The role of empowerment in setting a foundation for social and emotional wellbeing
Empowerment and community participation are major strategies, worldwide, for alleviating poverty and social exclusion, thereby reducing health disparities. In Australia, a lack of control, or mastery, has long been widely acknowledged as one aspect of a broader experience of powerlessness that needs to be addressed to reduce the current preventable Indigenous burden of disease and close the health disparity gap. Yet, it is hard to find empirical research examining the nature and attributes of empowerment and how to operationalise and evaluate these in the context of promoting Indigenous health.
This paper synthesises the findings of a five-year Family Wellbeing empowerment study aimed at enhancing the capacity of Indigenous Australian people in Cape York, far north Queensland, to take greater control over the issues affecting their health and wellbeing. Documenting and analysing empowering strategies over time can help us to better understand the process of empowerment and ways in which change is generated at multiple levels.
The study confirmed existing evidence that the process of empowerment is lengthy, taking years to achieve change beyond the individual level. It also highlighted the importance of initial engagement and personal capacity building, in socially and economically vulnerable communities where people experience relative powerlessness, as a critical foundation for improving the health of the broader community.
North Queensland Health Equalities Promotion Unit; School of Population Health, University of Queensland, Cairns QLD
Department of Social Work and Community Welfare, School of Arts and Social Sciences, James Cook University, Cairns QLD
Apunipima Cape York Health Council, Cairns QLD
Apunipima Cape York Health Council, Cairns QLD
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Indigenous, empowerment, social and emotional wellbeing, remote, program evaluation, social change
PP: 006 - 015
Empowerment is central to the Ottawa Charter for Health Promotion (World Health Organization: WHO, 1986) and subsequent WHO health promotion strategies. As a theoretical construct, empowerment involves both processes and outcomes, generating change at multiple levels (individual, organisational and community) and strengthening the capacity for collective action to positively influence social situations (Rissel, 1994; Wallerstein, 1992; Wallerstein, 2002). However, how to operat-ionalise empowerment with marginalised populations, in ways that contribute to reducing health inequalities, has remained less clear (Laverack & Wallerstein, 2001; Wallerstein, 2002; Williams, Labonté & O'Brien, 2003).
In 2006, twenty years after the Ottawa Charter, the WHO Health Evidence Network published a review of the evidence for the effectiveness of empowerment in improving health (Wallerstein, 2006). The report identifies pathways through which empowerment is generated at psychological, organisational and community levels, linking the effect of these outcomes to improvements in health. The report concludes that there is evidence that initiatives based on empowerment, as a multi-level construct, can reduce health disparities but successful approaches cannot be replicated across populations. There is a need for the development and evaluation of strategies relevant to the lived experience of populations experiencing social exclusion (Wallerstein, 2006).
This paper examines the pathway to empowerment by analysing the results of a five-year Family Wellbeing empowerment study aimed at enhancing the capacity of Indigenous people in Cape York (far north Queensland) to achieve greater control over their lives. The study describes ways in which empowerment outcomes are being sustained over time and utilised to address broader social determinants through efforts to integrate Family Wellbeing into the core business of a range of health promotion and illness prevention programs and services.
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