A planning framework for community empowerment goals within health promotion

Health promotion often comprises a tension between 'bottom-up' and 'top-dow n' programming. The former, more associated with concepts of community empo werment, begins on issues of concern to particular groups or individuals, a nd regards some improvement in their overall power or capacity as the impor tant health outcome. The latter, more associated with disease prevention ef forts, begins by seeking to involve particular groups or individuals in iss ues and activities largely defined by health agencies, and regards improvem ent in particular behaviours as the important health outcome. Community emp owerment is viewed more instrumentally as a means to the end of health beha viour change. The tension between these two approaches is not unresolvable, but this requires a different orientation on the part of those responsible for planning more conventional, top-down programmes. This article presents a framework intended to assist planners, implementers and evaluators to sy stematically consider community empowerment goals within top-down health pr omotion programming. The framework 'unpacks' the tensions in health promoti on at each stage of the more conventional, top-down programme cycle, by pre senting a parallel 'empowerment' track. The framework also presents a new t echnology for the assessment and strategic planning of nine identified 'dom ains' that represent the organizational influences on the process of commun ity empowerment. Future papers analyze the design of this assessment and pl anning methodology, and discuss the findings of its field-testing in rural communities in Fiji.