Power – a health and social justice issue (NHS Health Scotland and GCPH)


Power – a health and social justice issue Although power has long been accepted to shape
people’s lives, it’s difficult to describe what it is and how it affects us. Yet, increasingly,
evidence tells us that power has a real effect on our health and wellbeing. If someone asked you to describe what it is
to have power, what would you say? Having influence? Money? Knowledge? And if you think about the inequalities in
power between people, what springs to mind? Oppression? Privilege? Disadvantage? Power can be all of these things, and it’s
also a lot more. ‘Power’ is a concept which includes the ability
to do (or not do) something, and to exercise influence or control in a variety of different
ways. Evidence shows that those who have power to
control their lives, and the environments in which they live, are likely to have better
physical, mental and social well-being. Power isn’t always visible or obvious. If you have power you are more able to influence
the decisions that affect aspects of your life. When you are able to do this, it seems
normal, and you probably don’t recognise the power that you have. However, those with limited power may feel
their voice goes unheard, and may have little sense of control, even over things that are
important to them. The World Health Organization describes four
different types of power: 1.’Power over’ is when someone or some people
are able to influence or coerce others. This can be the most negative form of power. 2.’Power to’ is where individuals are able
to organise or change existing hierarchies or structures. 3. ‘Power with’ is the collective power of
communities or organisations. 4.And ‘power within’ is each individual’s
capacity to exercise control or act on their own will. Differences in power contribute to inequalities
in health outcomes Over the last century a lot has changed in
Scotland to make it a fairer and healthier place to live. Many of these changes were brought about,
not by a few powerful individuals, but by ordinary people who identified important issues
in their lives, engaged in collective action, and used their combined power to achieve their
goals. These developments may have been local, like
establishing a community garden; or national, like equal rights and equalities legislation. However, some people still do better than
others. While health is improving for us all, it has improved more quickly for some groups
than others. Those who live and grow in poorer circumstances experience fewer years in good
health. These differences in people’s health, known
as ‘health inequalities’, do not occur randomly or by chance. They are strongly influenced
by access to power, income, and wealth and are often beyond an individual’s direct control. As a result some people have more opportunities
than others to live longer, healthier, more fulfilled lives. For these reasons we call the unequal distribution
of power, income and wealth the ‘fundamental causes of health inequalities’. But when compared to the other fundamental
causes of health inequalities, what is unique about power? Power is often associated with income and
wealth. At the most basic level, having enough money to live comfortably brings security.
Money can also bring status and a wide range of opportunities. But power also has a separate and distinct
influence on health inequalities. Unlike income and wealth, power doesn’t belong to any one
person, but exists in the relationships between people or groups of people. Through these relationships, some individuals,
groups, communities and organisations can have greater power than others. This power is likely to differ in different
situations. For example, a community organisation may feel more powerful when working alongside
its community members, but less powerful when faced with working with the public bodies
that provide services for those community members. The impact of power on health inequalities Power, or lack of power, can have an important
impact on peoples’ circumstances, their control over things that affect them, and therefore
on their health. It can mean that individuals have limited
choices, are not able to make informed decisions and may not get the services that they need. It is now widely accepted that for the benefit
of everyone’s health and wellbeing, power has to be distributed more equally. This means empowering communities and groups
who experience disadvantage, so they have greater influence over the factors that determine
their health. Redistributing Power Public service reform in Scotland now requires
Community Planning Partnerships to engage proactively with their communities, and to
place these views at the heart of decision-making. Those who work for public bodies have a vital
role in ensuring that the way they operate, and the resources and opportunities they make
available, particularly to disadvantaged groups, enable this to happen in a way that gives
these communities greater control. So, rather than being directed by those who already hold
positions of power, policy makers and service providers should actively and respectfully
engage, involve and empower disadvantaged communities. Scotland’s Community Empowerment Act requires
those working in public bodies to move towards ways of working that promote ‘power to’ and
‘power with’ communities, giving members a stronger voice, using their knowledge, skills
and lived experience to influence the planning, delivery and assessment of local public services. Many public bodies already work with communities
and so this legislation is an opportunity to reflect on where power lies and what else
can be done to distribute power more equally. For example:
Actively involving communities in planning and prioritising services.
Ensuring that community voices are central to decision-making, including those who are
not part of organised collectives or associations. Asking communities how they would like to
engage and what issues matter to them. And making it easier for everyone to have
their say by addressing possible barriers to engagement (such as rigid or complex organisational
structures,) which can be just as challenging as individual needs (such as mobility, literacy
and language). A fairer and healthier future, where power
is more equally shared, is possible. How will YOU use your power to make it happen?

1 Response

  1. Matt Hu says:

    I fully support the opinion of this video. Sharing power is the only way for world peace.

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