be created to bring together important stakeholders from multiple sectors both to guide and to legitimate the process. Community coalitions, in their many forms, are one such vehicle. Through these vehicles, communities can identify relevant parties; find effective ways to engage parties with varying needs, resources, and values; set goals for the performance monitoring effort; ascribe responsibility for meeting goals; and manage the complex process of community-wide change.

Communities need to identify a variety of public and private stakeholders that can influence the health of their populations. These stakeholders can include health care providers, public health agencies, and community-based organizations explicitly concerned with health. They can also include other government agencies, community organizations, private industry, and other entities that do not explicitly, or sometimes even consciously, see themselves as having a health-related role—for example, schools, employers, social service and housing agencies, transportation and justice departments, faith communities, and the media.

The committee proposes a two-step approach to accountability. The first step involves the issue of shared responsibility. Communities should acknowledge that all stakeholders share responsibility for improving the health of a community's population. The second step involves ascribing to specific stakeholders accountability for accomplishing specific results as part of the community's strategy for addressing a health issue. Accountability should be conceptualized as a collaborative and cooperative process rather than a punitive process imposed by outside forces. This approach can be viewed as moving from a vertical to a horizontal structure, or from a top-down approach to a roundtable approach.

A process for putting these concepts into action is described in Chapter 4.


AHA (American Hospital Association). 1995. News Release. 25 Partnerships Named to Receive Grants in Community Network Competition. Washington, D.C. August 22.

Butterfoss, F.D., Goodman, R.M., and Wandersman, A. 1993. Community Coalitions for Prevention and Health Promotion. Health Education Research 8(3):315–330.

Feighery, E., and Rogers, T. 1990. Building and Maintaining Effective Coalitions. How-To Guides on Community Health Promotion, No. 12. Palo Alto, Calif.: Stanford Health Promotion Resource Center.

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