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Editorial

Community Empowerment: Holistic Approach for Sustainable

Improvements in Population Health
A state of good health and well-being improves the
lives of everyone and is essential for development.
Communities are groups of people who may or may
not be spatially connected but share common interests,
concerns, or identities. Communities may be local,
national, international, or even global in nature, and may
have either specific or broad interests.1
The determinants of health are diverse, and their
distribution varies within the community. This brings
about disparities within the community, putting some
people in a more advantageous position than others. This
results in differences in the health status of the people
in the community, with some disadvantaged groups
of people having little control over factors and events
that determine their conditions and health. This relative
state of powerlessness is a core social determinant of
health and acts as a broad risk factor for ill-health; it
can be addressed by strategies collectively termed as
empowerment.
Community empowerment is a process of enabling
communities to increase control over their lives by
renegotiating power. The strategies used in the process
of community empowerment are legitimate mechanisms
for targeting social determinants. By addressing the
socioeconomic, political, and cultural determinants of
health and development, community ownership and
action are brought about. Empowerment strategies
enable individuals and their communities to access
appropriate information, raise their assets, develop
critical thinking and decision-making capabilities, build
capacities themselves in this process, plan and engage
in appropriate collective action on issues of importance,
and also monitor and evaluate an empowerment program
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to solve their own problems. This process is facilitated

by an external agent that acts as a catalyst in bringing
about the change. Thus the communities are empowered
to identify and solve their own problems and take charge
of their lives.
Community empowerment is a multilevel construct
described for individuals, the organizations where
they work, and their community settings. Individual
empowerment, also referred to as psychological
empowerment, refers to individuals gaining control
over their lives with building up of self-confidence,
boosting up of their self-esteem, critical awareness of
their social context, and better decision-making capacity,
leading to participation in change for improvement.
Organizational empowerment deals with the potential
ability of the organizations to influence societal change
for improvement. Community empowerment deals
with power relations and intervention strategies that
enable communities to take control of the decisions that
influence their lives and health.
India is currently facing a triple burden of health problems:
infectious diseases, noncommunicable diseases,
and injuries. These diseases and their consequences
are avoidable to a large extent. By addressing the
socioeconomic as well as political and cultural barriers in
accessing health information and services, empowerment
can play a role as a potentially sustainable solution for
these problems.
Community empowerment has been reported to be a
successful strategy complementing the strategies in
a routine vector-borne disease control program, an
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DOI: 10.4103/0019-557X.164647
PMID: ***

Cite this article as: Sai T, Prathap SS. Community empowerment: Holistic
approach for sustainable improvements in population health. Indian J Public
Health 2015;59:163-6.

2015 Indian Journal of Public Health | Published by Wolters Kluwer - Medknow

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Sai and Prathap: Improving population health: Community empowerment approach

important component in the program for prevention and

control of highly pathogenic avian influenza, a promising
human rightsbased solution to overcoming the persistent
burden of human immunodeficiency virus (HIV) among
female sex workers across epidemic settings, and as a
strategy to reduce the impact of infectious diseases.2-5
Community empowerment has also been reported as a
successful model for prevention of noncommunicable
diseases in India and also for early detection of cancer.6,7
The importance of community empowerment has been
well recognized in the context of injury prevention and
safety promotion also.8
To protect and promote health, the joint efforts of those
across the whole social fabric must be involved, i.e.,
the individual, the community, and the state. Health is
everybodys business, and the responsibilities for health
lie at the individual level, the community level, the
state level, and the international level. Empowerment
plays a key role in enabling these components to take
control and act in order to improve health. The Ottawa
Charter for Health Promotion and The Bangkok Charter
for Health Promotion in a Globalized World identified
community empowerment as being a central theme of
health promotion.9,10 Empowerment brings about active
participation of the people in service planning, delivery,
and evaluation, and thus helps in shaping services for the
benefit of the community.
Community empowerment can be viewed both as a
process and an outcome. As a process, community
empowerment is a social-action process that promotes
participation of people, organizations and communities
towards the goals of increased individual and community
control, political efficacy, improved quality of life
and social justice. 11 As an outcome, community
empowerment is an interplay between individual and
community change that usually takes a long time and
results in changes in government policy or legislation in
favor of those involved in the programs and community
actions. Community empowerment is most often viewed
as a five-point continuum comprising:
1. Personal action,
2. Development of small interest groups,
3. Community organizations,
4. Partnerships, and
5. Social and political action.12
Domains are often used in empowerment strategies
and this helps in understanding the pathways through

