500245

13
HPQ19110.1177/1359105313500245Journal of Health PsychologyStephens

Article

Journal of Health Psychology

Beyond the barricades: Social 2014, Vol 19(1) 170­–175

© The Author(s) 2013
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DOI: 10.1177/1359105313500245
practice in health promotion hpq.sagepub.com

Christine Stephens

Abstract
Community-based health promotion has focussed on empowering disadvantaged groups, but there is
growing awareness of the need to address everyday practices used to maintain power and privilege across
social divisions. Participatory Action Research projects have proved subject to problems of resistance from
dominant social groups. Social movements seeking to reshape power relations, give voice to excluded
people and promote a social environment in which their problems are understood have been suggested as an
alternative approach. A model of social movements based on theories and observations of social movement
dynamics offers a practical framework for initiating such social change.

Keywords
community health promotion, community health psychology, critical health psychology, health education,
health promotion, inequalities, practice, theory

The observed effects of socio-economic ine- researchers in the literature (see, for example,
qualities on health have been the basis for a Lykes, 1997; Ramella and De La Cruz, 2000;
major shift in health promotion practice, from Torre and Fine, 2005).
individual behaviours to community-based Several articles also document problems
intervention. Participatory Action Research such as barriers to implementation and the need
(PAR) has become a popular way for commu- for ongoing reflexivity by health promoters
nity health promoters to include the needs and (e.g. Cochrane et al., 2008; Doyle and Timonen,
understandings of those whose health is most 2010; Smith et al., 2010). Of particular concern
affected by their social conditions. Based on the is that PAR projects have failed to create change
social psychology of Lewin (1946/1997), and beyond the ambit of the participants themselves
developed using critical theory, inspired by the and have proved subject to problems of
pedagogy of Freire (1970) in particular, PAR
involves researchers, community workers and
community members sharing knowledge and Massey University, New Zealand
skills to address local issues and work for social
Corresponding author:
change from a community-based perspective. Christine Stephens, School of Psychology, Massey
There are many successful and encouraging University, Palmerston North, 4442, New Zealand.
examples of PAR from community and feminist Email: [email protected]

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Stephens 171

resistance from dominant social groups. They unwilling to change the supply or pricing
may be colonised by interest groups represented regime for alcohol, and current media focus
by funders and non-governmental organisations remains firmly on the problems of youth drink-
(NGOs), or resisted and attacked by dominant ing. As a final example of the ways in which
groups in the wider society. From a feminist broader powerful groups in society counter the
perspective, Lather was already suggesting in efforts of deprived peoples, Estacio and Marks
1991 that the majority of the work inspired by (2010) describe a PAR project undertaken with
Lewin’s model ‘… operates from an ahistorical, a small indigenous Ayta community in the
apolitical value system which lends itself to Philippines which aimed to generate commu-
subversion …’ (p. 56). nity-based knowledge to inform and provoke
Power imbalances which prevent change in social action about health inequalities.
this way are manifested both within the projects Community action for literacy and develop-
and beyond. Within the project participants, ment was mobilised, but also initiated aggres-
those with more power can easily hold sway; in sion from more powerful groups in the society.
the United Kingdom and South Africa, Stern Disputes over the land on which a literacy cen-
and Green (2008) describe the ways in which tre was built led to death threats, attacks, burn-
community partnerships are dominated by rep- ing of homes and the disruption and movement
resentatives of vested interests who maintain a of the landless people. In general, PAR has
structural imbalance through the control of the focussed on assisting and empowering disad-
form and content of meetings. Campbell et al. vantaged groups, but there is growing aware-
(2007) describe how the process and achieve- ness of the need to address the practices that are
ments of a community development programme used to maintain power and privilege across
in a remote Australian Aboriginal community social divisions.
were undermined by power inequalities which Empirical studies based on feminist theory,
supported the reluctance of non-Aboriginal White studies, disability studies or queer stud-
health professionals to share control of health ies have provided a basis for understanding the
decisions with Aboriginal participants. More powerful role of the privileged in reproducing
broadly, Campbell (2003) describes a participa- inequalities (see Fenstermaker and West,
tory programme in South Africa which largely 2002; Kimmel and Ferber, 2003). Observations
failed to impact on the prevention of HIV/ using ethnographic methods and analysis
AIDS. The programme was not able to take into based on critical social theory provide recog-
account the complex social environment with nition of the mundane everyday practices used
competing interests and power differentials to maintain privilege across class, gender, age,
between different groups within and beyond the race and sexuality divisions (e.g. Aguinaldo,
community. In New Zealand, we have experi- 2008; Chapman and Berggren, 2005; Howard,
enced difficulties initiating changes beyond the 2000). Feachem (2000), noting the failure of
community level. A community and public public health interventions to address issues
health organisation partnership enabled young of poverty, pointed out that advantaged
people to portray the effects of adult alcohol groups of people, like the middle classes, rou-
abuse in counterpoint to the dominant dis- tinely use their advantage to commandeer the
courses positioning youth as the problem. Such resources of public health and education pro-
efforts, along with many other community level grammes. Bourdieu’s (1977) theory of practice
protests against cheap and highly available provides a useful explanation of the ways in
alcohol, particularly in deprived areas, have which everyday practice maintains the unequal
informed submissions to government with dis- structure of society. An important aspect of
appointing effects. A powerful alcohol industry Bourdieu’s (1984) theory is the recognition
lobby and a conservative government remain that social relations are ‘battles’ in which,

