title: Achieving Millennium Development Goals for health: building understanding, trust and capacity to respond.
abstract: Biomedical interventions promise achievement of health-related Millennium Development Goals provided social-, capacity- and knowledge-based constraints to scaling up and reaching marginalized people at risk, are addressed, and balance between prevention and treatment is struck. We argue for a new approach: multi-stakeholder capacity building and learning for empowerment: MuSCLE. MuSCLE is used as a way to frame three systemic weaknesses in traditional health science and policy approaches: (1) a lack of engagement with people at risk to build a collective understanding of the contexts of health problems, including social drivers; (2) a lack of multi-criteria evaluation of alternative interventions; (3) a lack of attention paid to integrated capacity building. The MuSCLE framework responds in three ways: (1) participatory assessment of the ecological, socio-cultural, economic and political contexts of health, identifying priorities using risk and vulnerability science, and modeling drivers; (2) selection among intervention alternatives that makes ecological, socio-cultural, economic and political tradeoffs transparent; (3) integrated capacity building for sustainable and adaptive interventions. Literature and field lessons support the argument, and guidelines are set down. A MuSCLE approach argues for a transformation in health science and policy in order to achieve Millennium Development Goals for health.
authors.affiliation: Environmental Science and Policy Graduate Program, Department of International Development, Community and Environment (IDCE), Clark University, 950 Main Street, Worcester, MA 01610, USA. tdowns@clarku.edu
authors.forename: Timothy John
authors.initials: TJ
authors.lastname: Downs
authors.forename: Heidi Jane
authors.initials: HJ
authors.lastname: Larson
mesh_terms: D003256:Community Participation; D003299:Cooperative Behavior; D003469:Culture; D006292:Health Priorities; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D009937:Organizational Objectives; D014480:United Nations