Community Engagement Definitions And Organizing Concepts -PDF Free Download

Community Engagement Definitions and Organizing Concepts

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Community Engagement: Definitions and Organizing Concepts from the Literature During the past two decades, researchers have provided evidence to support the notion that the social environment in which people live, as well as their lifestyles and behaviors, can influence the incidence of illness within a population (IOM, 1988). They have also ...



communities at any one time When initiating community engagement efforts one must be
aware of these complex associations in deciding which individuals to work with in the targeted
From a sociological perspective the notion of community refers to a group of people united by
at least one common characteristic Such characteristics could include geography shared
interests values experiences or traditions John McKnight a sociologist once said that if one
were to go to a sociology department in search of a single simple definition of the word
community one would never leave To some people it s a feeling to some people it s
relationships to some people it s a place to some people it s an institution CBC 1994
Communities may be viewed as systems composed of individual members and sectors that
have a variety of distinct characteristics and interrelationships Thompson et al 1990 These
sectors are populated by groups of individuals who represent specialized functions activities or
interests within a community system Each sector operates within specific boundaries to meet
the needs of its members and those the sector is designed to benefit For example schools
focus on student education the transportation sector focuses on moving people and products
economic entities focus on enterprise and employment faith organizations focus on the spiritual
and physical well being of people and health care agencies focus on prevention and treatment
of diseases and injuries In reality these sectors are a few of the many elements that comprise
the overall community system
A community can be viewed as a living organism or well oiled machine For the community to
be successful each sector has its role and failure to perform that role in relationship to the
whole organism or machine will diminish success In a systems view healthy communities are
those that have well integrated interdependent sectors that share responsibility to resolve
problems and enhance the well being of the community It is increasingly recognized that to
successfully address a community s complex problems and quality of life issues it is necessary
to promote better integration collaboration and coordination of resources from these multiple
community sectors
One useful way to describe the community and its sectors is through a technique known as
mapping Kretzmann et al 1993 As shown in the following diagram someone interested in
describing the bounds of a community can map it by identifying primary secondary and
potential building blocks or human and material resources Each of these resources has assets
that can be identified mobilized and used to address issues of concern and bring about
Again from the systems perspective another way to understand and describe a community
might involve exploring factors related to
People socioeconomics and demographics health status and risk profiles cultural and ethnic
characteristics
Location geographic boundaries
Connectors shared values interests motivating forces
Power relationships communication patterns formal and informal lines of authority and
influence stake holder relationships resource flows
Adapted from VHA 1993
Similarly we can define the community from a broader sociological perspective by describing
the social and political networks that link individuals and community organizations and leaders
Understanding the nature and boundaries of these networks is critical to planning engagement
efforts For example tracing individuals social ties may help those who are initiating a
community engagement effort to identify leaders within a community understand community
patterns identify high risk groups within the community and strengthen networks within the
community Minkler 1997
Beyond the collective definitions of community that researchers and organizers can apply an
individual also has her or his own sense of community membership The presence or absence
of a sense of membership in a community may vary over time and is likely to influence
participation in community activities This variation is affected by a number of factors For
example persons at one time may feel an emotional cultural or experiential tie to one
community at another time they might believe they have a contribution to make within a
different group At yet another time they may see membership in a third distinct community as a
way to meet their own individual needs Chavis et al 1990 Of course they may also have this
sense of belonging to more than one community at the same time Before beginning an
engagement effort it is important to understand that all these potential variations and
perspectives may exist and influence the work within a given community
Concepts of Community Engagement
The CDC ATSDR Committee for Community Engagement developed a working definition of
community engagement Loosely defined community engagement is the process of working
collaboratively with and through groups of people affiliated by geographic proximity special
interest or similar situations to address issues affecting the well being of those people It is a
powerful vehicle for bringing about environmental and behavioral changes that will improve the
health of the community and its members It often involves partnerships and coalitions that help
mobilize resources and influence systems change relationships among partners and serve as
catalysts for changing policies programs and practices Fawcett et al 1995
