Power – a health issue!

In our latest blog Elinor Dickie and Emma Doyle of NHS Health Scotland explore how power, and how it is shared between individuals, communities and statutory bodies, can affect health inequalities. 

Unequal distributions of power, income and wealth are the fundamental causes (or the main causes) of health inequalities. At NHS Health Scotland, we know a lot about how having, or not having, income and wealth impacts on our health, but we are just starting to explore the relationship between power and health. Unlike money or wealth, power does not belong to any one person, but exists in the relationships between people and groups of people. We know that those who have power over their lives and the environments in which they live are likely to have better physical, mental, and social well-being. So power is protective of health.

We’ve defined power as the ability to act in a particular way, as a capacity, shared resource or relation. It is a complex concept which includes the ability or capacity to do (or not to do) something and to exercise influence or control in a variety of different ways. People may have power in some situations, such as at home, but less power in others, such as at work or in their community.

If you have power, you are more able to make or influence the decisions that affect aspects of your life, such as where you live and where your children go to school. You are more likely to understand choices available to you and have some confidence that you can make your voice heard in decisions that relate to you and to the community in which you live. When you are able to do this, it seems normal. You might not even recognise it as power.

 However, if you don’t have power, you are likely to feel this lack of control in many parts of your life. You may feel that your voice goes unheard, or is not valued or respected, or that others know better and you will have little sense of control, even over the things that are important to you. People who do not have power may have limited choices, may not be able to make informed decisions and may not get the services that they need.

This means that empowering people at the individual, community and national level is necessary to improve health and wellbeing and to tackle disadvantage and inequality. So how do we do this?

One way is to think about power as a fluid resource, not a limited one. There are many different sources of power, positions of power, and spaces or levels where power is exercised. Understanding this helps us to identify where there may be opportunities to tackle inequalities in how power is distributed. For example, where can power be shared, where can it be ceded and where can it be claimed? We can start by understanding human relationships – who holds power over a certain matter? What influences them? Who or what do they listen to – research evidence? Public opinion? Corporate interests? We are all part of a complex social and political system in which power is exercised to advantage some groups over others.

We need to work with individuals and groups, as well as with the processes and structures that determine the interaction between communities and the state. It’s for us to think about our role in the system and how we can use our power to bring about change.

The Community Empowerment Act is an important new piece of Scottish legislation with opportunities to reduce health inequalities, giving communities greater control through the redistribution of power –  but that depends on us really understanding what power is and where power lies. In partnership with Glasgow Centre for Population Health, we have produced a new animation which explores these issues further.

It’s time for all of us to be part of creating a fairer, healthier Scotland.

Edgar S. Cahn – Scotland taking the worldwide lead in co-production

Edgar S. Cahn, founder of TimeBanking, former counsel and speech writer to Robert F. Kennedy and co-founder of the David A. Clarke School of Law at the University of the District of Columbia celebrates Co-production Week Scotland in this special blog:


In devoting an entire week to promoting co-production, Scotland is taking the lead worldwide. Congratulations. You are transforming what it means ‘to help others’ from a well-intended service delivery role to being a catalyst that enlists those being helped as partners and co-producers of real change, for themselves and others.

TimeBanks USA is undertaking to bring co-production into our higher education system – both for undergraduates at the University of the District of Columbia and my law school. The law faculty will shortly authorise a course in Becoming a Changemaker which introduces law students to co-production that reframes providing legal services to clients from a service delivery role to a transaction that enlists those clients as co-producers advancing System Change.

This past week, at the Annual Conference of our National Legal Aid and Defender Association (NLADA), TimeBanks USA, my law school, and the NLADA conferred a formal Client Contribution award to clients who had advanced social justice.

As we look at the recent election, we can see that we may be learning that the well-meaning effort of all our NGO’s to ‘do good’ may have relegated those recipients to being passive and disenfranchised – a status they did not appreciate. This election may have been their expression of dissatisfaction with that role and status. My hope is that co-production will be the way to restore us to the core values on which this nation was founded. Empowering the disempowered and disenfranchise is the mission to which I have committed myself since 1963 when I served as a Special Counsel and speech writer for Attorney General Robert Kennedy. I’m  not turning back – and you in Scotland have provided a model for us all.

Edgar recently gave a special lecture at our event Health, Human Rights and Co-production. Read the #LetsCoPro Storify here.


