This series of posts is about the link between community power and health on the basis of the medical literature. In the first post, I explained how we selected the articles to review, and in the second post, I described a synthesis of the many theories connecting community power to health. In this post, I start looking at the results of the articles.
The headline is that across the 93 articles reviewed numerous benefits to health were observed. I describe some of those below but there’s more to a story than the headline. On the way to health benefits, the process of building community power led to other outcomes in and between the community members involved. These are what Popay described as intermediate outcomes (see the first post), and our research tells us they matter as much as the health benefits.
That’s not to say that they matter because they led to health benefits (which is what is implied by the word ‘intermediate’). They matter in and of themselves.
The results from the 93 articles fall into the following categories:
- Classic health outcomes, including those related to health care services
- Changes to the environment (often focused on things known to impact health such as the placement of a toxic waste facility or the accessibility of parks)
- Changes in the skills of the community members involved
- Changes in the perceptions of the community members involved
- Changes in the social fabric between people
- Changes in the level of trust between people and between people and organizations/systems
In this post, I share the results of the 12 articles that were classified as high-quality (you can read about the quality assessment process in the full report). 45 articles were classified as medium-quality and 36 as low; I’ll talk about them in the next post. For now, I’ll use the 12 high-quality articles to illustrate how the results spanned the above categories.
The most commonly reported outcomes related to the skills of the community members involved. This included their emotional, social, organizational, communication and financial skills, which had an overall impact on their confidence (Blanchet-Cohen, 2014; Kim 2007; Porter, 2013; Pronyk, 2008; Watson-Thompson, 2008).
You could call confidence something that you perceive (it’s defined as a ‘feeling’, after all). Other changes in people’s perceptions included greater positivity towards (Lawless, 2012), pride in (ODPM, 2005; Orton, 2017) and belonging to (Blanchet-Cohen, 2014) their neighborhood. One study also found improvements in the general sense of safety (Lawless, 2012).
Feeling empowered is also a perception, and individuals reported it (Blanchet-Cohen, 2014; Kennedy, 2010; ODPM, 2005; Porter, 2013), with some people saying that the work made them feel as though they were making a difference (Orton, 2017), while others expressed a greater willingness to challenge their negative circumstances (Kim, 2007).
Positive changes to the social fabric between people were reported by a number of articles, whether it was called social cohesion or social connectivity (Orton, 2017; Popay, 2015; Porter, 2013). This was partly observed as greater group consensus (Blanchet-Cohen, 2014) and a greater willingness amongst individuals to be involved in local organizations (Lawless, 2012).
An interesting picture emerges when it comes to trust. While some studies reported an increase in trust in local agencies (Lawless, 2012), one reported a decrease (ODPM, 2005) and another reported that some community members were suspicious that their concerns were being trumped by the concerns of better-resourced community members (Orton, 2017).
Turning to classic health outcomes, one study showed that community members were more likely to access services as a result of the intervention (Pronyk, 2008) and there were also positive impacts on mental health (Popay, 2015) and social isolation (Porter, 2013). There were also reductions in partner violence (Kim, 2007) and unprotected sexual intercourse (Pronyk, 2008), although another study found no impact on the latter (Pronyk, 2006).
Finally, with regards to the environment, some studies reported positive impacts (Lawless, 2012; Orton, 2017), including greater access to green space (Porter, 2013).
Not All Positive
The picture is not unequivocally positive, however. One study reported increased physical and psychological strain amongst community members as a result of the power-building process, especially amongst disabled people (Edwards, 2001). Another described tensions and disagreements amongst community participants (Orton, 2017). And another reported that community members felt frustrated and dissatisfied with the process, as well as its outcomes (Watson-Thompson, 2008).
Although this post covers only 12 of the 93 articles that we reviewed, it illustrates how any serious research into the link between community power and health has to think beyond classic health outcomes. The changes amongst the community members involved, as well as their relationships with each other and with organizations and systems, are significant – in and of themselves and in how they might influence health.
In the next post, I’ll talk about the results from the articles classified as medium- and low-quality. In the meantime, I encourage you to revisit posts one and two, and think about how the above outcomes affect Popay’s model and play into the synthesis of theories by Whitehead and colleagues.
Until next time.
Pritpal S Tamber
- Blanchet-Cohen, N., Manolson, S., Shaw, K., 2014. Youth-Led Decision Making in Community Development Grants. Youth & Society, 46: 819-834. [link]
- Edwards, C., 2001. Inclusion in regeneration: a place for disabled people? Urban Studies. 38:267-286. [link]
- Kennedy, L., 2010. Benefits arising from lay involvement in community-based public health initiatives: The experience from community nutrition. Perspectives in Public Health 130(4):165–72. [link]
- Kim, J.C., Watts, C.H., Hargreaves, J.R., Ndhlovu, L.X., Phetla, G., Morison, L.A., et al., 2007. Understanding the impact of a microfinance-based intervention on women’s empowerment and the reduction of intimate partner violence in South Africa. Am J Public Health. Oct;97(10):1794–802. [link]
- Lawless, P., Pearson, S., 2012. Outcomes from Community Engagement in Urban Regeneration: Evidence from England’s New Deal for Communities Programme. Planning Theory & Practice, 13 (4), 509-527. [link]
- ODPM (Office of the Deputy Prime Minister) ⁄ Neighbourhood Renewal Unit, 2005. Views of New Deal for Communities – Focus Group Report. Office of the Deputy Prime Minister: London. [Not online]
- Orton, L., Halliday, E., Collins, M., Egan, M., Lewis, S., Ponsford, R., et al., 2017. Putting context centre stage: evidence from a systems evaluation of an area-based empowerment initiative in England. Critical Public Health, 27(4), 477-489. [link]
- Popay, J., Whitehead, M., Carr-Hill, R., Dibben, C., Dixon, P., Halliday, E., et al., 2015. The impact on health inequalities of approaches to community engagement in the New Deal for Communities regeneration initiative: a mixed-methods evaluation. Public Health Research, No. 3.12. [link]
- Porter, R., McIlvaine-Newsad, H., 2013. Gardening in green space for environmental justice: food security, leisure and social capital. Leisure Studies: 379-395. [link]
- Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, et al., 2006. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet. Dec 2;368(9551):1973–83. [link]
- Pronyk, P.M., Kim, J.C., Abramsky, T., Phetla, G., Hargreaves, J.R., Morison, L.A., et al., 2008. A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants. AIDS Aug 20;22(13):1659–65. [link]
- Watson-Thompson, J., Fawcett, S., Schultz, J., 2008. Differential effects of strategic planning on community change in two urban neighborhood coalitions. American Journal of Community Psychology, 42: 25-38. [link]
- The research being described in this season of posts was in partnership with the Insight Center for Community Economic Development, and I thank Brad Caftel of the Center for overseeing the administrative details involved.
The photo behind the title is by Markus Spiske on Unsplash.