Serving as an Associate Professor at the University of Miami, Dr. Eric C. Brown directs the Implementation Science track for the Department’s Ph.D. program in Prevention Science. Brown’s background in international studies and research design makes him uniquely suited to develop, implement, and assess community and education-based preventive interventions throughout North America and South America. Spanning from 1995 to 2023, Brown’s publications have expanded in terms of discipline and participant demographics, with many of his recent works assessing community-based programs' ability to mitigate public health issues within Latin America. Admittedly, this interest stems from a cultural connection he inherited through his Colombian mother. Visiting Colombia firsthand, Brown witnessed vast inequalities in the distribution of services and power. His following trips throughout elementary, junior, and high school continue to drive his work. I found Brown’s passion for prevention science fascinating, even more so when I discovered he has implemented different strategies in larger communities facing inequity. Whether in or outside of Latin America, communities continue to struggle with violence, corruption, or drug use. Consequently, it is essential to improve our understanding of existing community-based prevention strategies. Brown generously agreed to an interview in which I asked for community outcomes and methodological specifics.

Abby: Could you give me an overview of preventative science, given that it is an emerging field within Public Health?

Preventive science aims to answer questions like, “Can we take any precautions to prevent diseases from occurring?” Brown explains that within preventative science, there is a niche area referred to as implementation science. In the case of COVID-19, the vaccine was discovered at a record-breaking pace. Ultimately, the failure was found in implementing the vaccine, as public health professionals were unprepared for the public to object to the vaccine for fear of their health. This was a result of numerous factors, including misinformation. Individuals in rural and marginalized communities often did not have access to the vaccine due to language barriers or an inability to overcome the distance to vaccination sites. Brown notes that these disparities—the same systemic barriers that shape people’s access to basic care—mirror inequities seen across other fields of health, including maternal health. When communities lack equitable implementation systems, public health interventions, whether vaccines or prenatal screenings, fail to reach those most vulnerable.

Abby: From your implementation science research, I have gathered that you are familiar with the Communities That Care (CTC) prevention system. CTC uses community tools to address specific issues and encourage prevention, which community stakeholders oversee. What was the selection process for choosing stakeholders? And why did you decide to make them such a pivotal part of the prevention program?

After obtaining his PhD, Brown contributed to a study by a principal investigator, Jay David Hawkins. Hawkins founded the CTC alongside Richard F. Catalano. The research Brown conducted alongside Hawkins involved communities at large rather than a specific institution, like a prison, to gauge the pressing concerns of a more diverse group. The core element in this work was the creation of a coalition, or individuals who work alongside one another to pursue a mutually beneficial goal. These coalitions exist to provide the larger community with the skills and resources needed to mitigate the pressing issues identified earlier in the research. Serving as stakeholders, the selected coalition is comprised of students, teachers, media, local businesses, press, youth recreational leaders, and faith-based organizations alike. Essentially, various pillars of society combine to represent the community via a targeted coalition tech network. Empowering these groups is simple, with researchers guiding the coalition's choices to ensure they are based in science and likely to benefit the community.

This participatory approach directly opposes top-down forms of public health practice tied to structural inequity. In the context of obstetric racism, prevention science offers a model for shifting from institutional paternalism to community-informed systems that hold power-hierarchies accountable. By training local coalitions to collect and interpret their own data, Brown’s model parallels the work of maternal health advocates who emphasize lived experience as evidence—pushing against the medical neglect and mistrust historically imposed on Black and Brown birthing individuals.

Brown notes that CTC’s success lies in avoiding “helicopter research,” or research that enters a community and departs without structural change. This caution is crucial when mapping parallels to obstetric racism, where medical systems repeatedly extract data and experiences from marginalized mothers without improving their conditions of care.

This has proven effective, as Brown notes the results from a community-randomized trial found significant changes in communities that use CTC versus those that did not. One Colombian community that utilized CTC was aided in the collection and interpretation of data, all of which led the coalition to discover that the elected mayor failed to improve the community as they had claimed during their election four years prior. In empowering the coalition, researchers taught the community to advocate for themselves using science-based research. Brown is unaware of how the mayor responded, given that CTC discourages interactions with research once a study is concluded.

Ideally, all studies result in limited contact with the coalitions empowered to effectively foster independence and long-term success. Researchers continually receive updates on the progress of each community to measure the sustainability over long periods, however. These updates are three to five years following a research team’s interaction with a community, and detail the number of positions that exist within the coalition and the frequency and activity of the coalition. Take the COVID-19 vaccine, for instance. While effective, the vaccine required that the patient get repeated booster shots to continue its success. Similarly, equitable systems—whether for infection or reproduction—require sustained resources, not one-time interventions.

Abby: Throughout the updates you have received, would you say the majority of the communities that participate in CTC continue to implement coalitions and community-based empowerment?

Unfortunately, Brown maintains that communities fail to continue coalition implementation due to more pressing concerns. Gang violence and political corruption are rampant in a portion of the communities CTC has been introduced to. Such structural violence leads to an unequal distribution of resources, with gangs producing and selling illegal substances to maintain an influx of wealth within a community, thus causing a coalition to fail.

Structural violence, as Brown describes, parallels the systemic neglect embedded in obstetric care systems. Obstetric racism—manifested through bias, lack of accountability, and unequal access to quality maternity care—is another form of structural violence that implementation science seeks to dismantle by strengthening community self-advocacy. Brown’s emphasis on empowering coalitions to identify and solve their own problems offers a preventative framework that could similarly transform maternal health outcomes by centering community-defined interventions over institutional control.

Struggling communities can be aided in numerous ways, such as decreasing risk factors for drug and alcohol use. Low community attachment is one factor that contributes to the increased risk of substance use. Other factors, like poverty, can be mitigated given that one is in a bonded community. If an individual is not able to bond with their community, it is difficult to mitigate other contributing factors. In Havana, Brown explains that a community suffered from this exact problem. Following a survey, the research team found that the low levels of community involvement stemmed from immigrants struggling to connect with the larger population. To aid these connections, the team provided numerous community-based activities and resources, including bike riding, street parades, matching apparel, and youth classes.

These same principles—connection, coalition, and continuity—apply to correcting obstetric racism. The practice of empowering local leaders and care stakeholders offers a roadmap for culturally competent intervention in maternal care, allowing communities to reclaim agency and develop solutions rooted in trust, belonging, and prevention. Communities, whether institutions like hospitals or neighborhoods at large, can improve with empowerment and guidance from research teams. In providing average citizens, like students or religious leaders, with resources and education, they can identify areas of concern and address said areas independently. This, in turn, fosters sustainability and allows for a community to flourish over extended periods.