Spiritual_Wellness_Holistic_Health_and_the_Practic

New Health Promotion Movement 263
pointed out, “ behind the euphemistic phrases of community participation and empowerment
lay the uncomfortable realities of power, control and ownership ” (p. 43).
As a consequence of these realities, the move towards partnerships and other more
egalitarian arrangements, although certainly a positive step, may nevertheless ignore
the very real structural distinctions that exist between professionals and individuals or
communities. Professionals often are more educated, have more access to sources of
information, and use a different language to discuss health issues than either the individuals
or the communities for whom or for which they work. In addition, the health
professional ’ s very location in service agencies or health bureaucracies — what Gruber
and Trickett (1987) call their “ institutional embeddedness ” (p. 358) — confers a certain
power on them. This is primarily what Simon (1990) has called the power “ to set
boundaries around the domain of issues that will be considered germane ” (p. 32); in
other words, the power to decide the health agenda.
The operationalization of the notion of empowerment may thus be inherently problematic.
Many health promotion practitioners have become familiar with the idea of
empowerment and see their professional role now as being someone who empowers or
gives power to individuals and communities. In this conceptualization of empowerment,
there is no break up of the old provider/client power arrangement, for there exists a priori
a power differential between the empowerer and the empoweree. As Rappaport (1985)
has argued, empowerment occurs not when power is given, but when power is taken by
individuals and communities to enable themselves to set and achieve their own agendas.
What is it, then, that health promotion practitioners are to do in the light of this
conceptualization of empowerment? According to Rappaport (1985), “ What those
who have [power] and want to share it can do is to provide the conditions and the
language and beliefs that make it possible to be taken by those who are in need of it ”
(p. 18; emphasis added). In other words, empowerment occurs in a climate that first of
all fosters it ideologically. In a similar vein, Labonte (1990a) has argued that the role
of health promotion professionals concerned with empowerment is
to nurture this process and remove obstacles, the first being our own need to define
health problems for the community [since] the power of defining health belongs to
those experiencing it. (p. 87)
What this means is that, in the spirit of community organizer Saul Alinsky (1972)
and adult educator Paulo Freire (1973), health promotion practitioners who truly facilitate
empowerment do so by assisting individuals and communities in articulating both
their health problems and the solutions to address those problems. By providing access
to information, supporting indigenous community leadership, and assisting the community
in overcoming bureaucratic obstacles to action, such practitioners may contribute
to a process whereby communities increase their own problem - solving abilities — what
Cottrell (1983) has termed community competence . Indeed, as Rappaport (1985) and
community activists like John McKnight (1987, 1992b) have argued, empowerment
ideology is based on the notion of the already existing capabilities and competencies of
individuals and groups. In Rappaport ’s words: