Is empowerment too complicated to be a useful concept in practice?

In my experience, this is simply not the case. Empowerment is the means by which people, individually or collectively, increase control over events that influence their lives. They do this by building capacity through improving their knowledge, skills and competencies which in turn gives them more ability to have an influence on their health. The healthcare system places the health of the individual at its centre and the individual as the focus of empowerment. At an individual level empowerment has led to improved personal decisions about lifestyle, self-care and treatment choices. For example, in one study individuals who had more control were also better informed, had significantly better attendance at clinic appointments and a faster physical therapy completion rate.

However, the framing of health as individualized can create an obstacle to empowerment because this personalization provides a focus on the ‘fight’ against an illness. The emphasis is on self-blame, personal responsibility and individual action. Individuals may be committed to change but this is only at the personal level and does not address the broader structural level. Whilst it is important for an individual to have more control it is through collective empowerment that people have really had an influence on changing the up-stream causes of poor health. Ill health affects us individually, and the response is to deal with it at a personal level, but empowerment provides an essential link between individual and collective action to also influence, for example, supportive policy.

The value of collective empowerment is that it enables people to become more organized and mobilised, through networking and engagement, towards social and political change. Social change refers to societal norms, beliefs and behaviours that have an influence on others, for example, making passive smoking an anti-social behaviour. Political change refers to policy, legislation and governance that have a direct influence on others, for example, policy prohibiting smoking in public places. Collective empowerment not only enables people to have more of a ‘voice’ about their health and healthcare but also to be able to take action if this does not meet their needs and expectations.

What we must remember is that working in an empowering way is a political activity. Its aim is to redress the structures that create inequality and social injustice in the first place. But empowerment can only be successful if health practitioners understand a fundamental principle: before they can help to empower others they must first understand the sources of their own power. Building a more empowering practice means redressing the constraints placed on a profession by its institutional nature and a culture that does not necessarily share an ideology of empowerment such as in a hospital setting. Building a more empowering practice also means helping to legitimize the causes of others through our professional support and enabling others to have an influence on the healthcare system through, for example, patient advocacy and health pressure groups. I welcome your comments on this issue.


Dr. Glenn Laverack

Independent Health Advisor, Australia /
Unabhängiger Berater Public Health, Australien
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