摘要：There has been an appeal to reduce health inequities by increasing community involvement and social capital. Poder es Salud /Power for Health is a community-based participatory prevention research project that seeks to address health disparities in the African American and Latino communities by enhancing community-level social capital. We provide specific examples of how this intervention uses community health workers and popular education to reduce language and cultural barriers and enhance community social capital. Although the communities share fundamental challenges related to health disparities, the ways in which the Latino and African American communities identify health concerns, create solutions, and think about social capital vary. Members of the project are working together to identify opportunities for cross-cultural collaboration. COMMUNITIES OF COLOR continue to face a disproportionate burden of morbidity and mortality despite overall progress in improving the health of our nation. 1 The Healthy People 2010 objectives identified “eliminating racial and ethnic health disparities” as a priority area of focus 2 and recognized the need to identify approaches that address the social determinants of health, such as income inequality, social exclusion, job insecurity, poor working conditions, food insecurity, and inadequate housing. 3, 4 Many public health practitioners and researchers have identified greater community involvement and increased social capital as ways to reduce inequities related to income, race, gender, ethnicity, and geographic location. 5, 6 The principal goal of Poder es Salud /Power for Health, a community-based participatory prevention research project funded by the Centers for Disease Control and Prevention in 2002, is to begin to address social determinants of health and reduce health disparities in the African American and Latino communities in Multnomah County, Oregon. (In Spanish, the word poder means both “power” and “to be able.” To convey the same active notion in English, the project team chose the title “Power for Health” rather than the more directly translated “Power is Health”). Informed in part by the health disparities literature, which suggests that a more empowered and competent community is a healthier community, 7– 11 the project builds on existing social capital to expand ties between the African American and Latino communities and increase access to social and economic resources. The specific aims of the project are presented to illustrate culture-specific elements of an effective community health worker (CHW) intervention in the African American and Latino communities; to identify supportive policies and environments that allow CHWs and community members to effectively recognize and address health issues; and to determine how social capital both influences and results from an effective participatory approach to focusing on health promotion and disease prevention (Box this page). We describe the 3 core strategies used to address social determinants of health in the Poder es Salud /Power for Health project and provide illustrative examples of project activities. The Poder es Salud /Power for Health project is still in progress; thus, we are not yet able to offer conclusions as to whether the project has actually increased social capital in the African American and Latino communities in Multnomah County. However, we address 2 questions here, on the basis of our initial experience of “learning through doing”: (1) how do CHWs create projects designed to enhance social capital? and (2) what aspects of social capital are targeted by cross-cultural applications of the CHW model in the project’s partner communities?
