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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.

Reference

Dickie, E., Hearty, W., Fraser, A., McCartney, G., Doyle, E., & Myers, F. (2015). Power – a health and social justice issue. Edinburgh: NHS Health Scotland.

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