ASSIGNMENT-1

EMPOWERMENT AND PUBLIC HEALTH PRACTICE

INTRODUCTION:

Empowerment is a single word but has an in-depth meaning and importance especially in the
field of public health. As it is very well elaborated by Keleher and Helen, 2007 that
empowerment is a word which is mostly misinterpreted in the department of public health. The
burden of morbidity and mortality is increasing at a great pace throughout the globe and the
most vulnerable people are from the weaker sections of the society. The main reason behind
this serious issue is lack of power of empowerment to these poor people of the society. This
ultimately leading to continuous increase in the level of inequity as well as inequality in the
health care practice all across the world (Keleher & Helen, 2007). This reveals an alarming
urgency to empower those needy and destitute groups of the society who are suffering at the
extreme levels and carry the maximum burden of morbidity and mortality. This paper will
discuss in detail about the meaning and variation of power. Later, meaning of empowering
public health practice will be discussed along with its need. In addition, examples of political
activities will be described. Furthermore, different roles of public health practitioner will be
discussed. Last but not the least social determinants of health along with is actions and
relevancy will be mentioned.

POWER:

To properly understand the meaning of an empowering public health practice, appropriate

understanding of power and its different variations is highly important.

The most important aspect of empowerment is “Power”. Mostly power is interpreted as a form
of hard power in this form of power a person has control over others for example rich people
do wrong deeds with the power of the money the have. The second type of power which is one
of the best form of power is soft power. In this form of power, the person has the ability to
achieve their goals through continuous long term but indirect actions. The soft power requires
a great level of patience, consistency, and self-determination. (Wrong, 1988, p.2 cited in
Laverack 2016, p. 10). Another example of soft power stated by Gallarotti 2015, is social
medial as media spread the messages through the nation and all over the world continuously

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and softy. Therefore, indirectly imparting information to change the mind set of people
(Gallarotti,2015).

There are three main different variations of power which are as follows:

 Power from within:

Power within is a personal form of power which is also regarded as inner strength or self-
esteem. Power within is also well known as psychological personal and individual
empowerment. This type of power is one of the most essential aspect of empowering public
health. The reason behind the same is that realization of power in one self is highly important
both for the public health practitioners as well as for public. As if the public health practitioner
will not be aware of the power of their own self then they would not be competent enough to
empower the suffering from health-related issues (Sak, Rothenfluh, and Schulz, 2017).

 Power over:

Power-over is the second variation of power which mainly describes the social relationships.
Power over is considered as one of the rawest form of power. For example, the dominating
party forces the other party to do any kind of work forcefully and even after resistance. Such
as, the power exerted by the prison guard, power forced by using gun etcetera (Laverack 2016,
p.12).

In the field of empowering public health, power over has also been used as great tool by the
legislating health bodies to implement new policies or programmes to decrease the spread of
the diseases through quarantine. Therefore, power over can be used in two different ways that
is as negative or positive. In the field of empowering public health, it is highly important to use
this variation of power wisely, specially to promote healthy lifestyles. Another example of
positive power over in the field of public health can be the imposing fines on the food handlers
for unhygienic behaviour to bring a positive change (Laverack 2016, p.12).

 Power with:

Power with is another variation of power in the field of empowerment. This is the next stage
of power over in which power is deliberately used to bring positive change in the lives of those
people who are at greatest need rather than exploiting them. Out of all the variations of power
this type of power is considered to be the most appropriate in the field of public health. For
example, Power with establishes when people with power over chooses not to dominate the

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powerless people rather than helping them to gain power within ultimately leading to
empowerment. For instance, when a public health practitioner takes an initiate to empower the
patients through health education and positive reinforcement to get out of the illness and solve
their problem therefore developing power within the patients (Laverack, Glenn 2016, p.13).

In the field of public health complete understanding and control these three main variations of
power is highly essential. The main reason behind the same is that to empower the vulnerable
and needy people it is mandatory for all the public health workers to have optimum knowledge
and skill to bring and positive change in the society (Baum, 2016).

MEANING OF EMPOWERING PUBLIC HEALTH PRACTICE:

In public health practice empowerment is regarded as one of the most essential tool as
empowerment gives power and opportunity to people to have control over their own health
(Laverack 2016, p.16). In simple words, empowerment can be defined as the process through
which people have the capability to have control over the decisions as well as the distribution
of resources which directly influence their lives (Baggott 2000, cited in Laverack 2016, p.14).

The term and meaning of empowerment is mostly misinterpreted but in the field of public
health the real meaning of empowerment has been framed. As the approaches to empowerment
act as one an essential key to reframe the image of empowerment in the health care setting
(Keleher and Helen, 2007).

