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.