In practice community engagement is a blend of social science and art The science comes
from sociology political science cultural anthropology organizational development psychology
social work and other disciplines with organizing concepts drawn from the literature on
community participation community mobilization constituency building community psychology
cultural influences and other sources Several of these concepts from the social science
literature are presented here The equally important artistic element necessary to the process
however involves using understanding skill and sensitivity to apply and adapt the science in
ways that fit the community and purposes of specific engagement efforts
Insights from the Literature
Studies of participation in voluntary and community organizations have allowed social scientists
and other researchers to develop organizing concepts about communities and the ways in
which they are mobilized Florin et al 1990 Fawcett et al 1995 Hanson 1988 89 Thompson
et al 1990 Findings in the literature have helped to shed light on why community engagement
is useful and how we can engage people to most effectively address public health issues What
follows are brief descriptions of some of the organizing concepts found in the literature that
guide approaches to successful community engagement Additional resources on these and
other concepts not included here may be found in the Bibligraphy
Social Ecology
Social ecological theories provide insight into elements of individuals lives that contribute to
health promotion Such theories seek to describe the concept of community in terms of a
dynamic interplay among individuals groups and their social and physical environments
Stokols 1996 p 286 Researchers in this area help to integrate approaches to disease
prevention and health promotion which focus on modifying individual health behaviors with
environmental approaches which focus on the physical and social environment From the
social ecology perspective the potential to change individual risk behavior is considered within
the social and cultural context in which it occurs Interventions that are informed by this
perspective are directed largely at social factors such as community norms and the structure of
community services including their comprehensiveness coordination and linkages in addition
to individual motivations and attitudes Goodman et al 1996 p 34
Social ecology theory as it informs health promotion suggests that community engagement
efforts need to be focused at multiple levels 1 individuals 2 social network and support
systems 3 the range of organizations that serve and influence individuals and the rules and
regulations that these organizations apply 4 the community including relationships among
organizations institutions and informal networks and 5 public policy regulations ordinances
and laws at the state and national levels Goodman et al 1996 p 35
Several core concepts summarize the contributions of social ecology theories to community
engagement efforts Stokols 1996 p 285 286
Health status emotional well being and social cohesion are influenced by the physical social
and cultural dimensions of the individual s or community s environment and personal attributes
e g behavior patterns psychological dispositions genetics
The same environment may have different effects on an individual s health depending on a
variety of factors including perceptions of ability to control the environment and financial
Individuals and groups operate in multiple environments e g workplace neighborhood larger
geographic communities that spill over and influence each other
There are personal and environmental leverage points that exert vital influences on health
and well being
Cultural Influences
The literature on cultural influences suggests that health behaviors are influenced directly by
elements of one s culture As a result social norms and other elements of community culture
provide a potential tool for disease prevention and health promotion Culture involves the
integrated pattern of human knowledge belief behavior and material traits characteristic of a
social group Braithwaite et al 1994 p 409 Another way to understand this concept is to
think of culture as the luggage we always carry with us the sum of beliefs practices
habits likes dislikes norms customs rituals that we have learned from our families
Spector 1985 p 60 Cultural identity influences the group s design for living the shared set
of socially transmitted perceptions about the nature of the physical social and spiritual world
particularly as it relates to achieving life s goals Airhihenbuwa 1995 p 5 Therefore those
who wish to work with community members should carefully examine the differences and
similarities in cultural perceptions so that engagement activities are appropriate for that
particular cultural context This appropriateness often referred to as cultural sensitivity means
that programs are developed in ways that are consistent with a people s and community s
cultural framework Airhihenbuwa 1995 p 7
An individual s culture influences his or her attitude toward various health issues including
perceptions of what is and is not a health problem methods of disease prevention treatments
for illness and use of health providers As Spector 1985 p 59 notes We learn from our own
cultural and ethnic backgrounds how to be healthy how to recognize illness and how to be ill
meanings attached to the notions of health and illness are related to basic culture bound
values by which we define a given experience and perceptions Individuals initiating community
engagement activities should understand belief systems held by community members
especially if they are different from their own Cultural experiences also can influence how
individuals and groups relate to each other and to people and institutions of other cultures
Efforts to address these elements of a community could concentrate on affecting the landscape