Empowering public health practice has an in depth meaning which fluctuates according to own
experience, knowledge, and perception. As it is very well explained by Laverack that public
health is a bureaucratic activity which is mostly carried out by the governmental organizations
or within them. It is evident from many studies that earlier the concept of empowerment and
its approaches was not included in the public health practice (Laverack 2016).

Later, with the conceptual and technical advancement empowerment became an integral part
of public health practice. This evolutionary change came after the proper understanding of the
impact of social determinants upon the health status of the most vulnerable population of
society. As without empowering the most weaker section of the society the improvement in the
health status would be negligible only (Adler et al. 2016).

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NEED OF EMPOWERING PUBLIC HEALTH PRACTICE:

In a recent study done by Prince et.al,2015, revealed the fact that the more than 75% of the
burden of mortality and morbidity all across the globe upon the highly poor, vulnerable, and
disadvantaged sections of the society. These groups are also considered as the marginalized
groups of society. These statistics reveals the urgency and need of empowering public health
practices. This can be mainly done by relocating the empowerment process with the principle
of equity. In other words, the approaches of empowerment are needed to be collaborated with
the principle of equitable distribution of health (Prince et.al,2015).

As all the public health practitioner are aware of the fact that empowering is the main key to
upgrade the health. However, the locus of the empowering approaches should be the poor and
weaker section of the society. The main reason behind the same is there is an unequal
distribution of power. The powerful people of the society are already well empowered and
becoming richer. Whereas, the poor people are continuously becoming overburdened because
of morbidity, poverty, and mortality. Therefore, there is great and alarming need to empower
the poor sections of the society by imparting special health services and acting upon the social
determinants of health (Deveaux 2015, pp.126-133).

THE POLITICAL ACTIVITY IN TERMS OF EMPOWERING COMMUNITY:

To empower the whole nation there is a great need of community participation by application
of different principles. The two most important principles to engage communities in the process
of empowerment are positive reinforcement and education. The updated definition of
community is the heterogenous groups of people with different interest and social relation
living together to fulfil their own aims of life (Zakus and Lysack, 1998 cited in Laverack 2016,
p.59). As a result of the variations in the interests of people with in the community. It is highly
essential for all the health care practitioners to develop the critical skills and knowledge while
imparting education to empower the different groups of the society (Laverack 2016, pp..59-
60). Community play one of the most important role in imparting the education to empower
themselves from one community to another and ultimately the whole country. As politics play
an integral role in framing the health care structure of any nation. This directly links with the
process of empowering public and improving their health status (Martinson, Marty & Celina
2012)

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Throughout the world there are many examples of political activities done to empower a
community. some of the best examples from Australia are: “Empowering Aboriginal
Australians” and “Recategorizing transgenderism in Australia”.

“Empowering Aboriginal Australians”:

In the history of Australia, the Aboriginal people are the one who have suffered a lot in the
past. The intensity of the suffering was so serious that even after many decades many of the
people of the Aboriginal community are not able to recover from the trauma of painful past.
As everyone is well aware of the happenings in the past to the Aboriginal communities. As
they were complete excluded from the society, all rights from their own lands were abolished.
The children were taken away from their parents called as “Stolen Generations” during the
colonial rule. The children who were separated by fore from their parents are still searching for
their loved ones. The trauma and stress were so severe that it passes through many generations
(Aldrich 2017, p.22).

Therefore, to heal the scars of the Aboriginal communities and to empower them in the society
special initiative have been taken by the government and health ministry of Australia. For
example, provision of special services in all the sectors of society be it health, education, and
employment etcetera. Also, public health practitioners are trained specially to overcome
cultural barriers and empower the Australian Aboriginal communities. Thus, empowering
Australian Aboriginal communities is one of the most recent and successful example of
political activities to empower vulnerable communities (Carey et al. 2017, 261-267).

“Recategorizing Transgenderism in Australia”

Earlier, the people with transgenderism were considered as the mentally ill. All the people in
Australia who are homosexual lived their life in this social stigma by the society (Perales,
Francisco, and Abram Todd 2018). Later, in the recent year Australian authority and public
health department official removed transgenderism from the stigma of mental disorder.
Moreover, empowered the Transgender people as equal as the people with other gender. This
again proved to be a great example of a highlighting political activity to empower the
marginalized and weaker community of the nation (Byrne 2018, P 4).

ROLE OF PUBLIC HEALTH PRACTITIONER:

Public health practitioner plays many different roles while delivering health services and
empowering the people. All the public health practitioners have different kinds of roles and

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responsibilities according to their specific area. Some of the highlighting roles of public health
practitioners are:

 ENFORCER:

All the health policies and programmes are planned and made by the higher health authorities.
However, the actual enforcement of the proposed policies or programmes are done by the
public health practitioners only. As the public health practitioners owns the main responsibility
to give execute the planned policies and deliver the services to the people who are in great
need. This role of enforcer is one of the most traditional role which in directly motivate the
public to avail the medical services made available by the official and health services (Laverack
2016, p.12).

