Community empowerment: What is its role in improving health in the Nordic countries? Glenn Laverack

Empowerment Individual Organisational Family Community

Empowerment: The Means to Attaining Power Community empowerment is (David Werner, 1988): ‘a process by which disadvantaged people work together to increase control over events that influence their lives’. Social, cultural, environmental, economic and political.

Social and Political Change Social change exerts influence over the nature of social behaviour or relations within society. Values and behaviours. Political change exerts influence over the actions of organizations, institutions and civil society. Policy and legislation.

The Continuum of Collective Empowerment 1 2 3 4 5 <-- ---------- ------------- ------- ------- ----> Action for Social & Political Change Personal action Small groups Community organisations Partnerships 5

Local Health Profiles Community safety. Anti-social behaviours. Shabby environment. Unemployment/low income. Public transport. Housing standards. Heating. Social exclusion. (Wanless, 2003; Liew, 2007) Random household survey – low socio economic area. 6

Government Health Profiles Obesity (Exercise & Diet). Cancers. Violence & Injury (Domestic violence and abuse). Dangerous Consumptions (Gambling, Alcohol, Drugs, smoking). National Security. (Wanless report, 2002)

The Saskatoon ‘In Motion’ Programme A 3-5 year plan to increase physical activity in urban and rural communities in Saskatchewan, Canada. Used public awareness, education and motivational strategies targeting individuals for behaviour change. In Saskatoon 57% people surveyed said that they had seen, heard or read about the ‘in motion’ programme. 18% surveyed said that the ‘in motion’ messages had led to them definitely thinking more about physical activity. 30% said they had become more active. However, overall 49% had no change in physical activity and 14% had become less active & 7% unsure (SRHA, 2005). No influence on low socio-economic, adolescents, indigenous people and ethnic minority groups

Marginalisation `subordinate segments of society that have special physical or cultural traits and are held in low esteem by dominant segments of society. They do not feel themselves to be members of society but as objects of discrimination having been singled out by others in society, or by those in positions of power, for unequal treatment` Simpson and Springer, 1965

Working with marginalised groups Ethnicity Indigenous peoples Age Religion Economic status Disability Sexual preference Migration

Rosengård, Malmö Rosengård is home to 25,000 of Malmö`s 300,000 population Of 1200 students in the secondary school- 8 are native Swedes Unemployment is 30% (Herrgården 90%) High population of migrants, High population of muslims, sharia law practised.

Empowerment challenges of working with marginalised groups To develop and maintain trust. Fair, equitable and open partnerships. To help identify the groups` own power base to build from a position of strength. How to assist members to organise and mobilise themselves collectively. How to create an adequate (sustained) resource base for action.

Working with migrants

Working with Chinese migrants By 2020 15% of NZ population will be Asian and by 2016 some urban areas will be 34% Asian. Injury is a leading cause of premature death and disability in the Asian population. Most common accidents are falls and road traffic accidents. Asians have a compensation claim rate well below the national average (4.6 Asian popn). (Tse, Laverack, Nayar and Foroughian, 2010).

Chinese migrant issues Resettlement and relocation issues. Lack of communication. Community readiness. Community capacity.

Guidelines to engage with Chinese Migrants Listening and communication. Community involvement. Needs assessment. Working in partnerships. Building community capacity. Monitoring and evaluation. Learning lessons.

The role in improving health People address their concerns in regard to health when others do not or cannot. Engages with and helps to empower marginalised groups in society. Allows health programming to mobilise people towards collective action to improve their health.

Research and Development PEOPLE PRACTITIONERS POLICY MAKERS Beneficiaries, Civil Society Organisations, participants, target audiences. The `bridge` between government and civil society. Who are the policy makers? Can practitioners or people influence policy?

Research and Development PEOPLE PRACTITIONERS POLICY MAKERS Effective approaches to engage with marginalised groups. Professional competencies to facilitate the empowerment of people at all levels. Scaling up successful bottom-up approaches. Evidence of the link between empowerment, the determinants of health and health outcomes.

grlavera@hotmail.com