Health Promotion Practice: Building Empowered Communities

Health Promotion Practice: Building Empowered Communities

Health Promotion Practice: Building Empowered Communities

Health Promotion Practice: Building Empowered Communities

Excerpt

I grew up in a single-parent family at the bottom of the social and economic gradient and draw on my personal experiences in Chapter 3. My work in public health and health promotion over the past 25 years has always been with those who have to suffer the consequences of poverty and inequality. Throughout my life I have observed the powerlessness of others or have myself been directly affected by those who have power over my health and its determinants. This will continue to motivate me to write about and to work with people who struggle to gain power.

The idea for this book began when I was working on a school health promotion programme in southern India. It was typically top-down with control over decisions and resources taken by an outside agent that also designed, implemented and evaluated the programme. This created an imbalance in power and a continual struggle for control between the Indian authorities and the outside agent. The parties involved were bound by the bureaucratic procedures imposed by the conditions of funding, lines of management and the ‘milestones’ imposed for meeting outcomes. The outside agent would not relinquish control because it was concerned with the effectiveness (costs and targets met) and accountability of the programme. This situation increasingly frustrated the Indian counterparts, who as the recipients felt that they already had the necessary skills and competencies to implement the programme.

At the time I strongly believed that there had to be a practical solution to reconcile these differences and my opportunity came when I went to Australia to begin my research on empowerment. My aim was to understand how programmes could be an empowering experience for the intended beneficiaries by strengthening their capacity. To achieve this I would have to tread a fine line between theory (academic excellence) and practice (pragmatism), to produce something that was rigorous and useful to the stakeholders of health promotion programmes. I began by unpacking the concept of community empowerment into its individual components. This involved a rigorous process of review and led to the categorization of what I termed the ‘empowerment domains’, discussed in Chapter 5.

I now had a theoretically and empirically ‘rich’ basis for the development of an approach to empower communities and carried out its field-testing in Fiji. This worked well and I was also able to develop the idea of ‘parallel . . .

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