Background: Being empowered has to do with having control over the determinants of one’s quality of life (including health) (Tengland 2007). Many things can be changed, on many levels, to increase empowerment in this sense and increasing the empowerment of individuals and groups can be seen as a goal for many kinds of social interventions, e.g. health promotion (WHO 1986).
Empowerment can also be seen as the process of facilitating increased control. This process involves fully engaging the person or group concerned in the change process, so that they controls as much of this process as possible. The professional supports this process, and has no agenda of her own other than to facilitate the individual or group in achieving their aims (Tengland 2007).
Empowerment has a positive ethical ring to it. It is supposedly superior to other ways of working towards health and social change – better than top-down interventions and behavior change projects. But is this so?
Objectives: The aim of the paper is to critically discuss the ethical pros and cons of empowerment and relate it to other kinds of goals and interventions within health promotion and public health.
Underlying values and principles: Ethical principles and theories, such as utilitarianism, deontology, principalism, virtue ethics and theories of justice are used throughout the discussion.
Knowledge base/ Evidence base: The ethical analysis starts from a conceptual theory of empowerment (Tengland 2008) in relation to health promotion (Tengland 2007).
Context of intervention/project/work: The general context of the project are the ethical aspects of health promotion and public health (Holland 2007).
Methods: Ethical analysis (ethical theories and principles) is used when discussing and evaluating the goals and means of the empowerment approach, and relating it to other approaches (see underlying values and principles).
Results and Conclusions: A first conclusion is that empowerment as a process is superior to many behavior change projects, since a) it reduces persuasion, manipulation and coercion of the subjects involved, something that is common in other approaches, b) it (thus) enhances autonomy, rather than reducing it, and c) it is founded on a more accurate theory of human nature, humanistic theory, rather than cognitive theory.
Another conclusion is that many top-down projects are ethically compatible with most empowerment goals (i.e. increased control), e.g. literacy projects in poor countries, although not with all such goals, e.g. requiring drivers to wear seat-belts. However, other ethical concerns are also important, e.g. social justice, equal opportunity, and positive freedom, some of which might not necessarily lead to empowerment of individuals or groups.
References: Holland, S 2007. Public Health Ethics. London: Polity.
Tengland, Per-Anders 2007. Empowerment: A Goal or a Means for Health Promotion? Medicine, Health Care and Philosophy, Vol. 10, No 2 (2007), 197-207.
Tengland, Per-Anders 2008. Empowerment: A Conceptual Discussion. Health Care Analysis vol 16, no 2, 77-96.
WHO (1986) Ottawa Charter for Health Promotion. WHO: Geneva.
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