Power, health & wellbeing

Public Health Well-being

 The Community Empowerment Evidence Network

Power can determine how we function, how we access resources for health, and how good we feel about ourselves, our lives and our futures. Sir Michael Marmot highlighted the importance of this kind of individual control or power:

how much control you have over your life – and the opportunities you have for full social engagement and participation – are crucial for health, well-being and longevity. It is inequality in these that plays a big part in producing the social gradient’. i

There is growing evidence that an individual’s level of power to influence decisions in workplace and healthcare settings and in the living environment impacts on their health.ii Current evidence shows that the more power or control over their lives a person has, or feels they have, the better it is for their health and wellbeing.

While there seems to be lots of action aimed at empowering communities, there is currently very little evidence on how such interventions actually impact on individuals’ health and wellbeing (positively or negatively). Close inspection of the evidence on things like collaborative health promotion and volunteering shows that such interventions rarely empowered people to shape decisions. This stresses the important point that simply being involved does not necessarily mean that you are empowered. Furthermore, when people appeared to be empowered through interventions, health and wellbeing impacts were rarely measured as part of evaluations, with most studies focussing on the extent or quality of service deliveryiii. It is undeniable that we need more health and wellbeing-focussed evaluations of community empowerment interventions, and we also need to bring together the limited evidence that is currently available. Both evidence synthesis and better focussed primary evaluations will help to strengthen future evidence and improve the quality of interventions that are offered. The Community Empowerment Evidence Network (CEEN) is an email group for researchers, practitioners, policy makers, and community groups who produce or use evidence on community empowerment. Emails to CEEN, including attachments, are stored in a searchable archive. CEEN is therefore a new and much needed depository for discussion, theory and evidence on the health and wellbeing impacts of community empowerment interventions.

If you are CEEN to join, please subscribe to the network here www.jiscmail.ac.uk/CEEN, then post your comments, questions, case studies and evaluations to CEEN@jiscmail.ac.uk.

i Marmot M (2004) Status Syndrome: How Your Social Standing Affects Our Health and Longevity. Bloomsbury: London.

ii Examples of systematic review level evidence: (a) Theorell T, Hammarström A, Aronsson G, et al. (2015) A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health. 15:738. (b) Shay L, Lafata J (2015) Where is the evidence? A systematic review of shared decision making and patient outcomes. Medical Decision making. 35(1):114-31. (c) Durand M-A, Carpenter L, Dolan H, et al. (2014) Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLOS ONE. 9(4):e94670. (d) Whitehead M, Orton L, Pennington A, et al. (2014) Is control in the living environment important for health and wellbeing, and what are the implications for public health interventions? Public Health Research Consortium: London.

iii Examples of systematic review level evidence: (a) O’Mara-Eves A, Brunton G, McDaid D, et al. (2013) Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Research. 1(4). NIHR Journals Library: Southampton. (b) Jenkinson C, Dickens A, Jones K, et al. (2013) Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers. BMC Public Health. 13:733. (c)