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172 Journal of Health Psychology 19(1)

while the underprivileged may be working to emphasis of PAR has been on liberating
develop their resources, the privileged are oppressed groups through critical conscious-
working as hard to maintain their advantage ness, and social movements seen as the active
(Stephens, 2010). participation of the oppressed in the construc-
Guareschi and Jovchelovitch (2004) use tion of alternatives (Johnston and Goodman,
their experience in the favelas of Brazil to sug- 2006), Freire’s (1970) essential notion of cul-
gest that change in unequal conditions tural revolution arising from such cultural action
has remained in the background. According to
does not happen without pressure from below. Freire, dialogical cultural action operates on the
Communities living in a situation of extreme dep- social structure itself to transform it.
rivation need to organize themselves and develop Habermas (1987) has developed this concept
the various competences required for effective of dialogical or communicative action. Rather
participation in the public sphere if they are to
than focus on resistance by the powerless,
improve conditions of living and thus enhance
health. (p. 312)
Habermas outlines social action in terms of
communicatively reached mutual understand-
ing (Ramella and De La Cruz, 2000). This is the
To this, we must now add that it is not suffi-
establishment of dialogue that can include both
cient to empower the oppressed without con-
the oppressed and privileged in a communica-
sideration of the power relations of the whole
society. To support such a ‘push from below’ tive space. Habermas (1981) describes the ways
Campbell et al. (2010) suggest social move- in which ‘new social movements’ enable com-
ments that change the consciousness of the munication with others in the ‘life-world’ and
privileged and work to ‘reshape power rela- challenge existing power relations which he
tions’. Social movements that include the believes are constructed in media-directed pub-
voices of the excluded and change the whole lic spheres and abstract identities. As the media
social environment are needed in local, national is increasingly democratised, the possibilities
and global settings. Campbell et al. (2010) use for social movements of this nature grow at all
examples of development projects which have levels of society.
successfully created social movements that The theories of Lewin, Freire and Habermas
gain the attention and participation of the more together point to the possibilities for health pro-
powerful in society. Their case studies include moters to contribute to the development of
the practices of developing critical thinking social movements that arise from the needs of
and related action strategies among deprived deprived groups and change the understandings
groups, along with uniting powerful interest of the privileged in society to achieve real social
groups, gaining access to elite resources and change. However, for practical purposes, these
appealing to morality among the privileged. theories often seem somewhat abstract, and the
However, practical experience shows that pow- call to change society may seem daunting to the
erful interest groups are also actively opposed health promotion researcher or community
to such change, and public morality often worker in the field. To consider some practical
includes strong principles that work against the steps towards these ends, I suggest drawing on
rights of deprived groups. To proceed practi- a model of social movements that provides a
cally, we need theoretical understandings of structured approach, but is not prescriptive, and
these inspiring examples. provides avenues of action for community par-
Such social change has always been at the ticipatory programmes aimed at developing the
heart of PAR theory. Often considered the health of underprivileged groups.
founder of action research, Lewin intended it to Crossley’s (2002) model (based on the
contribute to ‘more precise theories of social work of Smelser and other theorists such as
change’ (Dick et al., 2009: 6). While the Bourdieu) suggests that social movement

