Critical Reflections on This Historical Moment for Community-engaged and Participatory Research

Critical Reflections on This Historical Moment for Community-engaged and Participatory Research Milton "Mickey" Eder, PhD, Ysabel Duron, Lori Carter-Edwards, MPHPhD, Ella Greene-Moton, Meredith Minkler, DrPH, Leo S. Morales, MDPhD, Keith Norris, MDPhD, and Nina Wallerstein, DrPH Keywords Health Priorities, Health Promotion, Community Health Research, Community-Based Participatory Research, Power Sharing, Community-engaged Research, Participatory Research Research and training institutions, public health and health care systems often lack sustained, effective engagement with communities. This hinders the ability of scientists, researchers, and health care providers to examine their unconscious biases and improve their capacities to collaboratively work towards reducing health inequities. The coronavirus disease 2019 (COVID-19) pandemic starkly exposed, once again, the depth of the racial and social inequities in morbidity and mortality across individuals and communities. It reified systemic racism, with ongoing police shootings further highlighting the deeply entrenched anti-Black racism and how little has changed since the first slave patrols evolved into our system of policing. It further exposed the support for policing from a system of justice that effectively sustains racial separation accompanied by inequality of access to services. Social biases are further evident in the consistency of data by group regarding racial profiling and traffic stops, involvement with the legal system and incarceration rates. Although racism touches every group at some point in time, its genesis in the United States validated Native American genocide and African chattel slavery. As Native Indians were relegated to reservations, slaves remained a visible part of everyday America. Visibility has produced an embedding of anti-Black racism into our laws, policies, practices, history and media, resulting in a massive imbalance in the distribution of community level life and health affirming resources and opportunities. Confrontations regarding rights and the potential for silencing populations most adversely impacted once again occupies the public conscience. Current legislated actions to restrict voting rights, to censor and/or ban books from schools and libraries that address race and gender orientation and identity differences, and debates about academic freedom and first amendment rights in institutions of higher learning and the media, resonate with post reconstruction action to rescind the rights of freed Black Americans to citizenship through repressive Black Codes/Jim Crow laws.1,2 As we chart a way forward, the proactive response of many communities of color during COVID and the response to the brutal police murder of George Floyd, among so many other often unarmed Black people, remind us of the central role of community engagement for raising awareness and for collaboratively addressing the needs and priorities of our most marginalized. [End Page 557] Despite world-class scientific credentials and accomplishments, our leading research and academic institutions often do not know how to meaningfully engage with local communities or simply don't understand the importance of doing so; many departments of health are similarly challenged to genuinely reach and engage diverse local populations. The commitment to engagement must address identity concordance at all levels of the workforce, including research, administrative, financial, instructional and clinical staff. A strong evidence base now demonstrates that community engagement and community-based participatory research (CBPR) can improve the "rigor, relevance and reach" of research3 and positively impact multiple system and individual health outcomes.4–7 The improvements are multidimensional and accomplished through the unique insights and nuances community partners bring to understanding the root causes of health problems, illuminated by past and current understanding and exposures to varied social contexts. Our institutions need to expand their capacity to benefit from collective community wisdom, lived experience, and cultural strengths, if we are to reform current systemic approaches that too often restrain real solutions. Unfortunately, universities and academic medical centers typically are not structured to support such work; institutional, financial and administrative processes and policies all pose significant barriers. These include, for example, an inability to pay community partner organizations in a timely fashion or establish infrequent payment schedules for community member participation; the institutional capacity to set priorities that allow institutions to maintain control over infrastructure. There is evidence of insufficient support for and engagement of community investigators in institutional review boards, a lack of adequate training in engagement and participatory methods and practices, and a legacy...