In most cases a coalition will function on the basis of willing participation and acceptance of shared responsibility for improving health in the community, but incentives to participate may vary among stakeholders. For health departments, participation in a coalition may be an effective way to meet responsibilities to the community under the three "core functions" of assessment, policy development, and assurance (IOM, 1988).
For some, participation in health improvement activities reflects a basic commitment to the well-being of the community (e.g., CHA, 1995; Showstack et al., 1996). Good will may not always be sufficient, however, and financial responsibilities cannot be ignored. It was noted in discussions at the committee's workshops that despite a commitment to efforts on behalf of the community's health in an organization such as the Group Health Cooperative of Puget Sound, it will be difficult to sustain that commitment unless other health care organizations accept a similar responsibility, including public reporting on the extent to which their efforts are meeting expectations (see Appendix C). Sigmond (1995) proposes that the private sector use the influence of accreditation to encourage community involvement. Standards could be established for participation in community partnerships.
Self-interest can also be an effective motivation. Employers, for example, may expect to benefit from reduced health care costs if community efforts can improve the health status of the workforce. Some coalition participants may find that they can use resources more efficiently because they can coordinate their activities with others working on similar projects. For some hospitals and health plans, economic incentives to participate may exist because of "community benefit" requirements for nonprofit tax status or contract provisions for Medicaid and Medicare providers. Participants should not, however, allow a coalition to become a means of furthering a particular constituency's goals at the expense of the best interests of the community.
Missouri has assembled a Community Health Assessment and Resource Team (CHART) specifically to provide technical assistance to the state's communities in coalition formation and other steps in the health improvement process (see Box 4-1). Additional discussion of coalition building appears in Chapter 3.
Another phase of the problem identification and prioritization cycle is assessing the community's health status and health needs