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Stephens 173

formation depends upon the interaction of six The precipitating factors in Crossley’s model
aspects: structural conduciveness, structural are concrete events around which agents mobi-
strain, growth and spread of generalised belief, lise. In health promotion, the factors are com-
precipitating factors, mobilisation of partici- munity action group intervention and the
pants for action and social control. An impor- provision of educational and supportive
tant point is that these aspects of a social resources which trigger recognition of the need
movement need not occur in any particular for action to change social relationships. This is
order (e.g. structural strain and social control a change which includes recognition of their
may exist together for a long time). Crossley’s broader social situation, and action to change
aim is to explain social movements, but we can that situation by initiating change within the
draw on this model as a practical guide for broader society.
facilitating social movements. Crossley’s syn- Mobilisation is the stage which creates
thesised model may be used to structure the action in a social movement, and all social
application of theoretical approaches with action involves coordination and organisation
which community health practitioners are (Crossley, 2002). This may include local group
already familiar. action to change attitudes and norms (see
Structural conduciveness refers to the ways Campbell and Cornish, 2012) or broader action
in which social systems inhibit or facilitate col- using social media tools such as Facebook and
lective behaviour. Freire (1973) has described YouTube for communicative action (Habermas,
the ways in which the structure of society makes 1981), which broadens the scope for social rec-
dialogue with those who are oppressed more ognition and understanding.
difficult because of their position in the hierar- Movements aiming to draw attention to
chy and sense of powerlessness. The very first health-denying social relations and circum-
need met by support groups is usually the stances will inevitably evoke repressive
opportunity to make connections and the provi- responses which Crossley’s model character-
sion of space to connect and share understand- ises as social control. Freire (1970) describes in
ings of common circumstances. detail the ways those in power must resist dia-
Structural strain suggests that potential logue with the oppressed, and notes that change
members of a social movement must experi- is an ongoing dynamic process. From Habermas’
ence the system as problematic and stressful in (1981) perspective, social movements which
some way. Again we can draw on Freire (1970) arise to resist repressive abstractions provide
to provide the guidance for working with what opportunities for communicative action which
community members already know to develop opens cracks between system and life-world.
collective understanding of any needs for Participatory media provide a particularly fer-
change. Growth and spread of generalised tile space for conversations which open up criti-
belief relates to the readiness of any group of cal debate and potential for social change.
people to achieve that critical consciousness
through dialogue. Freire (1970) does not rely
Conclusion
on experience as a pure knowledge source, but
believes it should be problematised by engag- A social movement that will communicate with
ing subjective experience and objective situa- others in society and shift power relations
tions ‘in constant dialectical relationship’ (p. through communicative action is more possible
32). Campbell and Jovchelovitch (2000) pro- today in our mediated societies. Crossley and
vide an example of the interaction between the Ibrahim (2012) show the importance of social
knowledge of development workers and networks and critical mass to social move-
local experience to develop such critical ments. A social movement that can change
consciousness. dominant discourses employed by those in

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174 Journal of Health Psychology 19(1)

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