of information and ideas in which that community operates
Community Participation
Concepts concerning community participation offer one set of explanations as to why the
process of community engagement might be useful in addressing the physical interpersonal
and cultural aspects of individuals environments The real value of participation stems from the
finding that mobilizing the entire community rather than engaging people on an individualized
basis or not engaging them at all leads to more effective results Braithwaite et al 1994
Simply stated change is more likely to be successful and permanent when the people it
affects are involved in initiating and promoting it Thompson et al 1990 p 46 In other words
a crucial element of community engagement is participation by the individuals community
based organizations and institutions that will be affected by the effort
This participation is a major method for improving the quality of the physical environment
enhancing services preventing crime and improving social conditions Chavis et al 1990
p 56 There is evidence that participation can lead to improvements in neighborhood and
community and stronger interpersonal relationships and social fabric Florin et al 1990 Robert
Putnam notes that social scientists have recently unearthed a wide range of empirical
evidence that the quality of public life and the performance of social institutions are powerfully
influenced by norms and networks of civic engagement Moreover researchers in education
urban poverty and even health have discovered that successful outcomes are more likely in
civically engaged communities Putnam 1995 p 66 For example Steckler s CODAPT model
for Community Ownership through Diagnosis Participatory Planning Evaluation and Training
for Institutionalization suggests that when community participation is strong throughout a
program s development and implementation long term program viability i e institutionalization
is more likely assured Goodman et al 1987 88
The community participation literature suggests that
People who interact socially with neighbors are more likely to know about and join voluntary
organizations
A sense of community may increase an individual s feeling of control over the environment
and increases participation in the community and voluntary organizations
Perceptions of problems in the environment can motivate individuals and organizations to act
to improve the community Chavis et al 1990
When people share a strong sense of community they are motivated and empowered to
change problems they face and are better able to mediate the negative effects over things
which they have no control Chavis et al 1990 p 73 write Moreover a sense of community
is the glue that can hold together a community development effort Chavis et al 1990 p 73
74 This concept suggests that programs that foster membership increase influence meet
needs and develop a shared emotional connection among community members Chavis et al
1990 p 73 can serve as catalysts for change and for engaging individuals and the community
in health decision making and action
Community Empowerment
The literature suggests that a critical element of community engagement relates to
empowerment mobilizing and organizing individuals grass roots and community based
organizations and institutions and enabling them to take action influence and make decisions
on critical issues It is important to note however that no external entity should assume that it
can bestow on a community the power to act in its own self interest Rather those working to
engage the community can provide important tools and resources so that community members
can act to gain mastery over their lives
Empowerment takes place at three levels the 1 individual 2 organizational or group and 3
community levels Rich et al 1995 Fawcett et al 1995 Empowerment at one level can
influence empowerment at the other levels Fawcett et al 1995 At the individual level it is
generally referred to as psychological empowerment McMillan et al 1995 Rich et al 1995
Individual level empowerment can be described along three dimensions 1 intra personal an
individual s perceived personal capacity to influence social and political systems 2
interactional knowledge and skills to master the systems and 3 behavioral actions that
influence the systems Rich et al 1995 This concept of psychological empowerment has been
found to relate to an individual s participation in organizations the benefits of participation
organizational climate and the sense of community or perceived severity of problem
At the group or organizational level the literature distinguishes between 1 empowering
organizations which facilitate confidence and competencies of individuals and 2
empowered organizations which influence their environment Rich et al 1995 The degree to
which an organization is empowering for its members may be dependent upon the benefits
members receive and organizational climate as well as the levels of commitment and sense of
community among members McMillan et al 1995
Community level empowerment i e the capacity of communities to respond effectively to
collective problems occurs when both individuals and institutions have sufficient power to
achieve substantially satisfactory outcomes Rich et al 1995 Individuals and their
organizations gain power and influence by having information about problems and an open
process of accumulating and evaluating evidence and information Rich et al 1995 p 669
Empowerment involves the ability to reach decisions that solve problems or produce desired
outcomes requiring that citizens and formal institutions work together to reach decisions Rich
et al 1995
Capacity Building
Another set of organizing concepts that can help guide approaches to effective engagement
involves the process of capacity building In essence the literature on capacity building states
