This chapter is about intersectoral action, individual and community empowerment as keys ensuring community competency in public health.
A community is competent when it provides access for its members to the resources required to ensure their health and well-being, and when its members use the accessible resources to their advantage. Intersectoral action is a key to succeeding on the first level while empowerment is a prerequisite to achieving the second. Successful intersectoral action depends on an understanding of the role that each sector plays with regards to a community’s diverse functions.
The public and private sectors are generally instrumental while the non-profit sector includes an existential component. Concerted action between the sectors can thus result in a broader perspective of health promotion and more comprehensive, partnership-based service delivery.
Enabling factors include a win-win approach and realizing that the process takes time and resources. Obstacles include lack of flexibility, especially in government institutions, hidden agendas, and unrealistic expectations.
There are at least two simultaneous empowerment processes required for a community to be competent and there exists a dialectical relationship between the two. The individual empowerment process is comprised of four components (participation, technical ability, self-esteem, critical consciousness), each of which evolves along a continuum of its own. Empowerment stems from the interweaving of the four, with each component simultaneously building on and strengthening the others, and thus intervention is needed on all four levels at the same time. The community empowerment process also has four interwoven components: participation, knowledge and ability, communication, and community capital.
Intersectoral participation is influenced by the essential interaction of each process' components, since the two processes build upon and strengthen each other. An organisation can be an empowering environment since it is a functional community. The role of organisations in intersectoral participation is thus central.
Since the majority of community-based organisations operate in the health arena, either by offering social support to specific — and often at risk — population groups or by providing crisis or specialized interventions on problems such as homelessness, poverty, suicide prevention, prostitution, mental health, food security and nutrition, substance abuse, HIV/aids and domestic violence, ensuring that these organisations support individual and community empowerment can be considered to be a vital public health issue.
Finally, an organisation is an entity unto itself and, within the larger community that it is part of, it evolves through an empowerment process similar to that of an individual, but with recognition replacing self-esteem. Intersectoral strategies must take this process into consideration in order to be successful.
Bill Ninacs and Richard Leroux are members of La coopérative de consultation en développement La Clé