Spiritual_Wellness_Holistic_Health_and_the_Practic

New Health Promotion Movement 267
level, another aspect of capacity building is strengthening the ability of these mediating
structures to participate in political and economic decisions, thereby enhancing the
health of communities (McKnight, 1990).
Thus, the emphasis on community in the new health promotion movement is
explicitly political. Glendon (1991) calls communities “ the seedbeds of civic virtue ”
(p. 109). McKnight (1987) says that communities, as “ the forum within which citizenship
can be expressed, ” are “ the vital center of democracy ” (p. 57). The cornerstone of
this political aspect of community is the notion of participation.
In embracing community participation, the new health promotion movement has
pushed the field beyond the twin pillars of earlier, more traditional health promotion
efforts: individual responsibility and professionally based interventions. However,
there are still many unresolved issues surrounding the notion of community participation,
both as a theory and as a practice, including: What does it mean for communities to
participate in health promotion strategies to achieve health? How will we know when
participation is occurring? Are there some forms of participation that are better than
others?
Coming out of the social planning movement of the late 1960s, Sherry Arnstein
(1969) developed a ladder of participation, adapted in Figure 23.1 , by which the degree
of participation could be measured. At the bottom of the ladder are manipulation and
FIGURE 23.1
Ladder of Participation
8
7
6
Citizen control
Delegated power
Partnership
Degrees
of
citizen power
Real managerial power
(Partnership: Citizens may negotiate
and engage in trade-offs)
5
4
3
Placation
Consultation
Informing
Degrees
of
tokenism
Citizens/have-nots hear and may have
a voice, but may not be needed
2
1
Therapy
Manipulation
Nonparticipation
Enable powerholders to educate
or cure
Source: Adapted from S. Arnstein, A ladder of citizen participation, Journal of American Institute
Planners, July 1969.