间的联系并建立了信任。
从多个来源收集了关于进展和成果的数据。我们使用疾病控制与预防中心的2010年社区健康种族和族裔方法（REACH）社区变革模型作为能力建设和分析框架，以支持和记录联盟从项目向政策的转变。
在5年时间里，这些联盟在不同程度上实现了从以项目为重点向以政策规划和宣传为重点的转变。这些联盟提高了社区意识，建设了社区能力，鼓励了“变革推动者的变革”进程，并倡导社区环境和政策转变以改善健康行为。
这五个联盟通过参与政策宣传对环境和政策产生了影响。这些成果表明从项目向政策的转变即使并非始终持续，也是成功的。这些“变革推动者的变革”能否以及如何长期推广到更广泛的社区还有待观察。