 ADVOCATE:

Advocacy is a great skill which a public health practitioner learns through experience. In field
of public health, the role of advocator is highly crucial for health workers. The main reason
behind the same is that to empower the most vulnerable population in the society all the public
health practitioners must have the skill to advocate them through active participation. The role
of advocator needs a lot of practice and experience as advocacy results in changing the mind
set of the public from unhealthy lifestyles to health life choices (Hyde, Cheryl 2012).

 MEDIATOR:

Another important role of public health practitioner in the field of empowering people is
mediator. The public health practitioners act as a bridge which mediates the immediate needs
of the common people to the health authorities. public health practitioners also show the exact
picture of the condition of the public. Through the role of mediator, the level of progress in any
project or policy related to health is directly conveyed by the public health practitioner (Levy
and Sidel 2015).

 EDUCATOR AND TRAINER

In the field of health, education plays one of the most important roles in health promotion.
Through education only the public health practitioners enable the people to gain control over
their health status through healthy practices. Education is alone of the important tool of health
care professionals to gain skills by training and intensive learning. Thus, the role of educator

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and trainer is also highly important role for a public health practitioner to empower those
populations who carry the greatest burden of disease (Labonte and Ronald 2012, p.106).

SOCIAL DETERMINANTS OF HEALTH:

Social determinants of health are those conditions which directly determine the health and
wellbeing of an individual. Social determinants of health are directly interlinked the social as
well as the economic condition in which an individual is born with. According to the final
report of closing the Gap by World Health Organization, it was proposed that the main reason
behind prevailing inequalities all across the globe. All these inequalities exist due to unequal
distribution of power, resources, and finances. All these factors ultimately determine the health
status of an individual, community and in broader terms the whole country. Collectively all
these issues are called as social determinants of health (Marmot, Bell, & Goldblatt, 2013).

Reasons of inequalities:

The main causes behind this unequal distribution of health and other sources are unfair policies
and programmes, poor governing bodies, corruption. As in most of the developing countries
the maximum amount of wealth and power is in the hands of a hand full people which in turn
regulate the authorities according to their own wish and needs. Whereas, on the other hand the
poor and destitute people of the society suffer which covers the largest proportion have the
least amount of wealth, health facilities and power even to avail their basic rights. Some of the
social determinants of health are living conditions, housing, health facilities, employment,
education, social protection etcetera. As all these factors directly or indirectly determine the
health status of each and every human being (Wagstaff, A., 2014, p.99).

Actions on social determinants of health:

To upgrade the global health status of the poor people living in the entire world there is an
urgent need to tale action upon all the social determinates of health. The biggest action is to
address the inequality by establishing equality and equity especially to the most weaker
sections of the society. Another important aspect is to relocate the locus of power equally to
everyone rather than concentration of the entire power in the hands of few illiterate elite people
of the society. In other words, there is a need to establish equity right from the beginning.
Providing health place and environment to live to the homeless poor people. In addition, fair

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and decent equal opportunities of work and employment and social protection throughout the
lifetime to all the individuals equally etcetera (Marmot, Bell, & Goldblatt, 2013).

Relevance of the statement to taking actions on the social determinants of health

‘Practitioners need to recognise that an empowering public health practice is a political

activity’ (Laverack 2016, p.66)

The above-mentioned statement by Laverack is highly relevant in regard to take actions upon
the social determinants of health. The main reason behind the relevancy is that in the present
era where large number of inequalities are prevailing in all the sectors of the society. It is very
much important for the all public health practitioners that the process of empowering the public
especially the weaker sections of the society is not only limited to health field. As politics
influence each and every aspect and decision-making process of health sector. Also, the main
reason behind this is that the regulation of policies and programmes is entirely done by political
actors. Therefore, Laverack has very well explained the whole crux that it is highly important
to realize the fact for all the public health professionals that empowerment of public health is
also political activity rather than only health related activity (Laverack 2016, pp.60-66).

CONCLUSION:

Empowerment is one word with highly in-depth meaning and relevance in public health
practice. This paper so far has highlighted the different aspects how power can be utilized to
empower the people. This paper also reveals the fact that how political activities are controlled
by operating power at different levels. In addition, different types of roles of public health
practitioner has been discussed in the field health and empowerment. In paper also entails the
description od social determinants of health along with the relevant actions needs to be taken
to address the factors that are determining the health of the poor people. in the end this paper
provides a clear agreement with the statement given by Laverak that empowering public health
is a political activity. Therefore, it is highly recommended to all the public health practitioners
that wise use of power is very essential to empower the powerless people in a positive and
fruitful way.

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