Community coalitions for prevention and health promotion

In the last several years, health promotion specialists have stressed the importance of multiple interventions aimed both at individuals who are at health risk, and at risk-producing environments and policies (Milio, 1980; McLeroy et al., 1988; Pentz et al., 1989; Winett et al., 1989). The current emphasis on multiple interventions at multiple levels of the 'social ecology' is a response to the severity and complexity of chronic health conditions that are rooted in a larger social, cultural, political and economic fabric. The current wisdom in health promotion holds that targeting the behavior of individuals, without also intervening at these other social levels that shape behavior, will not have as great an impact on health status (McLeroy et al., 1988; Minkler, 1989; Hawkins and Catalano, 1992; Stokols, 1992). The development of coalitions of community agencies, institutions and concerned citizens to combat chronic health conditions is gaining popularity as an intervention aimed at strengthening the social fabric. Currently, hundreds of millions of dollars are being invested in coalition development as a health promotion intervention. For instance, both the COMMIT and ASSIST community tobacco control programs, funded by the National Institutes for Health, require coalitions of citizens in order to develop local strategies to decrease tobacco use (National Cancer Institute, 1988; Shopland, 1989).