Community-Based Asthma Management, Community Development, Community Empowerment, & Health Inequalities: A Critique of Evidence-Based Policy

The presentation will explore the topic of evaluating community-based asthma management and its application of community development and empowerment principles with high-risk, low-income Hispanic-minority populations in Puerto Rico, a US Territory with a high asthma life-time prevalence rate of 15.1% (CDC, 2009). The analysis will be centered on the study of 3 areas of focus: (1) community-oriented health promotion practice; (2) community development and community empowerment; and (3) critical realism, as an increasingly accepted scientific paradigm that will be drawn upon to establish ontological and epistemological foundations to critique this body of evidence-based policy. With this proposal, I hope to achieve the following research objectives: (1) describe the field of community-based asthma management, its community development and empowerment claims, and the predominant theoretical and methodological approaches it employs to address health inequalities; (2) justify the application of critical realism and contribute to the development of interventions that address health inequalities through the deliberate consideration and transformation of power relations. A rationale for this argument is first offered by the value of translating aspects of community-oriented health promotion practice across cultures with the Puerto Rican population as the bearer of significant asthma-related health disparities. Second, information on the effectiveness of community-based initiatives is considered modest because evaluation has not completely caught-on to this innovation in practice (Fawcett et al., 2001) and has been described as limited by its “traditional scientific assumptions about causality” (McGuire, 2005), which have been found limited in their attention to social context and entrenched power relations. Third, there are many conceptual and operational challenges associated with the assessment of community development and empowerment (Wallerstein, 1992). Within community-based asthma management a knowledge gap still exists about how community development and empowerment are actually implemented in these interventions when analyzed against the power relations amid all stakeholders involved.