Public-private partnerships are integral to our public health paradigm. The Coalition Training Institute (1995–1998) trained 283 participants from 29 U.S. cities, 49 states, and 7 U.S. territories to foster and sustain partnerships that improve immunization rates. Evaluation consisted of on-site and follow-up surveys, effectiveness inventories, and focus groups. The Institute met participants' expectations. Four months later, participants reported training was applicable (93%) and helpful in overcoming organizational barriers. Most built or improved coalitions (81%), helped organizations apply new ideas (86%), and obtained training/support (60%). Participants requested more on-site and distance-learning opportunities to network, train coalition leaders and members, and learn new skills.
Coalitions have emerged as effective tools to improve the health of communities in the United States and abroad.1,2 A coalition is defined as a group of individuals representing diverse organizations, factions or constituencies within the community who agree to work together to achieve a common goal.3 Coalitions are often characterized as formal, multipurpose, and long-term alliances.1 As an action-oriented partnership, a coalition focuses on reducing or preventing a community problem by analyzing the problem, identifying and implementing solutions, and creating social change. No single approach for community change is as effective as a broad-based coalition effort that provides the means for multiple strategies and involves key community organizations.4 Coalitions have been used to successfully address health issues such as cancer prevention, tobacco use, alcohol and drug abuse, human immunodeficiency virus/acquired immune deficiency syndrome, heart disease, and diabetes. Because our nation's children remain underimmunized, coalitions are one innovative approach that have mobilized communities to increase immunization rates. As a nation, we did not attain the 2000 goal5 of immunizing 90 percent of children under 2 years with the basic immunization series (4 DPT: 3 polio: 1 MMR: 3 Hib). By 1998, the percentage of U.S. children who received the recommended series of vaccines (4DtaP:3 polio:1 MMR:3 Hib:3hep B) was at 73 percent. (Note: hepatitis B was added and DTP was replaced by DtaP). The Healthy People 2010 target for this age group for the 4:3:1:3:3 series is 80 percent, 10 percent lower than the Year 2000 immunization goals.6 In fact, the latest national immunization survey conducted by the Centers for Disease Control and Prevention (CDC) reported 4:3:1:3 coverage levels at 76.7 percent±1.0 and 4:3:1:3:3 levels at 73.1±1.0.7
A presidential Childhood Immunization Initiative in 19938 established coalition development as a goal. The initiative mandated that all states, territories, and major municipalities develop an immunization action plan (IAP) and a local immunization coalition. Basic technical assistance in coalition development was offered regionally. In the Guide to Community Preventive Services, the majority of task force recommendations focus on improving health behaviors, reducing the burden of disease, and addressing environmental challenges.9 The recommended interventions to accomplish these aims include:
* building, maintaining, and strengthening social networks that provide supportive relationships for behavior change
* community-wide education, incentive, and enhanced enforcement campaigns
* creating or enhancing access to care and information outreach
All of these interventions are at the core of what community partnerships and coalitions do best. Therefore, although coalitions are still embraced as indispensable tools for positive health status outcomes, experience suggests that many state and local health departments still struggle with the difficult demands of coalition work.10–15
Frances D. Butterfoss, PhD, MSEd, is Professor and Head of Health Promotion and Disease Prevention at the Center for Pediatric Research in Norfolk, Virginia.
Ardythe L. Morrow, PhD, MPH, is a Professor and Director of the Center for Epidemiology and Biostatistics at Children's Hospital Medical Center in Cincinnati, Ohio.
J. DeWitt Webster, PhD, MPH, CHES, is a Kellogg fellow at the University of Michigan, School of Public Health, Ann Arbor.
R. Clinton Crews, MPH, is a research associate and coalition trainer/coordinator at the Center for Pediatric Research in Norfolk, Virginia.
Corresponding author: Frances D. Butterfoss, PhD, MSEd, Associate Professor Pediatrics, Center for Pediatric Research, Eastern Virginia Medical School, 855 W. Brambleton Ave, Norfolk, VA 23510.
The Coalition Training Institute was funded by the Association of Teachers of Preventive Medicine and The Centers for Disease Control and Prevention, National Immunization Program.
The authors thank Tricia Daniels at the Center for Pediatric Research and Patricia Louis of the. Safe Kids Coalition in Washington, DC. Without their help and dedication, this project would not have been possible.