that before individuals and organizations can gain control and influence and become players
and partners in community health decision making and action they may need resources
knowledge and skills above and beyond those they already bring to a particular problem
Fawcett et al 1995 Participation in community engagement efforts can offer people the
possibility of developing these skills
The kind and intensity of capacity building that may be needed to sustain community
engagement efforts is not entirely known too often community leaders can be caught up in
selling the engagement effort without an accurate idea of the resources needed to actually
support it over the long term Florin et al 1993 For example people and organizations in the
community might need technical assistance and training related to developing an organization
securing resources organizing constituencies to work for change participating in partnerships
and coalitions conflict resolution and other technical knowledge necessary to address issues of
concern to the community
Coalitions
Engaging the community will very often involve building coalitions of diverse organizations A
community coalition can be defined as a formal alliance of organizations groups and agencies
that have come together to work for a common goal Florin et al 1993 p 417 Coalitions are
usually characterized as formal multi purpose and long term alliances that fulfill planning
coordinating and advocacy functions for their communities Butterfoss et al 1993 p 316
318 They can be helpful in a number of ways including maximizing the influence of individuals
and organizations exploiting new resources and reducing duplication of effort While the
literature reveals that coalitions have not been systematically studied and contains little data to
support their effectiveness funding sources have been giving serious commitment to
developing coalitions as an intervention to address health issues Butterfoss et al 1993
The concept of coalition has its roots in political science In parliamentary democracies for
example a coalition government is formed by two or more parties when no single party has a
sufficient mandate to represent the majority In addition in almost all kinds of governments
informal coalitions exist among factions that share general or specific policy or legislative
objectives The types of coalitions that might be necessary for engagement efforts can be
viewed the same way The experience of political theorists suggests that
Coalitions require a perception of interdependence each party must believe it needs help to
reach its goals
There must be sufficient common ground and a clearly articulated mission or purpose so the
parties can agree over time on a set of policies and strategies
At the same time coalition members typically have primary goals and perspectives that are
distinct if not conflicting they agree on some issues but disagree on others
Coalitions require continuous and often delicate negotiation among participants
The distribution of power and benefits among coalition members is a major focus of ongoing
concern each member needs to believe that over time he or she is receiving benefits that are
comparable to their contributions see discussion on Benefits and Costs below AED 1993
Benefits and Costs
A critical set of organizing concepts involves analysis of the benefits and costs of community
engagement The literature suggests that participants will invest their energy in an organization
only if the expected benefits outweigh the costs that are entailed Butterfoss et al 1993 p
322 It appears that an individual s desire to join and continue a commitment to an engagement
effort depends more on this benefit cost ratio than on his or her demographic characteristics
Wandersman et al 1987 Potential benefits include networking opportunities access to
information and resources personal recognition skill enhancement and a sense of contribution
and helpfulness in solving community problems Costs can run the gamut from the contribution
of time required to lack of skills or resources needed for participation to basic burn out By
identifying the specific benefits and barriers to participation in the engagement effort community
leaders can put the appropriate incentives in place
The social exchange perspective investigates the benefits and costs of participation to help
explain who participates and why The literature has long discussed health related organizations
as being involved in an exchange system whereby they voluntarily share resources to meet
their respective goals or objectives Levine et al 1961 Similarly social exchange occurs
among community members organizations and others to overcome potential costs in an
engagement effort a social exchange takes place in organizations such that participants will
invest their energy into the organization only if they expect to receive some benefits
Wandersman et al 1987 p 538
Community Organization
The community organization literature provides insight on the kinds of engagement activities
that may prove useful This and related concepts offer a path to engagement through a process
by which community groups are helped to identify common problems or goals mobilize
resources and in other ways develop and implement strategies for reaching goals they have
set Minkler 1990 p 257 Organizing activities are a way of activating the community to
encourage or support social and behavioral change Bracht et al 1990 This approach to
bringing about change at the community level is based on principles of empowerment
community competence active participation and starting where the people are Minkler 1990
Labonte and Robertson support the particular importance of starting where the people are by
stating that if we fail to start with what is close to people s hearts by imposing our notions of
health concerns over theirs we risk several disabling effects Labonte et al 1996 p 441
These include being irrelevant to the community exacerbating the community s sense of
