Academic journal article Journal of Health Population and Nutrition

Improving Health Outcomes through Community Empowerment: A Review of the Literature

Academic journal article Journal of Health Population and Nutrition

Improving Health Outcomes through Community Empowerment: A Review of the Literature

Article excerpt


Empowerment, the means to attaining power, is described here in the broadest sense as the process by which relatively powerless people work together to increase control over events that determine their lives and health. Most definitions give the term a positive value that embodies the notion of empowerment coming from within an individual or group (1,2). The essence of empowerment is that it cannot be bestowed by others but must be gained by those who seek it. Those who have power or have access to it, such as a health practitioner, and those who want it, such as their clients, must work together to create the conditions necessary to make empowerment possible. In this paper, the term 'practitioner' has been used for describing the range of population, health and nutrition professionals, who in their everyday work, have an opportunity to help empower individuals, groups, and communities.

Community empowerment is a process that involves continual shifts in power relations between different individuals and social groups in society. It is also an outcome and, in this form, can vary, for example, as a product of the redistribution of resources and decision-making authority (power-over) or as the achievement of an increased sense of self-determination and self-esteem (power-from-within) (3). But it is most consistently viewed in a programme context as a process in which individuals, groups, and communities progress towards more organized and broadly-based forms of social action. This is a rather linear interpretation of what is a very dynamic process but it does help clarify the way in which different people, who have a shared interest, can come together to progressively gain more power. This can be to address the underlying social, structural and economic conditions that impact on their health or their immediate needs, such as improving access to recreational facilities (4) or improving the condition of rented housing (5). In a programme context, the role of the practitioner is to create opportunities to help others gain more power-over the determinants of health, and this often involves a process of capacity-building.

The link between empowerment and health outcomes

In the literature on community psychology, empowerment is seen to enhance individual competence and self-esteem which, in turn, increase perceptions of personal control which has a direct effect on improving health outcomes (1). This argument can be extended to include an individual's connectedness with other people and their participation in groups and communities of interest who wish to gain more power with the intent of bringing about changes in their external environment (6).

In the literature on community health, empowerment is generally viewed as a process beginning with individual action and then the development of small mutual groups, community organizations, partnerships, and ultimately social and political actions (7,8). Power is seen as a finite entity. Communities can only possess X amount of power (control over resources and decision-making) to the extent that another group has an absence of an equivalent amount. It is, therefore, a 'win/lose' situation. Power is also resource dependent in that it can be used as a lever for raising the position of one person or group, while simultaneously lowering it for another person or group (9). The literature on community health recognizes that many inequalities in health are a result of power relations that have an effect on the distribution of resources and the development of policy. People attaining the power they need to redress inequalities can bring about social and structural changes, and community empowerment is often the process they use to do this (10).

Community-based empowerment initiatives that lead to improvements in health outcomes have focused largely on environmental changes. These often have an immediate impact on behaviours that are measurable during the time period covered by the intervention (11). …

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