title: From program to policy: expanding the role of community coalitions.
abstract: BACKGROUND
  Diabetes mortality at the United States-Mexico border is twice the national average. Type 2 diabetes mellitus is increasingly diagnosed among children and adolescents. Fragmented services and scarce resources further restrict access to health care. Increased awareness of the incidence of disease and poor health outcomes became a catalyst for creating community-based coalitions and partnerships with the University of Arizona that focused on diabetes.
  
  
  BACKGROUND
  Five partnerships between the communities and the University of Arizona were formed to address these health issues. They began with health promotion as their goal and were challenged to add policy and environmental change to their objectives. Understanding the meaning of policy in the community context is the first step in the transition from program to policy. Policy participation brings different groups together, strengthening ties and building trust among community members and community organizations.
  
  
  METHODS
  Data on progress and outcomes were collected from multiple sources. We used the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health (REACH) 2010 Community Change Model as the capacity-building and analytic framework for supporting and documenting the transition of coalitions from program to policy.
  
  
  CONCLUSIONS
  Over 5 years, the coalitions made the transition, in varying degrees, from a programmatic focus to a policy planning and advocacy focus. The coalitions raised community awareness, built community capacity, encouraged a process of "change in change agents," and advocated for community environmental and policy shifts to improve health behaviors.
  
  
  CONCLUSIONS
  The five coalitions made environmental and policy impacts by engaging in policy advocacy. These outcomes indicate the successful, if not consistently sustained, transition from program to policy. Whether and how these "changes in change agents" are transferable to the larger community over the long term remains to be seen.
authors: Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, P.O. Box 245163, Tucson, AZ 85724, USA. abhill@email.arizona.edu
authors: Anne
authors: A
authors: Hill
authors: Jill Guernsey
authors: JG
authors: De Zapien
authors: Lisa K
authors: LK
authors: Staten
authors: Deborah Jean
authors: DJ
authors: McClelland
authors: Rebecca
authors: R
authors: Garza
authors: Martha
authors: M
authors: Moore-Monroy
authors: JoJean
authors: J
authors: Elenes
authors: Victoria
authors: V
authors: Steinfelt
authors: Ila
authors: I
authors: Tittelbaugh
authors: Evelyn
authors: E
authors: Whitmer
authors: Joel S
authors: JS
authors: Meister
mesh_terms: D001130:Arizona; D003159:Community-Institutional Relations; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D004641:Emigration and Immigration; D006265:Health Care Coalitions / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration*; D006630:Hispanic or Latino; D006801:Humans; D008800:Mexico / Q000208:ethnology; D009936:Organizational Innovation; D011050:Policy Making; D012939:Social Planning; D014495:Universities