Spiritual_Wellness_Holistic_Health_and_the_Practic

Health Promotion and Empowerment 185
Personal Care
This sphere is one at which most front - line workers encounter individuals living in relatively
powerless situations; it is the venue of direct service. McKnight (1987) argues
that “ resources empower; services do not. ” This witty play on the disabling tendencies
of large “ institutions nonetheless denigrates the community of caring professionals and
reinforces a “ we/they ” polarity that creates and reinforces a false cleavage between professionals
and community members, the former being bad, the latter being good. The
irony of this cleavage lies in the formative mobilizing role often played by professionals
and intellectuals who participate in social justice actions (Zald, 1988; Freeman,
1983; Eder, 1985). It also risks denying persons what they often require and request:
Respectful services. One Canadian health center mistakenly drove a wedge between its
clinical workers and its community workers, reversing the historic tables by extolling
the importance of community development over medical care. The dissatisfied clinical
team suffered rapid staff turnover, the poor neighborhood lost its continuity of care, and
the health center lost some of its empowering credibility.
The two pillars that allow service delivery to be empowering are that they are
offered in a supportive, noncontrolling way and that they are not the limit of the services
and resources offered by the agency. This approach builds towards community
organizing and coalition advocacy — the political elements of empowerment at the
structural level remain explicit — while recognizing “ that low income people have
the right, here and now, to support in the face of difficulties … our credibility in working
with disempowered groups rests to a large extent on whether or not these groups
find community workers to be of practical usefulness ” (Jackson, Mitchell, & Wright,
1988, p. 4). Some recent examples from Canadian public health practice include
these:
1. Poor women in a state - run rooming house, who complain of giving blowjobs
to use the bathroom, and a community health worker who believes them, who
spends time with them, who advocates with them for better safety and more
dignity in the house.
2. Nutritionists and health educators who visit elderly live - alones, maintaining their
healthy diet by cooking with them, and sharing their meals.
3. Street people shut out by attitudes from the institutional services to which they are
entitled, and public health nurses who take the personal care to where they live: in
the hostels, in the 24 - hour donut shops.
Unless professionals think simultaneously in both personal and structural ways,
they risk losing sight of the simultaneous reality of both. If they focus only on the individual,
and only on crisis management or service delivery, they risk privatizing by
rendering personal the social and economic underpinnings to poverty and powerlessness.
If they only focus on the structural issues, they risk ignoring the immediate pains
and personal woundings of the powerless and people in crisis.