Abstract
Community initiatives aiming to reduce health inequalities are increasingly common in health policy. Though diverse many such initiatives aim to support residents of disadvantaged places to exercise greater collective control over decisions/actions that affect their lives - which research suggests is an important determinant of health - and some seek to achieve this by giving residents control over a budget. Informed by theoretical work in which community capabilities for collective control are conceptualised as different forms of power, and applying a relational lens, this paper presents findings on the potential role of money as a mechanism to enhance these capabilities from an on-going evaluation of a major place-based initiative being implemented in 150 neighbourhoods across England:The Big Local (BL). The research involved semi-structured interviews with 116 diverse stakeholders, including residents and participant observation in a diverse sample of 10 BL areas. We took a thematic constant comparative approach to the analysis of data from across the sites. The findings suggest that the money enabled the development of capabilities for collective control in these communities primarily by enhancing connectivity amongst residents and with external stakeholders. However, residents had to engage in significant 'relational work' to achieve these benefits and tensions around the money could hinder communities' 'power to act'. Greater social connectivity has been shown to directly affect individual and population health by increasing social cohesion and reducing loneliness. Additionally, supporting enhanced collective control of residents in these disadvantaged communities has the potential to improve population health and reduce health inequalities.
Highlights
Community empowerment as a route to greater health equity is enshrined in foundational health promotion/public health statements (WHO, 1997; WHO, 1986)
Social Science & Medicine 260 (2020) 113176 control are conceptualised as different forms of power - ‘power within'; ‘power with’ and 'power to' – this paper considers the role of money as a mechanism to enhance these capabilities presenting findings from an on-going evaluation of a major place-based initiative being implemented in 150 neighbourhoods across England
Through a health equity lens these latter developments pose an important question: in what ways and through what pathways could the transfer of control over how money is spent in disadvantaged communities ‘work’ to enhance their collective control over decisions and actions that have potential to positively impact on their lives and their health? This paper addresses this question by exploring the role of money in the Big Local (BL) community empowerment initiative in England
Summary
Community empowerment as a route to greater health equity is enshrined in foundational health promotion/public health statements (WHO, 1997; WHO, 1986). Definitions vary but we define community empowerment as processes through which communities of interest or place develop the capabilities they need to exercise greater collective control over decisions and actions impacting on their lives and health. Initiatives aiming to enhance individual or community empowerment are supported by a growing body of research demonstrating that ‘control over one's destiny’ (Syme, 1989) is a fundamental determinant of health, and lack of control could be a significant cause of health inequalities. Community empowerment is integral to the Global Sustainable Development Goals and many local, national and international strategies for social and health development (e.g. WHO EURO, 2013; 2019; UN Economic and Social Council, 2019). Local place-based initiatives designed to be ‘empowering’ are diverse but some seek to enhance collective control over decisions and actions by giving community members control over a budget. Informed by theoretical work in which community capabilities for collective
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