Community empowerment

Last week, there was post on this website discussing how to create a community contagion.

The point of the contagion post was to think through ways the community can begin to work together and spread their message. While this remains the challenge, let’s take this a step further. Let’s begin to consider the role of engaging the community and community empowerment.

According to the World Health Organization (WHO):

“Community empowerment refers to the process of enabling communities to increase control over their lives. “Communities” are groups of people that may or may not be spatially connected, but who share common interests, concerns or identities. These communities could be local, national or international, with specific or broad interests. ‘Empowerment’ refers to the process by which people gain control over the factors and decisions that shape their lives. It is the process by which they increase their assets and attributes and build capacities to gain access, partners, networks and/or a voice, in order to gain control.”

How often is the community empowered in healthcare? How often is the community voice heard?

While there are ample studies on community empowerment (e.g. May, 1995, Eng, 1992, Rose, 2002), how often do we hear of the community stepping up to do demand more from healthcare?

Could it be that the community, as the WHO defines it, does not have a common “interest, concern or identity” as it relates to healthcare? Surely there are some communities that have made healthcare their mission to change. It is hard to imagine that after hearing stories of healthcare failing communities that more is not done. Just pick a story. Any story.

Is it that “we” have failed to actively engage the community in changing healthcare?

Rather than describe here examples of community empowerment for healthcare, let me pose the question – what have you seen? What are examples from your community where the community, feeling empowered, have demanded change in healthcare?

Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

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Posted in Community, Contagion
  • Alex Fair

    Well, one thing I have seen is patients asking for care at affordable prices. We actually call all the best doctors in their area on behalf of the patient. It works pretty well and then many of the providers get listed on the site for free. It certainly sends a message of “get price transparent” because people want it, especially with so many of us who are on High Deductible plans (HDHPs), Consumer Directed plans (CDHPs), uninsured, and under-insured.

    Because healthcare is an individual thing, group action is hard to organize among patients but when providers and their organizations notice and say, “yeah, I can get price transparent” or states pass laws requiring it, we really start to change things and make healthcare more affordable, accessible, and fairer for all.

  • Melanie St. Ours

    I think about community in two different ways—ecologically and culturally. Culturally, communities may be of “place, spirit, or tradition,” as so eloquently stated by Roadside Theater. This is our customary definition of community as we think about it relating to human beings. This definition is useful when we are celebrating our heritages, our cultures, the places and ideas that make us who we are. It is not so useful when it leads us to “us” and “them” thinking.

    Differences and disparities in SES, ethnicity, cultural expression, education, occupation, and health outcomes can make it seem as if health care providers are somehow of a different community than the people we care for.

    The ecological reality of community is different. In an ecological system many different organisms with diverse needs, ways of functioning, and outputs form a web of inter-dependence that allows the entire system to continue functioning.

    In the ecological definition, there is no way to separate providers from “the community.” It is a false dichotomy. This kind of “us” vs “them” thinking serves to obscure the truth that any dis-empowerment of “community members” is often the result of disproportionate power being held by providers, insurance companies, or governmental structures.

    Learning to share power is hard. It is also vital if we are to really transform healthcare into a healthy ecological system that can provide for the needs of the diverse groups that constitute that system.