Power

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About

Power is the ability to achieve a purpose and to effect change. People can build community power when they organize and act together to set agendas, shift public discourse, influence who makes decisions and cultivate relationships with decision makers. Societal rules and how they are created and maintained by those with power are referred to as the structural determinants of health.

Relationship to health and equity

The health and well-being of people and places is determined by the ability - particularly for those most impacted by inequities - to make change through collective actions that support social, economic or environmental conditions needed to thrive. People, organized and acting together, can use their power to influence society’s rules by changing or challenging laws and policies, institutional practices, worldviews, culture and norms. Power, in the ongoing negotiation of social, political and economic resources, can either maintain society’s rules or push for changes that can improve health and advance equity.

Though history shapes the rules we live with now, each day we build a history that we are collectively responsible for. For example, after women organized and won the right to vote in 1920, infant mortality rates dropped dramatically when lawmakers passed a law that set up maternal and child health units in every state health department, expanded birth and death data collection and supported home-visiting initiatives. The Civil Rights Act, which included hospital desegregation, is also associated with health improvement. From 1965 through 1971, infant mortality rates dropped significantly and the gap between Black and white infant mortality narrowed. This followed the passage of the Voting Rights Act in 1965, which shifted electoral power in the U.S. and ushered in a new era of government responsiveness to Black and other marginalized populations’ voter participation.

Relationship to systems and structures

People have also used power to their advantage to reinforce rules that maintain patterns of social, economic and health inequity. For example, leaders in the tobacco industry have long wielded significant corporate power to craft rules that promote commercial tobacco use and undermine public health efforts. They’ve done so by lobbying against regulations that limit advertising, advocating for legislation that minimizes restrictions on tobacco sales, and marketing to marginalized communities. Through financial contributions to political campaigns and public health organizations, tobacco companies have also wielded power to influence governance and public perception, creating a façade of corporate responsibility while continuing practices detrimental to health.

Advancing health and equity requires us to contest power. This means building power by cultivating the capacity of people who are disproportionately burdened, and who therefore have the most at stake, and disrupting the power of those whose interests align with perpetuating health inequities.

Additional Reading

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