The committee's review and discussions with some of those associated with the development of the PRC program indicate that there are at least three ways in which the PRC program can serve CDC's purposes. First, in fulfillment of its mission as the nation's prevention agency, CDC could use the PRC program to undertake the research and development that any successful, forward-looking science-based agency must have. The PRC program could generate new knowledge, from fundamental concepts to practical approaches, and could support prevention practice at CDC, as well as at state and local public health agencies, in communities, and in health service delivery settings. CDC has an organizational focus on community health and has both a unique interest and experience to bring to public health practice research. Increasing numbers of researchers are recognizing the importance of community factors among the determinants of health and the consequent potential for community-based interventions, as well as the value of community involvement in the conduct of health research—that is, setting the research goal or question, developing community-appropriate methodology, interpreting results, and disseminating findings. Through the PRC program, CDC could lead the way in generating needed knowledge about this new community-based approach to research. Although other approaches to health promotion and disease prevention research remain important, addressing community-based interventions would allow CDC to distinguish itself from other research sponsors, develop a promising area of work, and most important, create a field program that reflects the reality of the communities CDC is intended to serve.
Second, CDC could use the PRC program as a way to build capacity for public health practice outside its Atlanta headquarters. The university-based PRCs, which have collaborative relationships with state and local health departments, community organizations, and other entities, might serve as extensions of CDC's activities based in Atlanta and state health departments to field settings that would otherwise be beyond the agency's reach. In this model, the PRCs would function as field laboratories for research and development relevant to CDC's mission and would provide the staff and connections to the community necessary to respond to public health issues that may arise in those communities. More generally, if CDC viewed schools of public health and similar academic institutions as important components of the nation's capacity to address public health problems, a research program could strengthen the institutions, just as National Institutes of Health (NIH) research support since World War II has increased and improved the capacity of American medical schools to address the nation's medical problems (IOM, 1984).
Finally, CDC could use the PRC program as a way to work with disadvantaged communities on critical public health problems. Taking