Power Dynamics and Empowerment in Health Promotion - Essay Example

?Power dynamics and empowerment in health promotion through the behavioural change approach Introduction The introduction of health promotion has been defined, first, by the way in which the discussion and language used in regard to health has changed. As the discourse has changed, the shift in responsibility has fallen on the individual so that self-health care has become a part of understanding the nature of health and how it is a daily effort, rather than an effort that is focused on reactions and the help of health care professions. Preventative health attention is now a part of the discourse on health care (Ashcroft 2007). Through behavioural approach theories that support empowerment, health promotion has shifted the way in which health care is considered (Lee 2001). The power dynamics of the relations that are created through health promotion is supported through self empowerment knowledge that allows for changes that create significant health care benefits within a community. Empowering the individual towards better health care is about the language that is used to discuss health and well-being. According to Kerr (2000), the language that was used to discuss health care was first kept under the purview of the health care professional, a sort of territorial discourse that left a gap between the professional and the patient. During the late 1980s, the discourse shifted and began to emphasize the responsibility of the patient for caring for and monitoring their own health. Kerr (2000) discusses the duality of the intentions to both allow self-determination and to seek improvement of health care. According to Jamison (2001, p. 15), “Members of the public are gradually being viewed as “producers” of health care rather than simply “consumers” of health care”. The shift that Kerr (2000) referred to is in the way in which the patient has become involved in his or her own health administration. The language of how health care is considered has shifted from the idea that when a tragedy hits an individual, it is put into the hands of health care professionals; to an understanding that health care is a daily, on-going process in which the individual becomes centrally involved in the process of health. Health care was once a reactionary event after something within the body required attention. The new dialogue is about conscious changes towards health-care behaviours. One of the criticisms that have been made on this new approach is that the ideology of health promotion has shifted the concept of illness into a reflection of character. Being ill can now be seen as a consequence of poor self awareness and attention to the body. Risk, as it relates to health behaviours, is not equated with sin, thus changing the way in which health is considered on a social level. Going to a health professional becomes like an act of confession, the individual admitting culpability in their own ill health, thus having to take social responsibility for the consequences of those risky behaviours. This becomes part of a ‘risk discourse’ which can ultimately make people reluctant to seek out help when it is needed ((Marks, Evans, Willig, Woodall, and Sykes 2006) Health Promotion and Awareness Through efforts to change public awareness and the way in which health care is considered within the framework of culture, the psychology of the community has been an area of interest. Community psychology concerns broad patterns of thought and behaviour that affects the overall public good about a social issue. According to Diller (2011), change that has been necessary towards creating an empowered public where health care is concerned has been a process that has been achieved through community psychology. Those using methods of community psychology do so in order to provide context for understanding issues as they affect a broader population. Rather than creating individual blame and associating disenfranchisement of the individual to the issue, problems are addressed through applications of means of understanding how a greater population is being affected. Through understanding meanings and reactions, the psychology of the community can be shifted towards healthier alternatives. There are considerations that support the goals of health promotion. The assumptions that are made about health promotion is that, first, that good health is an objective that is desired on a universal level. The second assumption is that there is agreement on what it means to be healthy. The third assumption is a bit more complicated in that it is based upon a belief that there is a scientific consensus on what it means to be healthy (Marks, Evans, Willig, Woodall, and Sykes 2006, p. 411). These three assumptions tie the nature of health promotion into a socially relevant concept that can be developed through approaches towards the defining goals. . Three of the primary theories in creating community change are the behaviour change approach, the self empowerment approach, and the collective action approach (Marks, Evans, Willig, Woodall, and Sykes 2006, p. 412). Each of these three approaches has differences in goals with a variety of intervention criteria. Through approaches that are geared towards specific goals, individuated circumstances can be addressed within the same overall goal, thus providing the community with approaches that address their needs. One of these approaches, the behavioural change approach, provides context of the subject of health care promotion as it concerns power dynamics and empowerment. The Behaviour Change Approach The behaviour change approach is defined by a series of criteria in which the problem is addressed. The first criterion is based upon active participation by the patient towards finding ways in which to create problem solving. The behaviour of the client is assessed the conditions that control that behaviour is then measured. Behaviour programs are then created through individual needs. Empirically tested procedures and guidelines are used to stimulate desired