Power Dynamics in a Behavior Change Approach to Health Promotion - Term Paper Example

Power dynamics in a behaviour change approach to health promotion Introduction In the midst of new and severe illnesses afflicting the people around the globe, it has been observed and is continuously being studied by health practitioners around the world the question of behaviour change approach towards health promotion. In analyzing the power dynamics surrounding behaviour change approach in health promotion , it is inescapable to deal with the power structures operating in a given community and society and even within the family and church. Power structure is a very intricate and complex issue. Moreso, it becomes very personal when it is dealt within the marriage and family, where the ‘hidden’ question of powers are at stake and lived everyday. In wider society , power structure deals with power wielders and the powerful on one side of the pole and the powerless on the other end of the pole. Primarily when we talk of power structures and power dynamics, we need to study where such power emanates. Basically, power is a question of who owns and controls the economic resources of the community. Whoever controls the economic power also wields the political and cultural power in a society. Therefore, in analyzing the power dynamics of behaviour change approach in terms of health promotion, we are dealing primarily with the sensitive question of who owns and controls the health resources (medicines, knowledge, hospitals, clinics, medical services and medical equipments) and the question of its accessibility to those who does not own and control it. In this, economic angle of power, it is crucial to study the clear cut link i.e. of the role (between) of the dominant global economic system and the continuous inaccessibility of majority of the people to health service, which seems to be generally missing in the current behaviour change approach in terms of health promotion . Secondly and an equally important matter in analyzing the power dynamics at play in behaviour change approach is the patriarchal system which is strongly embedded in the economic, political and cultural sphere of the people’s lives. Central in this aspect are power relations between couples and partners and the prevailing view of women as a commodity and as a property. The Power Structures in Current Society Whether we like it or not, the world is divided into haves and have nots. Some economic and political analysts have divided the world into First World, Second World and Third World country categories. The existence of G8 countries is a clear manifestation that there are far few economically and politically powerful countries of the world. And of the more than hundred member countries of United Nations, it is unfortunate that more than half of it belongs to the so called third world category or countries that are economically poor and widely underdeveloped. Unfortunately, it is in these third world countries where severe infectious diseases are still rampant. Curable and preventable diseases such as tuberculosis and measles, for instance, still afflicts and causes death among folks of third world countries who are living in most depressed and rural areas. In such case, the major question is, how come the already available medical treatment is inaccessible to the people of third world countries? Why, despite the worldwide accord and treatment through the Millenium Development Goal where national government pledges to finally curb curable diseases from slaughtering humanity such as tuberculosis ,it caused the death of 1.7 million people around the world in 2009 (WHO) (2010). While in the first world countries, chronic diseases is now becoming a major concern. For instance obesity related health illnesses and lung cancer brought by smoking is now considered as one of the biggest health threat in the United Kingdom. These health concerns are founded largely on people’s behaviour and therefore also opens a big opportunity to reverse its growing impact on people’s health through health promotion. In most circumstances, health promotion comes in the form of protection and prevention awareness campaign and legislative lobbying. Most often than not, the campaigns are designed and implemented from top to down approaches, where health workers and authorities in the local and national governments are at the helm and of pursuing behaviour change among the local population. This top –down approach provide very little room for majority of the people to make their own choices and to take decisions into their own hand , as the powers at be, select choices for the people. In top-down approach, health promoters are in a powerful position over the population. They are in command in which health programmes to promote and more importantly what are the specific knowledge they are willing to share with the people. Moreover, they are in the position to distribute resources and funding, they are in command where to put biggest and small allocations ( Laverack and Laonte) (2000). These power dynamics, is disempowering to the people at the local communities where they are put at the ‘mercy’ of the health promoters. In the end, the whole matter of health and wellness of the people is at the hands of health professionals. On the other hand, it is positive to note that an empowering form of health promotion have also emerged, which is the bottom-up approach. Such approach is more concern on enabling communities to take control of their own health. An approach where power resides on the collective skills and choices of the people. According to World Health Organization, the process of enabling communities to increase control over their lives is community empowerment ( WHO). Empowerment refers to the process by which people gain control over the factors and decisions that shape their lives. While enabling implies that people cannot be “empowered” they can only empower themselves by acquiring more of power’s different forms (Laverack,2008). The above explanation implies that people and