{"id":47168,"date":"2020-04-16T11:00:20","date_gmt":"2020-04-16T10:00:20","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47168"},"modified":"2020-04-20T09:23:48","modified_gmt":"2020-04-20T08:23:48","slug":"confronting-power-and-privilege-for-inclusive-equitable-and-healthy-communities","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/16\/confronting-power-and-privilege-for-inclusive-equitable-and-healthy-communities\/","title":{"rendered":"Confronting power and privilege for inclusive, equitable, and healthy communities"},"content":{"rendered":"

The authors set out a call to interrogate power and analyse privilege to create and sustain healthy communities. This article is part of the Building Healthy Communities<\/a> collection.<\/em><\/p>\n

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According to the World Health Organization, inclusive, healthy and just communities are places that continually create and improve the physical and social environment to enable all people to be mutually supportive in all functions of life and to develop their maximum potential.1<\/sup><\/span> It is suggested that only 16% of health outcomes are determined by the quality and availability of health care; and the social and economic determinants of health, including where people live play a more significant role.2<\/sup><\/span><\/p>\n

This goes beyond the quality of physical structures in the urban environment or the space inside a home. It is about understanding neighbourhood conditions and the availability and quality of other determinants of health, such as employment, healthy food, childcare, schools, transport and recreation space. We know geographic disparities in health, which often fall along lines of ethnicity and socioeconomic status, are growing and can exist even between people living in adjacent neighbourhoods.3<\/sup><\/span> Health professionals and urban development practitioners therefore have an important role to play to ensure the practices and processes governing the design and development of our urban environment are inclusive and equitable for all and ultimately contribute to improved population health.<\/span><\/p>\n

A call to action: interrogate power and analyse privilege to create and sustain healthy communities<\/b><\/p>\n

The scale of current and potential inequalities in the urban environment demands a revolution of purpose and accountability. The challenges we face in building and sustaining healthy and equitable communities demand new forms of thinking, problem solving, governance, and decision making. Most importantly, it requires that we learn the skills of interrogating power and analysing privilege<\/span>.\u00a0<\/b><\/p>\n

Whether resources do, or do not, flow to communities is a direct product of both individual and institutional power. <\/span>Power<\/em> is defined as the ability to direct laws, policies, and investment that shape people\u2019s lives. <\/span>Privilege<\/em> is the accumulation of benefits of special rights. Both power and privilege have been extracted and hoarded, consciously or not, by certain groups at the expense of others based on social categorisations including, but not limited to, class, ethnicity, religion, physical ability, and gender.4,5,6<\/sup><\/span><\/p>\n

We call on health professionals, planners, public servants, developers, financiers, and engineers \u2013 in fact, all practitioners working at the intersection of health and the built environment \u2013 to shift their normal course of business towards adopting practices that recognise privilege and cede power. This requires pushing against conscious and unconscious practices and the societal beliefs and norms that marginalise, exclude and perpetuate inequity. We charge this community of practitioners to dismantle the structures, systems and practices that reinforce inequity. Even with best intentions, data-driven interventions, and evidence-based improvements, we will inadvertently perpetuate inequities and widen disparities if we are not conscious of our own power and the power structures within which we work.<\/span><\/p>\n

We know that power and privilege can be complex and sometimes overwhelming concepts, but we can and must engage with them. We have proposed steps below for health professionals, policy makers and urban development practitioners and other stakeholders to begin the journey. We make this call to action to fundamentally shift the way we plan, build, program, advocate, and legislate our communities to ensure the health and quality of life for all. While it may seem a daunting task to connect this aspirational call to on-the-ground practice, we urge that this not be a reason for inaction since \u201cprofessional silence in the face of social injustice is wrong.\u201d7<\/sup><\/span><\/p>\n

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Steps for examining power and privilege in support of healthy and inclusive communities <\/b><\/p>\n

1. Create and\/or seek out \u201cBrave Spaces\u201d to explore the role of power in your work<\/strong><\/p>\n

Confronting power and its role in our work begins by creating \u201cBrave Spaces\u201d. <\/span>Brave spaces are intentional environments and settings that facilitate the courageous, uncomfortable, and honest exploration of social categorisations such as physical ability, race, ethnicity, class, and gender identity and the privilege or marginalisation that is extended to individuals based on these categorisations.<\/span>\u00a0<\/span><\/p>\n

Brave spaces are created and maintained by a transparent commitment to practices that allow difference and celebrate new forms of action and strategy. You create brave spaces when you:<\/span><\/p>\n