The Paucity of Policies 

Clarity. That’s what’s missing.

Over the last couple of weeks, I’ve been looking for recommendations of policies to support community power. I’ve been surprised by how few there are and how they’re either incredibly specific or utterly vague – with very little in between.

On one level, it’s not surprising that there are few. The activists, advocates and practitioners that I have learnt from have told me in various ways that power is never given, it is only ever taken [1]. Governments have power, so, the logic goes, they’re never going to give it, no matter how eloquent the policy recommendations by community groups and think tanks.

But the specific/vague finding is surprising. Advocates are either pushing well-known methodologies or general notions of ‘community empowerment’. For me, specific stuff about methodologies misses the broad complexity of where power comes from. And the vague stuff about community empowerment cannot be serious if the given/taken rule is true (communities can’t be empowered, they have to take power).

A Logic Model for Power

In order to avoid falling into the specific/vague trap, I have spent a few hours turning the key ideas in my report on community power and Ratio’s very good report on what it calls ‘relational social policy’ into a sort-of atomised logic model of where power comes from, what it is, how it’s used, and what limits or resists it.

There are 26 elements to the model and I am going to see how the policy recommendations that I find speak to each of the elements.

To give the model some direction, I have framed it on the basis of ‘double disadvantage’. This term comes from one of the funders of this work and refers to the fact that some communities suffer inequities because they endure both deprivation and a lack of social infrastructure.

Social infrastructure is an interesting term. It gets used a lot but is variably defined (if at all). My definition is informed by the aforementioned Ratio report and encompasses non-judgemental spaces for people to meet, the existence of conversations between people, and a sense of what is normal. From those comes a sense of place and the possibility of mutual support.

I realise that for many people this is all just woolly nonsense. But while it might be hard to get down in words, the consequences of not being able to see it and act on it are dire. The opioid epidemic in the US. The recent riots in the UK. The rise of the right in France. The examples are numerous and global. People wring their hands about populist politicians but they’re the result, not the cause – they’re merely downstream opportunists.

Disingenuous Gaps?

Will the 34 reports that I’ve amassed offer policy recommendations across all 26 elements of the model? Of course not. And in many ways, that’s the point. Being able to illustrate where there are gaps should make clear where new thinking is needed. It should also illustrate why so much of the policy-oriented rhetoric is either inadequate or disingenuous.

I use the word ‘disingenuous’ intentionally. A few months ago I reviewed six issues of a world-leading health journal to see how they used the term ‘inequities in health’. I was amazed to find constant conflation with disparities. For me, this is simply unforgiveable. Inequities in health were defined in 1992 and clarified in 2014. How is it that the editors of a world-leading health journal are still getting it wrong? There is something deeply disingenuous about that.

Anyway, my rage withstanding, over the next couple of weeks I’m going to plough through the 34 reports. Wish me luck. I’ll do my best to share what I learn – and at some point will ‘announce’ which think tank I am working with.

See you in a couple of weeks.

Dr Pritpal S Tamber MBChB
Evidence, Power and Health Equity

Notes

[1] In writing this post, I have learnt that the given/taken line comes from Gloria Steinem, a journalist, social-political activist and feminist, according to Wikipedia.

The image behind the title is from Matt Kenyon / Ikon Images.