Partnerships thus have various advantages over independently operating organizations. However, the notion of community partnerships requires its own justification. This rationale comes in part from an emerging public health promotion model(10) that claims a strong relationship among health, life style and social norms: while individuals are still considered to have a role and some responsibility, environmental factors are viewed as crucial in supporting or preventing individual health promoting behavior. Organized community support programs and environmental changes can reinforce individual life style changes. In other words, many chronic health conditions, such as violence, alcohol and other drug use, heart disease, and adolescent pregnancy, "are rooted in a larger social, cultural, political and economic fabric."(11) The social ecological approach to health promotion maintains that prevention efforts must affect both personal and environmental factors because of the "interactive and transactional nature of behavior-environment relationships."(12)
By strengthening the environment, community partnerships can affect these chronic health conditions. Without changes in the social and cultural environment, however, interventions that affect individuals are likely to have little success. In the late 1970s the World Health Organization endorsed community development, with emphasis on self-help, citizen participation, and community control, as an approach to health promotion.(13)
Those who study the factors that underlie adolescent sexual behavior, pregnancy and childbearing have noted the relationship between these health concerns and a variety of factors in the family and the community. Some have concluded that "to reduce pregnancy markedly, [programs] must have multiple effective components that address both the more proximal antecedents of adolescent sexual behavior as well as the more distal antecedents involving one or more aspects of poverty, lack of opportunity, and family dysfunction, as well as social disorganization more generally."(14)
Those who study other complex social problems have reached similar conclusions. Examining the issue of violence prevention, Cohen and Lang conclude that there is no single or simple solution to violence because the behavior is the result of a complex of environmental, political, cultural, educational, and behavioral factors. They find that effective community-based strategies must be coordinated, including a variety of interventions to reach specific risk groups in multiple settings and provide social support for individual behavior change.(15) Various branches of the Department of Health and Human Services recommend community-based, multi-strategy approaches to a variety of problems. The National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (CDC) makes this recommendation: "no single action in isolation is likely to solve the problem of youth violence. There are too many types and too many causes to be solved by one strategy. The most effective programs include several types of activities."(16)
Similarly, the Office of Substance Abuse Prevention (OSAP) of the Substance Abuse and Mental Health Services Administration notes the complexity of the problem of substance abuse, its multiple, interrelated causes, and the interaction of the individual, drugs and the environment. OSAP establishes a framework guided by the principle "that no one system, agency, or organization can prevent alcohol and other drug problems in communities."(17) The Family and Youth Services Bureau of the Administration for Children and Families advises communities interested in creating youth development programs that "the complexity and interrelatedness of factors contributing to crime, violence, and other social problems...require a commitment to looking beyond superficial solutions."(18)
Community partnership is referred to in journals of education, public health, and social work, in the fields of housing, substance abuse, and violence prevention, and it is becoming part of a new type of public-private business approach. It is mentioned in conjunction with collaboration, empowerment, and initiatives. And yet, in spite of its prevalence in the literature and in practice, there is no single, clear definition, framework, or application. Community partnerships seem, instead, to reflect the motivations and purposes of those who are involved, and they are greatly affected by the availability of financial resources, commitment of the members, and the host of macro social, economic, political, and cultural factors that influence change. In spite of this ambiguity, there does seem to be some agreement that community partnerships, although difficult, can be invaluable components of a community's attempt to effect change.