communities have lost control of their lives or for a long time, there are elements or group of people that have defined their course of life. Communities are robbed of their to health access. Enabling and empowerment means coming out from powerlessness. Thus empowerment could mean a shake of status quo. Community empowerment addresses the social, cultural, political and economic determinants that underpin health, and seeks to build partnerships with other sectors in finding solutions. However, as reiterated earlier, health promotion and empowerment is also relative to and affected with the income of the community and other related factors such as peace, environment and sustainable resources. People from lower income communities or economically depressed communities have lesser access to a healthy diet brought by the difficulty of accessing food brought by severe poverty and or poor education and information on healthy foods. Thus, in third world countries, especially in rural areas, the question of health promotion is very much affected with the whole question of access to resources. On the other hand, in western and developed countries, ‘over’ access to food brought by consumerist culture are also running in contradiction with health promotion. Despite their people’s wide access to information on healthy lifestyles through different medium –internet, print and broadcast, it is the very same medium being use by capitalist to bombard its people with different products and commodities. Consumerism psychologically prods people to consume more than their healthy needs. Gender Inequality/ Power Relation Between Men and Women vis a vis in the Health Promotion Another major factor to be consider and which is largely in play with health promotion in terms of behaviour change approach is the question of power relation between men and women and the overall perspective of society to women. According to Son Dug Soo (1994) a woman- man relationship in the modern capitalist society is economically and sexually unjust and abusive. Consequently, women does 2/3 of the world’s work yet merely gets only 1/3 of the total wages (United Nations) (1980). The ‘human –reproduction’ is not considered true work , but is seen as natural, ‘non productive’ and a mere personal service and therefore unpaid. This perspective of women’s work has greatly alienated the women in modern capitalist system and have marginalized women economically, politically and socially. Furthermore, the UN states that women measly own 1% of the world’s total wealth. Unfortunately these status of women is reflected even in marriage. In many cultures around the world, women are still ‘shared’ amongst men in tribes; extramarital affairs are rampant and widely acceptable for men. In Korea, 88% of married men have experienced extramarital affairs ( Son Dug-Soo) (1994). In terms of health promotion, these unequal status of women are still reflected upon. In the case of HIV/AIDS prevention , the issue of gender inequality poses a major hindrance in dramatically putting forward and advancing the great possibilities of behaviour change approach as a tool towards the disease risk reduction and prevention. In the 2008 document, Behaviour Change and HIV Prevention (Re) Considerations for the 21st century by the Global HIV Prevention Working Group concluded that in Sub Suharan Africa, where more than 2 out of 3 HIV infected are living, behaviour change initiatives still play a major role in HIV prevention, but a more crucial step in changing sexual and relationship norms is needed to get a more meaningful result. This is so, because the social norms where men could have sex outside of the marital relationship is still widely accepted. Moreover, polygamy amongst men in African society is deeply embedded in their culture. Some of these practices include the ‘passing on’ of widowed women to the brother in laws of women. Change of Behaviour Approach in HIV case While it is claimed by the World Health Organization that behaviour change approach have helped greatly in preventing a wider spread of HIV in Zimbabwe – an African country most afflicted with the said illness- individual change of behaviour could not address the major source of HIV widespread in the country, as the prevailing social norms of marriages is at play like early marriages for women and moreso, the deeply rooted practice of polygamy in African culture. Some argues that it isn’t easy for African national governments to simply outlawed polygamous marriages as it is part of the country’s cultural identity. These norms run counter to HIV prevention advocacy which includes practice of monogamy. On the other hand, advocacy of safer sex through use of condom, runs contrary to church believe In these cases, we could see the different powers at play in health promotion, the African national government, the enforced age old traditions of marriage practices, advocates of HIV prevention, and the African view of women in family and in the larger community. Cultural traditions are very powerful and needs to be confronted with a great deal of sensitivity. It is here where the power of community education should come into play, as policy makers and leaders are quite strong in imposing and preserving cultural norms, though it has become harmful to the health of the population. Grassroots health advocates ,on the other hand perseveres in educating the masses on informed choices. References: 1.Asian Women ‘s Resource Centre ,1994.Community of Women and Men. Kuala Lumpur 2. South African Women’s HIV prevention needs summit, 2010. [online] Available at < www.global-campaign.org/clientfiles/Womens-Prevention-Summit.doc> [Accessed 10 August 2011] 3.Global Tuberculosis Control, 2010. [pdf ] Available at [ Accessed 10 August 2011] 4. UNICEF, 2010. Child Protection from Violence,Exploitation and Abuse [online] Available at < http://www.unicef.org/protection/index_earlymarriage.html> [Accessed 10 August 2011] 5. Advocates for Youth, 2008.Giving Up Harmful Practices, Not Culture [online] Available at [Accessed 10August 2011] Read More