In my last column, I explored the issue of empowerment and how it is related to our health. But what does empowerment for health look like, and how do we do this?
A good place to start is with the wise thoughts of John McKnight, a revered expert in community development and capacity-building at Northwestern University in Evanston, Illinois.
In a wonderful short article in the late 1970s called “Politicizing health care,” he reported on a community-based effort to improve health in a low-income African-American community in Chicago.
After gaining control over their local hospitals — their main focus for organizing — the community was chagrined to find that their health did not improve.
However, on further analysis, they came to realize that their health problems were not medical problems that doctors and hospitals could fix, but “our” problems, which the community needed to fix.
This led to their involvement in such activities as rounding up stray dogs, lobbying local politicians to get better traffic controls and building greenhouses to grow fresh vegetables (thereby saving energy and providing jobs for unemployed area residents and recreational opportunities for senior citizens).
These activities did lead to improved health and also to a more cohesive and therefore a healthier community.
This story illustrates several key points. First, the people and communities who need to become empowered are those who lack control over their lives and their health. But working together, they can take on big issues and create social, political, environmental and economic changes in their communities that lead to improved health and human development.
Second, you start small and build up. In this case, the first thing they did was to solve the stray-dog problem, which reduced the number of people ending up in the ER with dog bites. You start by looking for small, quick and relatively easy wins, and in doing so, build up the capacity and confidence to take on bigger challenges.
Another key point is that when a community becomes more empowered, it creates the conditions and the support mechanisms that enable individuals to become empowered. And when we enable individuals to have more power over their lives, they are more likely to become engaged in activities in their community, helping the community to become more empowered.
At its best, empowerment creates a “virtuous circle”; empowered people create empowered communities, which create empowered people … and so on.
Integral to this approach is the recognition that people and communities already have some capacities, but can be assisted by supportive institutions and experts. So if we understand and respect the strengths of people and communities, we will work with them in partnership, rather than in a master-servant relationship.
McKnight is a longtime champion of “asset-based community development” and a founder of the Asset-based Community Development Institute. He suggests that instead of needs assessments, we should be doing capacity assessments: What are the capacities of the people, community organizations and institutions in the community, as well as its land base and infrastructure? How can they be mobilized or leveraged to improve the community?
Implicit in this is the idea that we should see people and communities not as empty vessels we need to fill up, but as having innate capacities that need to be built up — and built upon. The human glass is half-full, not half-empty.
We have our own version of the ABCD Institute here in Canada, in the Waterloo, Ont.-based Tamarack Institute. The institute “develops and supports learning communities that help people to collaborate, co-generate knowledge and achieve collective impact on complex community issues. Our vision is to build a connected force for community change.”
The institute has three key areas of work: Vibrant Communities, which focuses on comprehensive poverty reduction; Communities Collaborating for Impact, which focuses on collaborative leadership; and Deepening Community, which works to make the idea of community a guiding force in organizing our neighbourhoods and institutions.
There are many inspiring stories on the Tamarack website about what communities are doing across Canada to improve their well-being and human development and to reduce poverty and its health and social impacts. Check them out, because as McKnight says: “While institutions learn from studies, communities learn from stories.”
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.