Community Engagement: Reducing inequalities acting on environmental health. A Systematic Review

Sustainability is one of the most important challenges for Healthcare Systems all over the world. According to the Sustainable Development Agenda, one of the goals is to reduce inequalities, and environmental health is faced by several specific goals. Community Engagement can both empower vulnerable populations (so reducing inequalities) and identify the prior environmental issues to address. The aim was to search for public health programs using Community Engagement tools in healthy environment building.\r\n\r\nA systematic review was conducted searching on Scopus, MEDLINE and Cochrane databases. The search string was created according to the Population-Intervention-Context-Outcome model. The Risk Of Bias In Non-randomized Studies-of Interventions tool was used to assess quality. Data analysis was based on descriptive statistics and a Chi-Square test was performed to compare studies in which the community carried out engagement interventions with or without the direction of public health institutions (p < 0.05).\r\n\r\nOf 182 articles, 11 were eventually included. Risk of Bias was moderate in 70% of the articles.\r\n\r\n7 studies were conducted in rural areas, while 4 in urban contexts. Target populations were children in 20%, adults in 50% and elderly in 30% of the articles. Concerning the intervention design, 9 studies included the research of local leaderships, and in 7 there were both context study (to identify the main barriers and facilitators) and the active planning of motivational meetings by public health professionals. We found that the level of engagement reached is highly correlated with the presence of public health professionals acting as engaging coaches (p = 0.007).\r\n\r\nCommunity engagement allows Public Health to carry out promotion and prevention programs by leveraging community forces. This study shows that one of the most important ingredients to make it work is the active presence of the Public Health professionals acting as community coaches.