Implementing the Boston Healthy Start Initiative: a case study of community empowerment and public health.

This article examines the efforts on the part of a city health department, in partnership with a broad-based coalition of community-based, government, and social service agencies, to plan and implement, using principles of empowerment and community participation, a federally funded infant mortality reduction program. It examines the social and institutional dynamics of sharing power in an environment highly charged politically. Infant mortality in Boston is much more than a public health problem. It is the focal point of complex racial, political, and institutional factors. This case study illustrates how empowerment moves from rhetoric to reality and the challenge to both traditional public health practice and traditional community mobilization. The article describes the federal Healthy Start Initiative and its community participation mandate, the background on infant mortality in Boston, a case study of the development of the Healthy Start program from the perspective of community empowerment, and finally, the lessons learned in the first 2 years of the program. It describes the controversies encountered, some of the mistakes made, and the ways found that government must be reinvented if empowerment is to be a real public health tool.

The Women's Centre in Jamaica: an innovative project for adolescent mothers.

In 1978 the Jamaican Women's Bureau established the Women's Centre, the first project in the developing world to help pregnant teenagers avoid the usual hardships of poverty and dependence. The women take courses in academic subjects and prenatal and postnatal health, and receive good medical care. Fathers and parents are involved in counseling sessions where practical life skills, including family planning, are emphasized. The young mothers improve dramatically in self-confidence, self-esteem, and in their ability to take care of their babies. The Centre's success has helped to loosen the policies of the Jamaican government on the education of pregnant school-age women.

PIP: In 1978 the Jamaican Women's Bureau established the Women's Centre, the 1st project in the developing world to help pregnant teenagers avoid the usual hardships of poverty and dependence. The women take courses in academic subjects and prenatal and postnatal health, and receive good medical care. Fathers and parents are involved in counseling sessions where practical life skills, including family planning, are emphasized. The young mothers improve dramatically in self confidence, self esteem, and in their ability to take care of their babies. The Centre's success has helped to loosen the policies of the Jamaican government on the education of pregnant school age women.