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Understanding Power
The "Sick People or Sick Societies" podcast raises the issue of power as a major factor in health and health outcomes. A common issue in all of the social determinants of health is the amount of power people have. A lack of power or power void is thought to be of great importance and perhaps the common feature of the social determinants of health. Without power, one can be stuck in situations that are harmful to ones health. Lack of power may lead to "toxic stress" and health issues. Understanding the power issues in a person’;s life can be very important when trying to understand a person’;s health issues. For example, recommending condoms to prevent STDs is obvious and oft-spoken advice. But if a woman has very little power in a relationship, she may not be able to insist on the use of condoms and the STI will continue to be spread.
Nobel Prize winning economist Amartya Sen[7] speaks of the capability approach[5] which is a measurement of an individual’;s ability to change one's circumstances and navigate barriers. This capability approach in explored in detail in Dr. Sen’;s "Development as Freedom"[6]. Adding the assessment of power or capability with your patients may be helpful at times.
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5. en.wikipedia.org/wiki/Capability_approach accessed September 15, 2010
6. Sen, Amartya. Development as Freedom. Oxford: Oxford University Press. 1999.
7. nobelprize.org/nobel_prizes/economics/laureates/1998/sen-autobio.html accessed March 7, 2011