which the empowerment approach is related to

health outcomes. Participation forms the backbone
of empowering strategies. Individuals have a better
chance of achieving their health goals if they can
participate and have discussions with other people
facing similar problems or circumstances. Participatory
discussions result in a higher level of critical thinking.
Through participation, they can define and analyze
their concerns better, can understand the interplay of
factors affecting their health, and are likely to come
with a joint solution to their issues, thus enabling
them to take their own decisions. Participation also
strengthens social networks and improves social
support.
The establishment of community-based organizations
brings together people with common concerns. The
members of such organizations have an opportunity to gain
skills and competencies, which can address their concerns
and help them in achieving their health goals. These
organizations can also enter into partnerships, alliances,
and coalitions with other people and organizations
to address the communitys health needs. The Self
Employed Womens Association (SEWA) is the largest
trade union of informal workers in India with about
one million women members. The members organized
themselves into cooperatives and increased their ability
to bargain with middlemen and contractors. To meet
their needs, the members started their own cooperative
SEWA Bank, negotiated with government and nongovernmental organizations for access to preventive
and curative health care at low cost, health insurance
cooperative, and also a Mahila Housing Trust. It has
also entered into partnerships with other organizations
including the government to help its members and lobby
for favorable policies and legislations.13
Community organizations and groups also require strong
leadership to move toward achieving health outcomes.
However, it is important that the leaders work for the true
benefit of the community without any vested interests.
In addition, there may be formal and informal leaders,
and all of them have their own influence. The capacity
of the community to mobilize resources from within and
to negotiate resources from beyond is itself important in
meeting health needs and concerns.
Addressing health outcomes does not essentially start
with the community dealing with the health problems.
It may begin a wide range of factors such as personal,

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Sai and Prathap: Improving population health: Community empowerment approach

economic, environmental, social factors, and issues that

are close to the heart of the communities, all of which
may not be directly related to health.
Capacity-building at the community level by involving
local people as partners in improving local health and
well-being is important, and can have a greater long-term
impact and enable more inclusive participation. Joint
training with community members, professionals from
non-governmental organizations, and health staff will
help people get to know each other better, understand
various perspectives, and help in establishing linkages
and partnerships. Capacity-building is needed not
only in specific skills and competencies to meet health
concerns but also in program management, including
the management of resources, documentation, and
evaluation. Continued support by the program also
increases peoples knowledge and skills, which help
them in broader sociopolitical action such as lobbying
for better policies and legislations.
Empowerment evaluation is an integral part of the
program where the participants analyze the program
and discuss the objectives, interventions, and results
to foster improvement. This is a continuous, ongoing
process and the approach is strengths-based. The chief
output of empowerment evaluation is organizational
learning.
Measuring empowerment is a challenging process
with many limitations because of the multidimensional
nature of empowerment. Scales have been developed to
measure psychological empowerment and organizational
empowerment. 14,15 When measuring community
empowerment as a process, it is possible to keep track
of capacities, skills, and resources as well as changes in
health status and policies during the time frame of the
program. However, the self-reported information and
scales have their own limitations because of subjective
factors. The longer time frame makes measurement of
community empowerment as an outcome even more
challenging. Moreover, the range of experience of an
individual or community may change over a period of
time, as empowerment is a dynamic process and the
effects should not be construed as static. The outcomes
also vary with time and settings, making it more difficult
to measure. Use of qualitative approaches can improve
the understanding of the empowerment process and
outcomes and help in better measurement.

165

The vertical disease-control programs are non-sustainable

and hence there is a need to emphasize community-based
strategies. A communityempowerment approach has
been found to play an important role in tackling infectious
diseases, noncommunicable diseases, and also injuries,
and therefore should complement and supplement the
strategies used in all disease-prevention and control
programs. For this to happen, community empowerment
has to be mandatorily incorporated in all the public
health programs and policies. Since communities
are enabled to take charge of their health and lives, a
holistic communityempowerment approach can play an
important role in sustainable improvements being made
in population health.
Tirunagari Sri Ranga Sai1,Sai Shankar Prathap2
1
Professor and Head, Department of Community Medicine,
NRI Medical College, Guntur, 2Associate Professor, Department
of Community Medicine, Konaseema Institute of Medical
Sciences and Research Foundation (KIMS and RF), Amalapuram,
AndhraPradesh, India.
E-mail: prathapss@gmail.com

References
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2. Castro M, Snchez L, Prez D, Carbonell N, Lefvre P,
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