Spiritual_Wellness_Holistic_Health_and_the_Practic

New Health Promotion Movement 269
Communities are not homogeneous. In any geographical community there may be
several diverse communities of interest. Rather than generating consensus, a community
focus may, in fact, generate conflict and confrontation (Reynolds & Norman,
1988). Such “ dis - sensus ” has been witnessed in the United States, for example, where
efforts have been made to mobilize low income communities around experimental
needle exchange programs designed to reduce the spread of AIDS among intravenous
drug users. With parts of the community heavily invested in needle exchange as a literal
matter of life and death, and others arguing that such programs not only break the
law but also condone and encourage drug use, efforts to achieve community cooperation
and consensus on needle exchange programs have been fraught with difficulty.
Besides the local community, moreover, there are other stakeholders related to
health promotion that constitute communities or “ publics. ” The fact of these multiple
stakeholders increases still further the likelihood of conflict over perceived health
needs and resources, and hence over the formulation of health promotion policies and
strategies. Among these other publics, which must be considered in public or community
participation, are recipients of service; middle and upper income groups, the main
supporters of public health as taxpayers; medical and other health providers; the media,
which shape the perception of community issues; public policy makers; and public
health workers (Minkler, 1990).
The dangers in casting communities as homogeneous entities and ignoring these
diverse constituencies is that, as Farrant (1991) observes, there is “ little encouragement
to systematically analyze power relations within and between communities ”
(p. 431). As long as policy makers determine resource allocation, as long as the
media play such a large role in shaping public attitudes and consumer choices, as
long as business, industry, and the upper income groups have a loud voice in what
happens and does not happen in the policy arena, these other publics must be a critical
focal point for health promotion efforts. For example, health education and
health promotion professionals are in a critical position to show these other publics
that community coalitions comprised primarily of professionals and, at best, a handful
of community residents with the time and energy — and, more importantly, a
sense of personal power and efficacy — to devote to such work are unlikely to reflect
the needs and interests of the most vulnerable and disenfranchised members of the
community.
For these reasons, the notion of community participation implies a more politicized
role for professionals vis - à - vis the community (Labonte, 1990b, McKnight,
1992). However, this may be problematic for both professionals and the community.
In her analysis of the community activist movement in health and social planning of
the 1960s, Lily Hoffman (1989) found that when community groups were politically
radical, they often sought to use activist professionals and their services to gain power
for their own ends. For their part, communities claimed that the adoption of political
roles on the part of professionals deprived them of power, and that professionals who
were politically radical were often found to be professionally conservative both with
regard to defining the contents of services and in sharing expertise and control.