Spiritual_Wellness_Holistic_Health_and_the_Practic

268 Philosophical Foundations of Health Education
tokenistic forms of participation. It could be argued that much of current health promotion
practice, although using the rhetoric of community participation, in fact operates
at these levels when professionals attempt to get people in the community to take
ownership of a professionally defined health agenda. This occurs when professionals
have decided to focus on particular health issues in a community — low birthweight or
heart health, for example. Community participation in these instances often consists of
the professionals convincing the community to take responsibility for and to carry out
activities to address these issues, without the members of the community ever having
decided whether these are the issues of interest to them. As Labonte (1990b) has
pointed out, such an approach raises “ the specter of using community resources primarily
as free or cheaper forms of service delivery in which community participation
is tokenistic, at best, and co - opted at worst ” (p. 7).
Full community participation occurs when communities participate in equal partnership
with health professionals in setting the health agenda — in defining their health
problems and developing the solutions to address those problems. For that reason,
Rifkin et al. (1988) offer the following definition of community participation :
Community participation is a social process whereby specific groups with shared
needs living in a defined geographic area actively pursue identification of their needs,
take decisions and establish mechanisms to meet these needs. (p. 993)
If we accept the above definition of community participation, the role of professionals
must be carefully reexamined. In the new health promotion movement, the
role of the professional is recast from that of an expert who defines the community ’ s
needs and provides the solutions through professionally oriented strategies to that of
a consultant to the community; someone who, in the Alinsky (1972) tradition, facilitates
the mobilization of the community by providing technical and informational
support. Rather than service provider and client, the community and the professionals
are equal partners in setting the health agenda for the community. Within this
view, the capacity of communities is facilitated by health education and health promotion
efforts that strengthen the ability of those social units that we have called
mediating structures — families, networks, neighborhoods — to identify and meet the
needs of its members (McKnight, 1990; Eng, Hatch, & Callan, 1985). Such capacity
building further may involve facilitating processes whereby disparate groups within
a given community are enabled to interact more closely and effectively, ideally
achieving some joint community problem - solving as a consequence of their
collaboration (Brown, 1987).
Although we consider the shift in emphasis from a preeminent role for professionals
to the need for a central role for communities to be a welcome change in the field
of health promotion, we must also consider the question, Has the tyranny of the professional
been replaced by me tyranny of community? As Hoffman (1989) has suggested,
there may be a tendency in the community health promotion movement either
to simplify or to romanticize the notion of community, “ not only its unity and desire
for service, but its degree of support for political action ” (p. 197).