Power – a health and social justice issue
This resource is available in English only.
This briefing document by National Health Service (NHS) Scotland is designed for multiple purposes: first, to spark discussion about how an unequal distribution of power causes health inequalities, and second, to inform related public health work.
Power as a driver of social inequality
On page 4 of the document, the authors situate power, alongside income and wealth, as one of three fundamental drivers of social inequality.
A graphic on the same page titled “NHS Health Scotland’s theory of causation” depicts four related components that lead to avoidable and unfair health differences:
- Fundamental causes (e.g., the unequal distribution of income, power and wealth)
- Wider environmental influences (e.g., economic)
- Individual experiences within the wider environmental influences (e.g., social and interpersonal)
- Effects of your experiences (e.g., inequalities in healthy life expectancy)
Types and dimensions of power
The briefing note provides a useful overview of power as a concept, referencing four different types of power as described in the World Health Organization’s conceptual framework for action on the social determinants of health:
- Power over (influencing others)
- Power to (organizing to change power structures)
- Power with (collective power of communities or organizations)
- Power within (individual capacity)
Page 7 of the document reviews the different dimensions of power and the related opportunities to redistribute power and address health inequalities. Readers are encouraged to consider where the power in a situation is coming from, who has the power and where is the power exercised. The document also offers suggestions about where to intervene at multiple levels.
Use this resource to
- learn about the concept of power, including different types and dimensions of power;
- recognize power as a fundamental driver of social inequality; and
- begin conversations within your organization about how to address power through public health practice, programs and policies.
Dickie, E., Hearty, W., Fraser, A., McCartney, G., Doyle, E., & Myers, F. (2015). Power – a health and social justice issue. Edinburgh: NHS Health Scotland.
- A conceptual framework for action on the social determinants of health (2010)
- Just societies: Health equity and dignified lives (2018)