behaviours, while decreasing undesired behaviours. Short-term intervention programs with time limits are used to target specific behaviours. Finally, the program is evaluated by both the practitioner and the client in order to adjust and continue forward towards real change (Sundel and Sundel 2005). The power dynamics that are in play within the behavioural change approach are a key to how the success of such a program will be achieved. According to Potvin, McQueen and Hall (2006, p. 172) “health promotion evaluation is contingent upon the power dynamics of the situation”. Health promotion is dependent upon the dynamics of the relationships that are created by health care promoters and their clients, but all is contingent upon the greater influences of government and policies. In order for good health care promotion to exist, the power dynamics must be in harmony for the support of the goals of a program. Without this harmony, the conflict will result in a loss to the community of the benefit of the program. The use of the behavioural change approach can be two different types: the Social Regulationist Approach and the Radical Structuralist Approach. The Social Regulationist Approach is defined by its goal to change the behaviour of individuals. This is in individualist approach which is concerned the with behaviour changes of each individual towards mutual goals. The Social Regulationist Approach attempts to make changes at a social level where governmental and community change is instigated so that improvements in health care are seen at the individual level. The hope is that health promotion happens at both the individual level and the population level in order to provide better overall health within the community (Gard 2000). Power Dynamics An example of how the power dynamic can work against workers who are trying to assert behavioural change dynamics towards a solution to a health care problem can be seen through a case study done in Potvin, McQueen and Hall (2006). The case study concerns workers in a school who were trying to educate the students. The authorities over the school restricted some of the education that was being provided by precluding some of the topics. Therefore, the full extent of the education could not be imparted, thus the promotion of the program was provided with incomplete knowledge. Foucault’s position on power is relevant as the oppressors were also oppressed, thus the dynamic provided for vulnerabilities within the professionals trying to implement the program. Foucault built his theories about power through the idea of relationships as the “wielder’s of power as being just as inextricably caught in its webs as the powerless...relations built consistently into the flows and practices of everyday life, rather than something imposed from the top down” (McHoul and Grace 1993, p. 7). In the case of the school, the power dynamic was built upon the imposition of the school authorities, which trickled into the dynamic of the health promotion staff and the students as they were receptive and the staff was able to provide for their educational needs while working within the framework they had been allowed. Therefore it must be considered that the power dynamic that is most relevant to the promotion of health is through the relationship that is built between the health promoter and the recipient, as it is framed by authority (Manion, Lorimer, and Leander. 2006). Whether that authority be over an institution or through governmental frameworks of law and policy, the promotion of health is constrained through cultural acceptances of the power of the government or the reigning authority within an institution to constrain such promotion for whatever benefits have been deemed appropriate. Empowerment Empowerment, as defined by the World Health Organization, is defined as “enabling people to gain control over their lives” so that they can “identify their own concerns and gain the skills and confidence to act on them” (Naidoo and Wills 2000, p. 98). Naidoo and Wills (2000) identify two types of empowerment. The first is self-empowerment and the second is community empowerment. Self-empowerment is aimed at finding methods for people to gain control over their own situation. Community empowerment is defined by methods in which to help people to shift their social reality. This shift helps to promote social change throughout a population in order to address a problem. Behavioural change approaches are designed more for the self-empowerment paradigm in which personal change is promoted through tools with which to create change. Self-empowerment comes from triangulation of environment, humans, and social learning theory.(Tones and Tilford 2001). Social learning theory is based on the idea that most of what is learned is based upon observing and copying the behaviour of others (Newman and Newman 2009). The idea of empowerment is predicated on beliefs that human beings are competent during times of extreme challenge and that all humans experience a degree of powerlessness. Empowerment, according to Vandiver (2009), occurs when someone who is within a stigmatized group are given tools through intervention that increases their social value. Through health promotion self-empowerment, the individual gains the skills to cope with the various elements of their own responsibility and the stigma imposed by society. Conclusion The power dynamics of behavioural change approaches are based upon the relations that official authority has with health staff responsible programs, and the relationships they builds with clients. When an individual is empowered through strategies derived from behavioural change approaches, the individual can create a new social role in which coping with their issues are handled and their personal power increased through knowledge. The knowledge that is imparted through the discourse on health promotion, and within the programs themselves, provides the context for self-empowerment through having the tools to deal with illness. 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