Jennie Popay is Distinguished Professor of Sociology & Public Health, Division of Health Research, Faculty of Health & Medicine at Lancaster University.
A key message in the 2010 report A glass half full was that the ‘dominant’ approach to community development practice focused on problems, needs and deficiencies. It was argued that this approach risked disempowering communities already bearing the brunt of social injustice, creating dependency and turning people into passive recipients of services, rather than active agents in their own lives. In response the report argued this ‘deficit model’ needed to be replaced by new approaches emerging at that time, which involved a shift from illness and disease towards positive health and wellbeing and a focus on community strengths. A defining characteristic of these strength-based approaches is the priority given to identifying, assessing and working with community assets. Typically, these assets were (and continue to be) defined, at least in practice, as residing within ‘lay’ communities of place/interest (e.g. social relationships, practical skills and experiential knowledge of residents of neighbourhoods). Additionally, local amenities, such as community buildings, parks and local services, and diverse resources potentially available from local agencies may also be included.
Since A glass half full was published the rhetoric and practice of asset-based approaches to community empowerment have been woven into the fabric of almost all policy sectors in and beyond the UK – from local health care and public health strategies to the global sustainable development goals. Obviously, as demonstrated most recently by the Grenfell Action Group, communities develop power and respond collectively to the social injustices they face, without professional input but spontaneous community organising is not the focus of this chapter. Rather it is concerned with the local strength-based initiatives currently dominating the health and social policy sectors, arguing that many of these have replaced the problems of the deficit approaches with different but equally significant problems that are compounded by, but not the result of, draconian cuts in public expenditure resulting from austerity. Not only are many low-income communities being ‘asset-assessed’ to death, almost literally with life expectancy going into reverse for some lower socio-economic groups (Health Foundation 2019): they are also being burdened with primary responsibility to address the problems generated by growing social inequalities. In this way, strength-based approaches are helping create a new world of DIY welfare at the community level, feeding into and supporting the sustained attack on the provision of publicly funded and provided health, social and welfare service underway for the past few decades. Arguably, the Covid-19 pandemic has exacerbated these processes. As a Public Health England blog (June 2020) declared resilient connected communities have been springing into action to support people in need, local groups are burgeoning as is formal volunteering. What the blog doesn’t say is that communities and local groups are filling gaps that would not be there if public services had not been decimated by years of austerity; that the needs communities are trying to meet, including chronic poverty and inadequate housing pre-date the pandemic; and that volunteers are propping up a health and social care system that has long been underfunded and increasingly fragmented. This is the environment in which “strength-based community approaches” had taken root before Covid-19 in the most disadvantaged areas in the country. And our society after Covid-19 will be even more unequal; the poorest communities will be even poorer, their social and economic assets depleted even further.
Community empowerment in current health policy and practice
In a recent Scottish study (de Andrade 2016:136) local practitioners admitted that asset-based approaches were often not experienced as empowering by the communities involved and did not contribute to greater social and health equity. They suggested that practitioners lacked understanding and policy makers used the language of asset-based empowerment approaches as “rhetorical device ...driven by organisational and political self-interest rather than genuine concern for the wellbeing of the most unequal in society”. Given the difficult conditions austerity has created for local government in the UK, particularly in more disadvantaged areas, these findings are not surprising. However, the problems with these approaches arise not from practitioner’s lack of knowledge or experience nor from policy-makers lack of commitment but from the capture and corruption of community empowerment by macro-political dynamics.
As Newman and Clarke (2016:2) argue processes of ‘translation’ enable institutions and professionals to use terms such as ‘community empowerment’ to promote very diverse social, economic and/or political changes in new settings and processes of ‘articulation’ enable the term to be linked to other concepts and take on new meanings. In this way concepts such as ‘social capital’, ‘community capacities and competencies, community assets and community resilience’ have become integral to the new strength-based approaches to work with disadvantaged communities/groups.
Some people are unequivocal in their positive assessment, seeing these approaches as opening up spaces where ‘the state’ is sharing power with previously disempowered communities, working ‘with’ them to address problems (Taylor 2007). Conversely, however, these approaches have strengthened the ‘inward gaze’ on changes in community psychosocial dynamics, individual behaviours and proximal conditions in neighbourhoods. Obviously, professional input should support communities with relatively little power to release and/or develop the capabilities they need to take control of local decisions/actions to improve health and wellbeing. However, as this inward gaze has strengthened, the outward gaze on social transformation and political change for greater health equity, central to foundational statements on community empowerment in the Ottawa Charter, has weakened (Popay et. al. 2020). Notable here are the multitude of local health promotion projects adopting an asset-based approach to individual behaviour/lifestyle change, which Friedli (2013:140) argues, too often “attempt to reproduce, in poorer communities, psycho-social assets that are in fact tied to material advantage, while leaving power and privilege intact”.
What is driving these regressive power dynamics and what is to be done about it?