Co-production Week Scotland

Co-production Week Scotland 2016, running from the 14th – 20th November, highlights the co-production approach, shares the vision for co-production in Scotland and celebrates examples of it in practice on a local and a national level.

This week Ashleigh de Verteuil, Policy and Information Intern – People Powered Health and Wellbeing and Dementia Carer Voices at the ALLIANCE, provides a snapshot of where we are with co-production in health and social care across Scotland.

Co-production. Either love the word, or hate the word, it is increasingly being recognised as the transformational change health and social care services need. Auditor General Caroline Gardner has backed the use of co-production at a local level across Scotland as a means to better recognising what works for people in health and social care.

Giving evidence to the Public Audit and Post-Legislative Scrutiny Committee on Audit Scotland’s recent NHS in Scotland 2016 report, Ms Gardner responded to questioning by Gail Ross MSP by noting that some NHS Boards were involving people by “not just consulting on plans but involving people in developing those plans.”  She also noted that the NHS in Scotland “can’t do too much of that”.

In an online survey which 60 health and social care professionals completed, we asked ‘how important should using a co-production approach in your role be?’

copro-ashPPHW Survey: Health and Social Care Staff’s response for the importance of using a co-production approach

The survey presented a situation where professionals at a strategic and frontline level are at the early stages of adopting co-production approaches, and feel as if they are making progress, but acknowledge that they face a number of barriers to developing their engagement further.

And that’s exactly what People Powered Health and Wellbeing want to tackle, to help embed co-production approaches across Health and Social Care Partnerships. This would result in shifting the balance of power, to enable people with long term conditions and disabilities to be recognised as experts in their own health.

Results from PPHW survey also showed that respondents identified access to online examples of good practice as a helpful means of support, as well as co-production masterclasses, training conferences and events. They also identified the potential for practical development and consultancy support. The ALLIANCE can, therefore, play a key role as a hub for co-production work; producing materials and tools, sharing information, news and good practice, and brokering and supporting links between practitioners.



Podcast: Ceding power – Participatory Budgeting

What does ceding power mean in practice?

In the latest Academy podcast we hear from Alistair Stoddart, Scotland Network Manager at the Democratic Society, about how participatory budgeting (PB), a practical tool to support community decision making in resource allocation, is progressing across Scotland.

Read More “Podcast: Ceding power – Participatory Budgeting”

The Roots of Democratic Culture – Lisa Curtice

The Roots of Democratic Culture

You know the feeling. The meeting feels stuck. One person keeps making the same point, only more vociferously, another insists on bringing up something else just as the Chair tries to move the agenda on.  The rest have switched off and stopped trying to participate. Decisions are postponed and power relationships are reinforced.

Read More “The Roots of Democratic Culture – Lisa Curtice”

Citizen Voices – What is the impact of using them? by Sophie Dishman

This year’s Creative Competition theme is ‘Voices of the Experts’ as we ask our entrants to tell us of their experiences, and what a healthier and fairer Scotland looks like to them. In this blog post, Sophie Dishman talks of the importance of citizens using their voice to improve health and social care and the impact it can have.

Read More “Citizen Voices – What is the impact of using them? by Sophie Dishman”

A Sense of Belonging – Jo McFarlane

In this poem Jo highlights growing levels of inequality across Scotland. The recent Academy thinkpiece “The Right to Health” considered health inequalities across Scotland and how to tackle them.

In “A Sense of Belonging” Jo urges us all to not leave tackling inequalities to the politicians and managers. We all have a responsibility for social justice and we all have a stake in a healthy, flourishing Scotland.

Read More “A Sense of Belonging – Jo McFarlane”

People in Scotland at the forefront of change

“A social movement that only moves people is merely a revolt. A movement that changes both people and institutions is a revolution.”Martin Luther King Jr., Why We Can’t Wait

It seems extraordinary that it has been just 10 years since the birth of the ALLIANCE. A decade ago, the voice of the people who use health and social care services was muted. Now, people in Scotland are at the forefront of change. Read More “People in Scotland at the forefront of change”

The Courage to Cede Power

Has Scotland missed an enormous opportunity to have the expertise of some of the 2 million voices of users feed into the DNA of the new Health and Social Care Integrated Joint Boards?

In common, it appears, with most of Scotland’s national and local politicians, I had accepted that the obligation to have one third sector member, one carer member and one service user member on each of the new boards ensures the voice of the ‘customer’ is built into the new structure. Read More “The Courage to Cede Power”