Professor Jennie Popay, Professor of Sociology and Public Health in the
Division of Health Research, Director of the Centre for Health Inequalities,
Lancaster University, UK
Community involvement in action for health equity: A cautionary tale
Health inequalities are caused by structural inequalities in the conditions in which people
live and work and the control they have over their ‘destiny’. In theory community-based
initiatives in public health/health promotion policy and practice have potential to reduce
these inequalities by:
1. increasing the collective control disadvantaged communities have over decision impacting on their lives and
2. enabling communities to exercise their increased collective control to address inequalities that are amenable
to local action.
However, the impacts of these initiatives are shaped by access to the conditions and resources communities need to
develop and exercise collective control and these conditions and resources too are unequally distributed. This raises
the possibility that community-based initiatives in public health/health promotion could be increasing inequalities
by “imposing greater risks and responsibilities upon more disadvantaged communities in return for lower levels of
power.” (Rolfe, 2018:16).
In this presentation I will present findings from a longitudinal evaluation of a large community empowerment
programme in England - Big Local - that illuminate pathways to positive impacts and unintended negative outcomes
for community members involved.
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