Strength-based community approaches have emerged in policy regimes shaped by neoliberalism, an ideology that aims to shift responsibility for solving social problems from the national and local State to citizens and the market. (Rose,1999) Rolfe (2018:581) argue that the diverse techniques used - forms of discursive power- have successfully convinced many communities/individuals these “responsibilities rightly lie with them”. In the meantime, however, evidence is accumulating that strength-based local initiatives are actually increasing inequities in the control communities have over decisions and actions impacting on them, which may increase social and health inequities. For example, based on an evaluation of four empowerment initiatives in the UK Rolfe (2017:16) concluded “communities can have significant agency in making decisions…[but] the level of agency in each situation is shaped by community capacity [which] seems to demonstrate a distinct socio-economic gradient, reinforcing concerns that community participation policies can become regressive, imposing greater risks and responsibilities upon more disadvantaged communities in return for lower levels of power”. Similar findings are reported in other research in and beyond the UK (Kearns et. al. 2015; Craig et al 2011).
Overall the evidence suggests that the adoption and translation of the concept of asset-based community empowerment and its integration into diverse local ‘projects’ by institutions locally, nationally and globally is reconfiguring power dynamics in ways that could negatively impact on the equity potential of health sector work with disadvantaged communities (Gaventa 2006:24) In this context there are growing calls for practitioners of asset-based approaches to recentre power in their work with communities: to re-engage with approaches that focus on building alliance across communities of interest and place to “create the power necessary to demand and share in decision making” (Wolff et al. 2016:45).
In other work colleagues and I have proposed two frameworks that can help to re-centre power and collective control in local work with disadvantaged communities. (Popay, et al. 2020). The Emancipatory Power Framework comprises a multi-dimensional power lens (Box 1) through which capabilities for community control, and changes in these, can be understood and assessed. The first three dimensions of power are generative, expansive and ‘non-dominating’: emanating from relationships with others (Rowlands, 1997). The fourth dimension is a ‘zero sum’ understanding where power operates as a finite resource and one’s loss is another’s gain.
Box 1: Forms of Emancipatory Power
- Power Within: Internal confidence and belief in potential of collective action
- Power With: Collective action with others to achieve agreed ends.
- Power To: Taking collective decisions/action and their impacts
- Power over: Taking power from others
The Limiting Power Framework (Box 2 below) draws on a typology developed by Barnett and Duvall (2005) and identifies forms of power that restrict the collective control disadvantaged groups/communities have over their ‘destiny’.
Box 2: Forms of power that limit community control
- Compulsory power: direct and coercive e.g. police brutality, welfare reforms
- Institutional power: rules, procedures and norms controlling what information is publicly available, who is involved in decision making, etc.
- Structural power: creating/sustaining hierarchies of class, gender/sexuality, race/ethnicity, etc that distribute resources, opportunities and social status
- Productive power, operating through social discourses and practices to legitimate particular forms of knowledge so constituting social identities and possible actions
These multiple forms of power are simultaneously present in all social situations and interact in ways that generate social and health inequities.
There are many differences in the lived experience of groups bearing the brunt of social injustice, but it is inequities in power that generate and sustain these inequities and regardless of the context, similar strategies are required to change these dynamics. Building back better after Covid-19 requires public health practitioners to be centred on shifting power dynamics globally, nationally and locally in favour of greater social justice not centred on mapping and activating the ‘assets’ of local communities. Whilst asset-based approaches highlight community strengths, they are typically local and inward focused. Local strength-based initiatives need to start by mapping power dynamics not assets, and explicitly design and implement strategies to sift these dynamics in favour of local communities at multiple levels. The power frameworks outlined above can support these analyses or other tools The Power Cube. These strategies must be multi-dimensional: challenging structural power generating and sustaining a chronic lack of resources and opportunities, compulsory power constraining already limited resources, (e.g. reducing the value of, and restricting eligibility for welfare benefits); institutional power devaluing experiential knowledge (Health Foundation, 2018) and productive power that imposes stigmatized identities on people experiencing poverty and disadvantage and the neighbourhoods in which they live (Halliday et. al. 2020).
Participatory spaces need to be created or shaped to maximise their empowerment potential. (Powell, et. al. 2020). As Gaventa (2006:27) argues, disadvantaged groups need to be able to operate in diverse spaces in order to “challenge power by denying its legitimacy” and ‘to move citizen action from access, to presence, to influence’.
Finally, local collective action is not sufficient to deliver the redistribution of resources, opportunities and social status required to reduce social and health inequalities. Local organisations know this. In recent surveys in Scotland local organisations catalogued the problems in their communities: economic and financial insecurity, worries about employment, damage to the skills and education of young people, the availability and affordability of food and basic supplies; reduced mental health, increased loneliness and addiction. They acknowledged the positive response to the pandemic in many communities but had concerns about the sustainability of these arrangements and the community resources they depend on. Their policy priorities for the future were creating a sustainable and inclusive economy, tackling inequalities, and for more integrated and sustainable models of services in places and across sectors. To deliver this transformational agenda disadvantaged communities need to use emancipatory forms of power to build alliances locally, nationally and internationally, for example, with social movements such as Housing Rights Movements the international People’s Health Movement, the Global Call to Action to End Poverty and the International ONE movement to end extreme poverty. As acknowledged at the beginning of this chapter many communities develop the power they need to challenge the injustices they face without support from professionals and formal institutions or in the face of intense opposition from such institutions. However, in the UK and elsewhere there are also thousands of local ‘asset-based’ community projects supported by front line practitioners and local agencies that purport to be ‘empowering’. Only if these projects re-focus on action to shift the power dynamics that create and sustain the adverse living conditions responsible for growing health inequalities will they be operating according to the foundational values and principles of community empowerment for health.
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