Spiritual_Wellness_Holistic_Health_and_the_Practic

New Health Promotion Movement 265
suggest that people, individually and through such mediating structures as their
churches and voluntary associations, must do for themselves rather than rely on the
direct services of health and social service professionals to assist them in meeting their
needs (Berger & Neuhaus, 1977; Pilisuk & Minkler, 1986). Although couched in the
language of freeing people by decreasing their dependence on larger societal institutions,
this kind of thinking has been used to justify the withdrawal of needed health
and social services in times of fiscal conservatism (Binney & Estes, 1988; Estes, 1984;
Schwartz, 1990).
Direct services can be empowering to individuals and to communities. A maternal
and child health clinic in a low income neighborhood, for example, not only empowers
individual women and children by ensuring their optimal health — especially if we
think of health as a resource for daily living — it also has the potential to create solidarity
and community among the women who use the services of the clinic. The important
criterion in terms of empowerment is how the direct services are delivered: Are
the women considered as supplicants to or beneficiaries of the service, or are they
regarded as being entitled to good perinatal health because they are members of the
community? Empowerment ideology would dictate the latter.
Much has been written on the importance of health and social services to, what is
essentially, capacity building. In health education and health promotion circles, capacity
building is conceived of as the nurturing of and building upon the strengths,
resources, and problem - solving abilities already present in individuals and communities
(Cottrell, 1983; McKnight, 1987). Community - based support services for family
caregivers of the elderly, for example, may be essential to allowing and enabling family
members to continue to function effectively. Unless such support services are provided,
family support systems may break down, leading to adverse health outcomes as
well as feelings of powerlessness among both the recipients of care and the providers
of this informal support (Gallagher, 1989). Thus, not only may services provided to
individuals and communities be empowering — depending on the ideology of their
provision, as noted above — but services may be essential to maintaining the supportive
capacity of families, networks, and communities (Pilisuk & Minkler, 1986).
This brings us to an examination of another piece of the new health promotion
movement over which there is much ideological confusion and conflict: the notion of
community participation.
RHETORIC AND REALITY OF COMMUNITY PARTICIPATION
Together with the concept of empowerment, it is the notion of community participation
that the new health promotion movement invokes as its defining feature, as what
sets it apart from more traditional individualized approaches to health promotion.
Community participation — sometimes the term public participation is used —represents
the legitimizing concept of the new health promotion movement in terms of both analysis
and intervention. But, probably more than any of the other contested domains
examined in this discussion, the concept of community participation may be the most