powerlessness further complicating individuals lives and possibly channeling local activism
away from broader challenges and into individual level changes
The community organization approach also reflects findings that individuals and communities
1 must feel or see a need to change or learn and 2 are more likely to change attitudes and
practices when they are involved in group learning and decision making Minkler 1990 An
important element of community organizing is helping communities look at root causes of
problems while at the same time selecting issues that are winnable simple and specific can
unite members of the group involve them in achieving a solution and help build the community
or organization Minkler 1990
Community organizing can be an empowering process for individuals organizations and
communities At the individual level community organizing activities provide individuals with the
chance to feel an increased sense of control and self confidence and to improve their coping
capacities Minkler 1990 These have been shown to have physical health benefits Organizing
activities also strengthen the capacity of communities to respond effectively to collective
problems Individuals organizations and communities can be empowered by having
information about problems and an open process of accumulating and evaluating evidence and
information Rich et al 1995 p 669
Stages of Innovation
The concept of stages of innovation can be useful when dealing with the potential differences
that might exist within a community as it changes over time All individuals within a community
are not necessarily at the same stage of readiness to change behaviors This is an important
notion to understand before and during a community engagement effort Rogers offered one of
the earliest formulations of this idea with his 1962 work Diffusion of Innovations In this book he
states that all individuals do not adopt innovations at the same rate or with the same willingness
Stages of innovation in general can help implementors of engagement efforts to match
strategies to the readiness of a community to adopt them In applying these concepts to
community development for example desired outcomes are predicated upon the community
working through a number of phases including raising awareness of the severity of a health
problem transforming awareness into concern for the problem establishing a community wide
intervention initiative and developing the necessary infrastructure so that service provision
remains extensive and constant in reaching residents
General Conclusions about the
Power and Userfulness of Community Engagement
There is a consensus in the literature that engaging and supporting the empowerment of the
community for community health decision making and action is a critical element in health
promotion health protection and disease prevention The impact of programs that target
individual behavior change is often transient and diluted unless efforts are also undertaken to
bring about systematic change at multiple levels of society Braithwaite et al 1994
Scholars have described several trigger activities that might begin the community engagement
process Some of these trigger activities are tied to legislative or program mandates while
others involve special initiatives such as those of public health departments grant makers
health service providers or existing community groups and coalitions Once triggered the
community engagement process itself can take many forms It can range from cooperation
where relationships are informal and where there is not necessarily a commonly defined
structure to collaboration or partnerships where previously separated groups are brought
together with full commitment to a common mission Mattessich et al 1992
The organizational concepts from the literature discussed in this section of the document lead to
a number of general conclusions about what lies at the heart of successful community
engagement efforts These conclusions which follow here provide a useful segue to the
community engagement principles outlined in Part 2
Community engagement efforts should address multiple levels of the social environment
rather than only individual behaviors to bring about desired changes
Health behaviors are influenced by culture To ensure that engagement efforts are culturally
and linguistically appropriate they must be developed from a knowledge and respect for the
targeted community s culture
People participate when they feel a sense of community see their involvement and the issues
as relevant and worth their time and view the process and organizational climate of
participation as open and supportive of their right to have a voice in the process
While it cannot be externally imposed on a community a sense of empowerment the ability
to take action influence and make decisions on critical issues is crucial to successful
engagement efforts
Community mobilization and self determination frequently need nurturing Before individuals
and organizations can gain control and influence and become players and partners in
community health decision making and action they may need additional knowledge skills and
Coalitions when adequately supported can be useful vehicles for mobilizing and using
community assets for health decision making and action
Participation is influenced by whether community members believe that the benefits of
participation outweigh the costs Community leaders can use their understanding of perceived
costs to develop appropriate incentives for participation
The following table based on the social science literature and the above conclusions offers a
set of specific factors that can positively influence the success of community engagement
efforts Planners and organizers of these efforts may find it useful to keep the factors in mind as
they work through the engagement process and apply the principles detailed in Part 2
