1. The role of empowerment for health and health promotion
Glenn Laverack
Adelaide, Australia

2. Health Promotion
‘Health promotion is the process of enabling people to increase control over, and to improve, their health’. (Ottawa Charter, WHO, 1986).
‘Health promotion is the process of enabling people to increase control over the determinants of health and thereby to improve their health.’ (Bangkok Charter, WHO, 2005).

3. The Early Reformers Rudolph Virchow (1821-1902)
Silesian miners-causes of poor health were-‘one pathological and the other political’.
Margaret Sanger ( )
A key advocate for women to be able to make decisions about birth control at a time when it was illegal for any woman, even those who were married, to use these methods (in the United States of America).
Rose Kushner ( )
Fought for the right of women to have more control about their own bodies -openly critized the medical profession- advocated that radical mastectomy (in the 1970s) should no longer be the standard procedure in the USA for suspected cases of breast cancer.

4. Expressions of Health
Think of the last time you experienced yourself as “healthy” and jot down a few phrases to express the feeling and the context’ (Labonte, 1993).
Power-from within: Being loved; loving; belonging; happiness; confidence.
Power-over: Being in control; able to the things I want/enjoy.
Power-with: Giving; sharing, caring.

5. Health Promotion
Enables people to increase control (empowerment) over their lives and health (gaining more power).
Health promotion uses a range of communication, capacity building and empowerment interventions to achieve its goals.

6. Empowerment: The Means to ‘increasing control over’
Personal
Organisational
Family
Community/ collective

7. Personal Empowerment
The goal of psychological or personal empowerment is to increase feelings of value and a sense of mastery.
Psychological empowerment integrates perceptions of personal control, a proactive approach to life, and a critical understanding of the sociopolitical environment. It is not individualism but an active engagement in one’s community and the sociopolitical environment.
(Zimmerman, 1995)

8. Collective Empowerment
‘a process by which disadvantaged people work together to increase control over events that influence their lives’ (David Werner, 1988).
It is social organisation and action aimed at addressing an injustice or inequity.
It is used to influence those who hold power and who use it to control other people.

9. Social injustice and inequality
‘Social injustice and health inequality are killing people on a grand scale even though this could be avoided through the redistribution of power from people at the top to those lower down the social gradient’.
(Marmot et al, 2010)

10. Those lower on the social gradient have less financial or social protection and are more vulnerable to policy change.
Transforming inequalities in the distribution of power requires social, political and economic action, for example, on welfare, social services, housing, transport, employment and income.

11. Social change Political change Economic change
Values and behaviours (stigma, societal norms)
Political change
Policy & legislation (minimum wage, taxation)
Economic change
Policy & legislation (welfare and benefits, labour markets)

12. 1 2 3 4 5 <-- ---------- ------------- ------- ------- ---->
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Action for Social & Political Change
Personal action
(adapted from Jackson et al, 1989; Labonte, 1990; Rissel, 1994)
Small groups
Community organisations
Partnerships 12

13. The fight for access to Herceptin®
About 1 in 5 women with breast cancer have tumours that are sensitive to treatment using Herceptin®.
Women’s groups campaigned for NHS Trusts in the UK to fund the use of Herceptin® more widely.
The minimum cost to pay for the treatment was well beyond the means of most women with breast cancer.
The Trusts refused to fund the drug and preferred to wait, for safety concerns, for a decision from the National Institute of Health and Clinical Excellence.
This outraged many women.

14. NICE was then put under pressure to make a quick decision.
The women took actions such as sit-ins outside hospitals and petitions to their MPs.
NICE was then put under pressure to make a quick decision.
Eventually, the success of a high profile court case ensured that Herceptin® was approved for use on the NHS.
(Boseley 2006)

15. An Empowered Community
The existence of functional leadership, established community structures, participation and the ability to mobilize resources are indicative of strong organizational and social abilities and capture the essential qualities of an empowered community.
A link between the inter-personal elements such as individual control and positive relationships and the collective elements such as community capacity, mobilization and action.

16. Community Empowerment
Stakeholder participation.
Problem assessment capacities.
Local leadership.
Resource mobilisation.
Organisational structures.
Links to other organisations and people.
Stakeholder ability to ‘ask why’.
Control over programme management.
Equitable relationship with outside agents.

17. The role in improving health
People can address their concerns in regard to health when others do not or cannot.
To engage with and help individuals and groups to empower themselves.
Mobilises people towards broader collective action to change the circumstances that can lead to an improvement in their health.

18. The Professional Context
Identify your own power base - you cannot help others to empower themselves without first understanding your own power base.
Facilitate others to identify their own power base by mapping, ranking and prioritising their concerns.
Enable others to build their capacity to find the solutions to their concerns.

19. Research and Development
PEOPLE
PRACTITIONERS
POLICY MAKERS
Effective approaches to engage with disadvantaged groups in society.
Professional competencies to facilitate the empowerment of people at all levels.
Evidence of the link between personal empowerment and collective action.
Evidence of the link between empowerment and health outcomes.

20. grlavera@hotmail.com www.conrad-verlag.de