Evidence based on multi-level research designs shows that empowering initiatives can lead to health outcomes and that empowerment is a viable public health strategy. However, the effectiveness of empowerment initiatives may depend as much on the agency and leadership of the people involved, as on the context in which they take place. The most effective empowerment strategies are those that ensure autonomy in decision-making, a sense of community and local bonding, and the psychological empowerment of community members. Participatory processes alone are insufficient; it is also important to build the capacity of community organisations and individuals in decision-making and advocacy.
Empowerment strategies, participation, and other bottom-up approaches have become prominent in efforts to improve health and to reduce health disparities. Empowerment is both an end in itself, and a step towards the achievement of long-term health outcomes.
Much research has focused on the empowerment of socially excluded populations (such as women, youth, people at risk of HIV/AIDS, and the poor):
- Youth empowerment interventions have produced multiple empowerment and health outcomes: strengthened self- and collective efficacy, stronger group bonding, formation of sustainable youth groups, increased participation in structured activities including youth social action, and policy changes, leading to improved mental health and school performance.
- Multi-level empowerment strategies for HIV/AIDS prevention which address gender inequities have improved health status and reduced HIV infection rates.
- Women’s empowering interventions, integrated with the economic, educational, and political sectors, have shown the greatest impact on women’s quality of life, autonomy and authority and on policy changes, and on improved child and family health.
- Patient and family empowerment strategies have increased patients’ abilities to manage their disease, adopt healthier behaviours, and use health services more effectively, as well as increasing care-giver coping skills and efficacy.
- Coalitions and inter-organisational partnerships that promote empowerment through enhanced participation and environmental and policy changes have led to diverse health outcomes.
Empowerment strategies, including community-wide participation, need to be integrated into local, regional and national policies and into economic, legal, and human rights initiatives. Structural barriers to and facilitators of empowerment need to be identified locally. Further policy considerations include the following:
- Empowerment programmes for specific groups are needed to overcome the larger political, social, racial, and economic forces that produce and maintain inequities. It is important to build on documented successful strategies for youth, those at risk of HIV/AIDS, women, and the poor, and to support partnerships and coalitions that work with them.
- Empowerment strategies are more likely to be successful if integrated within macro-economic and policy strategies aimed at creating greater equity. Case studies have shown that synergy between all elements (anti-poverty strategies, NGO-government collaboration, empowerment and participatory development and active health programmes) is probably most effective at improving health and development outcomes.
- Health promotion should involve: increasing citizens’ skills, control over resources and access to information; small group work; promoting community involvement in decision-making and in all phases of public health planning, implementation and evaluation; and transferring authority to participants of interventions.
- It is important to foster training for health and development professionals, service providers, policymakers and community leaders on community empowerment strategies and participatory research and evaluation.
- Governments need to invest in multiple-method research and evaluation to collect evidence on the impact of empowerment strategies over time.