Factors Contributing to the Success of Community Engagement Efforts
Environmental
History of collaboration or cooperation in the community
Collaborating group and agencies in group seen as leader in community Favorable political
and social climate
Membership
Mutual respect understanding and trust
Appropriate cross section of members
Members see engagement in their self interest benefits of engagement as offsetting costs
Ability to compromise
Process Structure
Members feel ownership share stake in both process and outcome
Every level in each organization in collaborating groups participates in decision making
Flexibility of collaborating group
Clarity of roles and guidelines
Ability to sustain itself in midst of changing conditions
Communication
Open and frequent interaction information and discussion
Informal and formal channels of communications
Goals clear and realistic to all partners
Shared vision
Unique to the effort i e different at least in part from mission goals or approach of member
organizations
Sufficient funds
Skilled convener
Based on a review of the literature and excerpted from Mattessich and Monsey 1992
References
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model In Bracht N editor Health promotion at the community level Newbury Park CA Sage
Publications 1990
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participation and community development American Journal of Community Psychology
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Harris KJ Berkley JY Fisher JL Lopez CM Using empowerment theory in collaborative
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development In Glenwick DS Jason LA editors Promoting health and mental health in
children youth and families New York Springer Publishing Company 1993
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community development insights for empowerment through research American Journal of
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institutionalization case study International Quarterly of Community Health Education 1987
1988 8 1 5 21
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community based interventions for prevention and health promotion approaches to measuring
community coalitions American Journal of Community Psychology 1996 24 1 33 61
Hanson P Citizen involvement in community health promotion a role application of CDC s
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Institute of Medicine National Academy of Sciences Assessing the social and behavioral
science base for HIV AIDS prevention and intervention workshop summary and background
papers Washington DC National Academy Press 1995
Kretzmann JP McKnight JL Center for Urban Affairs and Policy Research Neighborhood
Innovations Network Northwestern University Building communities from the inside out a path
toward finding and mobilizing a community s assets Chicago IL ACTA Publications 1993
Labonte R Robertson A Delivering the goods showing our stuff the case for a constructivist
paradigm for health promotion research and practice Health Education Quarterly
1996 23 4 431 447
Levine S White PE Exchange as a conceptual framework for the study of interorganizational
relationships Administrative Science Quarterly 1961 5 4 583 601
Mattessich PW Monsey BR Collaboration what makes it work a review of research literature
on factors influencing successful collaboration St Paul MN Amherst H Wilder Foundation
McKnight JL Kretzmann J Mapping community capacity Evanston IL Center for Urban
Affairs and Policy Research Northwestern University 1990
McMillan B Florin P Stevenson J Kerman B Mitchell RE Empowerment praxis in community
coalitions American Journal of Community Psychology 1995 23 5 699 728
Minkler M Improving health through community organization In Glanz K Lewis FM Rimer BK
editors Health behavior and health education theory research and practice San Francisco
Jossey Bass Publishers 1990
Putnam RD Bowling alone America s declining social capital Journal of Democracy
1995 6 1 65 78
Rich RC Edlestein M Hallman WK Wandersman AH Citizen participation and empowerment
the case of local environmental hazards American Journal of Community Psychology
1995 23 5 657 676
Rogers EM Diffusion of innovations New York Free Press 1962
Spector RE Cultural diversity in health and illness East Norwalk CT Appleton Century
Crofts 1985
Stokols D Translating social ecological theory into guidelines for community health promotion
American Journal of Health Promotion 1996 10 4 282 298
Thompson B Kinne S Social change theory applications to community health In Bracht N
editor Health promotion at the community level Newbury Park CA Sage Publications 1990
Voluntary Hospitals of America Inc VHA Community partnerships taking charge of change
through partnership Irving TX Voluntary Hospitals of America Inc 1993
Wandersman A Florin P Friedmann R Meier R Who participates who does not and why an
analysis of voluntary neighborhood organizations in the United States and Israel Sociological
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Association Ottawa charter for health promotion an international conference on health
promotion Ottawa Ontario Canada November 17 21 1986
For further information on community collaboration visit the Public Health Practice Program
Office Internet site at www cdc gov phppo or contact Michael Hatcher at Mail Stop K39 4770
Buford Highway N E Atlanta GA 30341 3724 or email mth1 cdc gov


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Thierry Hertoghe L'insuffisance Thyroidienne part 1PDF

Thierry Hertoghe L

e Dr Thierry Hertoghe, 55 ans, consacre sa vie à promouvoir une médecine centrée sur les besoins des patients et basée sur des preuves scientifiques. Il est le fondateur de la Hertoghe Medical School, 7-9, Avenue Van Bever, 1180 Uccle- Bruxelles, en Belgique. Avec un groupe de médecins à la pointe de la recherche, le Dr Hertoghe

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