Power – a health and social justice issue

Written by: Elinor Dickie, Public Health Advisor, NHS Health Scotland
and Jill Muirie, Public Health Programme Manager, Glasgow Centre for Population Health

Published: 09/10/2017

Elinor and Jill explain why power matters for health and why its fair distribution is a matter of social justice.

‘Power’ includes the ability to do (or not do) something, and to be able to exercise influence or control in a variety of different ways. Power matters for everything we do: it acts as a capacity and shared resource in all aspects of all our lives. Power, or lack of power, can have an important impact on our circumstances and on our control over the things that affect us. As a result, it is an important and fundamental determinant of health, and of inequalities in health. 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.

As public health professionals, we strongly believe that understanding how power operates and how it affects our lives is important if we are to understand why health is improving for some people in Scotland, but not for everyone. Those who live and grow up in poorer circumstances experience fewer years in good health and die younger than people in more affluent areas. Known as health inequalities, these differences in outcomes across different groups are influenced by the different distributions of power, income and wealth in society. This unequal distribution means some groups are better off and better able to take advantage of their circumstances, and consequently means they have better health.

The Community Empowerment Act is an important new piece of Scottish legislation that provides a number of opportunities to reduce health inequalities through the redistribution of power – but that depends on us really understanding what power is and where power lies and using that knowledge to change the way we operate, and how we plan and run services.

Power exists in the relationships between people and groups of people – at home, within families; at work with managers, colleagues and unions; and in how people access services, such as the GP or the housing office.

Some of these relationships are fair and equal, where we are treated with dignity and respect. Positive relationships enable us to get the guidance we need when we are asking for advice, to get the information we require to make our own decisions, and to feel equipped to deal with the issues in our lives. However some relationships prevent us from doing that; in some there can be an imbalance of power that is neither helpful nor healthy.

When relationships make us feel empowered, evidence shows that this has a positive impact on our health. However, when they make us feel powerless or disempowered, this impacts negatively on our mental, physical and social wellbeing. So, when some individuals, groups, communities and organisations have greater power than others, they will have more opportunities than others to live longer, healthier, more fulfilled lives.

Scotland’s Community Empowerment Act requires public bodies to move towards ways of working that promote ‘power to’ and ‘power with’ communities, giving them a stronger voice and supporting them to use their knowledge, skills and lived experience to influence the planning, delivery and assessment of local public services. 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 develops positive relationships and gives these communities greater control.

As public health professionals this matters to us. We work in the public sector to support and improve policy and practice so that it benefits everyone. To do this, we need to understand the importance of power in influencing health outcomes, and how it can be shared more equally. Watch our animation below to find out more.

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