Health Promotion Practice; Power and Empowerment. Building Empowered Communities

Dr Viv Speller (Independent Public Health Consultant)

Health Education

ISSN: 0965-4283

Article publication date: 27 February 2007




Speller, V. (2007), "Health Promotion Practice; Power and Empowerment. Building Empowered Communities", Health Education, Vol. 107 No. 2, pp. 237-238.



Emerald Group Publishing Limited

Copyright © 2007, Emerald Group Publishing Limited

Laverack's book aims to elucidate the role of power and politics in health promotion and places empowerment at its heart as a process to address the social determinants of disease. While this provides an interesting perspective on practice, I think the author sets up an oversimplified dichotomy of the views of top‐down and bottom‐up health promotion, which runs throughout the book. While it is true that there are tensions in different approaches to health promotion they are rarely as polarised as this in practice. The descriptions of different forms of health promotion practice used to illustrate this standpoint, appear rather caricatured and do not reflect what many practitioners do who aim to deliver health promotion in an empowering way involving communities, despite or as well as, aiming for behavioural and health outcomes required by policy‐makers and funders. Possibly this is because the examples given, and much of the literature sourced is fairly dated – mostly from the mid‐1990s.

Although the author's views, and that of Labonte, are extensively cited, the theoretical basis of many of the fields of health promotion and the methods discussed are generally not adequately reviewed. So, for example, despite their obvious relevance, the importance of psychological constructs such as self‐efficacy and self‐esteem are glossed over. Similarly, although mentioned, little attention is paid to “classic” health promotion models, such as Precede‐Proceed, which also concern themselves with action on social determinants and involving and building capacity in communities. Social capital is also only briefly considered, and the distinctions claimed between the elements of social capital and empowerment is not well rehearsed.

In the section on evaluation, more detail could have been given on how to evaluate empowerment, what measures can be used as outcomes for example? When considering whether top‐down or bottom‐up programmes work only single studies rather than review sources are arbitrarily selected to illustrate failure and success respectively. This is then compounded by a quite classic error of comparing failure in achieving behavioural change outcome with apparent success in change in attitudinal and knowledge measures from the empowering approach quoted. A final criticism of the discussion of the section on evaluation is that there is scant mention of research methods that are sympathetic to the arguments for empowerment espoused. It would have been helpful to see discussion on approaches such as participatory research and realistic evaluation for example.

In contrast the chapter on power transformation provides a useful and detailed description of different forms of power relations, an area not often covered in such depth. This may provide food for thought for practitioners to reflect upon the relative positions of “power‐over” rather than “power‐with” they may find themselves in, in routine practice. The book also contains many useful examples of case studies of empowerment in communities in different parts of the world, which would be illustrative to students. Similarly the rather partisan perspective of the arguments proposed could provide useful prompts for informed discussion and debate on the role of empowerment in effective health promotion practice.

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