Empowerment in Health Promotion.

[hamid]

Dear All,

I am delighted to officially launch the forum on empowerment in health promotion. This interesting topic has been proposed by Glenn Laverack, and I am Hamid Benalia and will try to manage this forum.

I would like that people with different perspectives and backgrounds contribute to this forum and it would be great if people could introduce themselves with their name, area of work or study and the name of their organization.

I am myself doing a PhD at King’s College London in health promotion & education as well as working for the NHS as Co-ordinator of an Exercise referral programme.

Some background to start our discussion:

“In 1986 the Ottawa Charter identified community empowerment as being a central theme of health promotion discourse. Community empowerment became a topical issue in the health promotion literature soon afterwards, though its roots also come from earlier literatures in community psychology, community organizing, and liberation education. Subsequent international conferences to address health promotion in Sundsvall, Adelaide and Jakarta, have acted to reinforce this concept. It is as relevant today as it was more than a decade ago. The literature surrounding health promotion has since moved onto other overlapping theoretical perspectives such as community capacity and social capital. And yet the critical issue of making community empowerment operational in a programme context remains thorny and elusive.”

Questions we are looking to explore in this context are:

• What is empowerment?
• Why is community empowerment core to health promotion theory and practice?
• Why is community empowerment crucial to the future success of health promotion programming?
• What other concepts overlap with and are relevant to empowerment and health promotion?

Some reading:
Labonte, R. (1994) "Health Promotion and Empowerment: Reflections on
Professional Practice." Health Education Quarterly 21(2): 253-268.

Labonte and Laverack (2008) Health Promotion in Action: From Local to
Global Empowerment. London. Palgrave Macmillan.
http://www.palgrave.com/products/title.aspx?PID=276270

Laverack, G. (2005) Public Health: Power, Empowerment & Professional
Practice. London. Palgrave Macmillan.
http://www.palgrave.com/newsearch/Catal ... 1403945608

Laverack (2007) Health Promotion Practice: Building Empowered
Communities. London. McGraw-Hill.
http://www.mcgraw-hill.co.uk/html/0335220576.html

Rissel, C. (1994) "Empowerment: the holy grail of Health Promotion?"
Health Promotion International 9(1): 39-47.

Wallerstein, N. (1992) "Powerlessness, empowerment and health.
Implications for health promotion programs." American Journal of Health
Promotion 6(3): 197-205.

Looking forward to your thoughts.

Hamid Benalia

[glenn.laverack]

Thx Hamid. All comments and other questions around the topic of empowerment - in its various forms - are welcome - especially from those working in the field and struggling with how to implement or measure this concept.

Glenn Laverack.

[glenn.laverack]

Is community empowerment a wothwhile strategy in HP programmes?
EG. The evidence that community based actions actually do influence health policy is weak- rather than just having a localised (NIMBY) effect.

The use of petitions, lobbying and even demonstrations have a diluted effect. Communities need to be able to access the internal process of policy making -which is difficult to do. The best that they can hope for is to raise the profile of an issue to such an extent that someone in a position of influence will act as the 'champion' for their cause. Why should HPs bother trying to mobilise communities if the level of influence that they can have is minimal - if any at all?

Any comments?

[mduggan]

Surely by 'mobilising communities' in the first place, this is raising the awareness of health promotion and allowing 'these communities' to access part of the policy making process by providing them with an opportunity to take some responsibilty, be heard, to join in if they so wish.

[glenn.laverack]

In a passive way yes. But HP/PH has placed too much emphasis on participation - and to what end? Does participation improve health outcomes (eg. through influencing health policy) there is very little evidence to support this.

Do 'communities' really have an opportunity to access the policy making process - do governments/policy makers really listen and respond to what communities want? For example, it took many years for policy/legislation on smoking to be introducted long after we had evidence of its harmful effects and after strong public opinion to prevent passive smoking. This battle still goes on.

As HPs we have to be more activist in our thinking and actions and less willing to accept the status quo.

[Torill.Bull]

Interesting.

Do you think level of policy making is important here? And maybe also the definition of health policies? I mean, we do see examples in my local area of neighbourhoods actually influencing local health relevant policies, when it comes to traffic, for instance, and new waste handling procedures (reducing toxins released into surburban environment). Of course, the health effects have not been measured...

I like the idea of activism. How would you define activism as opposed to community empowerment, or rather, how would the relationship between them be?

Torill Bull
Research Centre for Health Promotion, Bergen, Norway
ISECN

[glenn.laverack]

That is true. We do have more examples of community-based actions influencing local policy-including health related policy. But level is important and I am thinking of broader policy (national and international) on health. A NIMBY action group might be quite successful at changing policy and local by-laws on for say banning the sale of fast foods in hospitals or dog fouling and dog control in a local public space. But how does this benefit others elsewhere in the country - this is about inequality and access and the distribution of power. So my focus is on influencing this broader policy dimension.

Activism is associated with direct and fast actions, both violent and non-violent to influence the policy development cycle. The process of community empowerment ie. the continuum of community empowerment is one framework that can encompass these actions. The 2 closely overlap therefore and the difference in the relationship is more in the methods/ strategies employed to achieve the same desired outcomes- social and political change in favour of those undertaking those actions. In HP we have not pursed activist methods with which other sectors have had great success ie. the rights movements and environmentalists.

Is there scope within HP to be more activist? If we want to position ourselves as key players in addressing inequality and the determinants of health I would argue that as a profession we must.

[Torill.Bull]

Again, interesting!

I am thinking while I'm writing here, and have more questions than well-funded opinions!

So, it is about getting away from 'niceties'. I think this strongly relates to the themes of ethics and of the use of media/new media, as ISECN is focussing on in two working groups. Web2 could be a way of getting influence at a higher level of policies, as held forwards by Hope Corbin at the IUHPE conference in Turin last September, giving the example of the Obama campaigns in the US. Also, ethics is related to this - both the ethical considerations in actually ACHIEVING change, not just talking about equity, and also the ethical challenge of which activist actions could be, or maybe rather should NOT be, on the list of options for health promoters...

Any suggestions? And how can we most effectively learn from successful organizations, learn to use activism as a tool?

Torill

[glenn.laverack]

The core business of HP is practice. And using a more activist approach to our work does raise potential conflicts of interest. Eg. should i as a gvt employed HPer support the work of action groups wishing to change health policy or legistaion - empowerment is about gaining or ceasing power (control over decisions and resources) from those that already hold it - those in governance/governments. And who largely employs HPers? Governments.

If u want more details about what works and what does not work from an activist perspective in HP and the specific actions that can be undertaken - legitimate or not then I recommend:

Labonte, R. and Laverack, G. (2008) Health Promotion in Action: From Local to Global Empowerment. London. Palgrave MacMillan. Chapters 3 and 4.

[Torill.Bull]

I'll get the book, but it would be interesting to have some opinions in the open here at VHPO! Certainly this must be an issue to discuss??

Torill