Document Type : Original Article
Authors
1 Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
2 Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
3 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Community empowerment has been proposed since the 1980s as a way to increase people’s power
to influence social determinants of health. However, community empowerment for health promotion
in urban slums still faces challenges. The present study examined interventions, challenges, actors,
scopes, and the consequences mentioned in various studies and with emphasizing interventions
and executive challenges tried to create a clear understanding of empowerment programs in slums
and improving their health. Narrative review method was used to conduct the study. Databases
including PubMed, Scopus, Embase, Web of Science, and Cochrane were searched. The selection
of studies was done according to the “community empowerment” defined by the World Health
Organization, the concept of bottom–up approach for health promotion of Laverack and Labonte’s
study and definition of slums by UN-HABITAT. Finally, Hare and Noblit’s meta-synthesis was used
to analyze the studies. From 15 selected studies, the most intervention proposed for empowerment
was identified to be “residents’ participation in expressing problems and solutions.” The challenge of
“creating a sense of trust and changing some attitudes among residents” was the greatest challenge
in the studies. Moreover, “improving living conditions and health services” were the most important
outcomes, “slum residents” and “governments” were the most important actors, and “sanitation”
was the most important scope among the studies. Having a comprehensive view to the health and
its determinants and attention to the factors beyond neighborhood and health sector would lead to
fewer implementation challenges and better intervention choices to health promotion of slum dwellers.
Keywords
Population Division (2019). World Urbanization Prospects
2018: Highlights (ST/ESA/SER.A/421). Available from:
https://population.un.org/wup/Publications/Files/
WUP2018‑Highlights.pd. [Last accessed on 2020 Dec 22].
2. Voices WAB. Listening and Responding to the Health Needs of
Slum Dwellers and Informal Settlers in New Urban Settings. Kobe,
Japan: World Health Organization; 2005. Available from: https://
www.who.int/social_determinants/resources/urban_settings.
pdf?ua=1. [Last accessed on 2020 Dec 24].
3. United Nations Human Settlements Programme (UN‑HABITAT).
State of the World’s Cities 2006/7. New York: United Nations; 2006.
Available from: https://sustainabledevelopment.un.org/content/
documents/11292101_alt.pdf. [Last accessed on 2020 Nov 24].
4. Ezeh A, Oyebode O, Satterthwaite D, Chen YF, Ndugwa R,
Sartori J, et al. The history, geography, and sociology of slums
and the health problems of people who live in slums. Lancet
2017;389:547‑58.
5. Rugadya M, Kamusiime H, Nsamba‑Gayiiya E, Koojo C. National
Slum Upgrading Strategy and Action Plan. Ministry of Lands
HaUD; 2008. Available from: https://housingfinanceafrica.org/
app/uploads/Uganda-The‑National‑Slum‑Upgrading‑Strategy‑
and‑Action‑Plan‑2008.pdf. [Last accessed on 2020 Des 24].
6. Nekoei‐Moghadam M, Heidari N, Amiresmaeili M,
Heidarijamebozorgi M. Identifying the health problems of slum
residents using social determinants of health: Kerman, Iran. Int
J Health Plann Manage 2019;34:e1179‑87.
7. PawarAB, Mohan PV, BansalRK. Social determinants, suboptimal
health behavior, and morbidity in urban slum population: An
Indian perspective. J Urban Health 2008;85:607‑18.
8. Ompad DC, Galea S, Caiaffa WT, Vlahov D. Social determinants
of the health of urban populations: Methodologic considerations.
J Urban Health 2007;84:i42‑53.
9. Bahadori M, Sanaeinasab H, Ghanei M, Mehrabi Tavana A,
Ravangard R, Karamali M. The social determinants of
health (SDH) in Iran: A systematic review article. Iran J Public
Health 2015;44:728‑41.
10. Palmer RC, Ismond D, Rodriquez EJ, Kaufman JS. Social
determinants of health: Future directions for health disparities
research. Am J Public Health 2019;109:S70‑1.
11. Popay J, Escorel S, Hernández M, Johnston H, Mathieson J.
Rispel L on behalf of the WHO Social Exclusion Knowledge
Network. Understanding and Tackling Social Exclusion.
Final Report to the WHO Commission on Social
Determinants of Health, February 2008; 2011. Available fr
om: https://www.who.int/social_determinants/knowledge_
networks/final_reports/sekn_final%20report_042008.
pdf?ua=1. [Last accessed on 2020 Nov 26].
12. Wallerstein N. Empowerment and health: The theory andpractice
of community change. Community Dev J 1993;28:218‑27.Available
from: http://www.jstor.org/stable/44257078. [Last accessed on
2020 Dec 24].
13. Haan MN, Kaplan GA, Syme SL. Socioeconomic status and health:
old observations and new thoughts. Hentry J Kaiser Family
Foundation. 1989 [Book Chapter], Available from: http://hdl.
handle.net/2027.42/60344. [Last accessed on 2021 Jan 05].
14. Mahal‑Chali MA. Community‑Based Empowerment in Order to
Achieve Good Urban Governance. Tehran, Iran. Arman Shahr;
2016. 192. SBN: 978‑600‑6248‑33‑2
15. Hoyt‑OliverJ. Communities and the Kingdom: Introduction from
the Editor in Chief. SWC [Internet]. 2020May13 47(3):3‑5. doi:
10.34043/swc.v47i3.172
16. World Health Organization. Community Empowerment, Health
Promotion 7th Global Conference on Health Promotion; 2009.
Available from: https://www.who.int/healthpromotion/
conferences/7gchp/track1/en/. [Last accessed on 2020 Oct 18].
17. Kanaskar M. Urban health: Participation of the urban poor and
communication. J Health Manage 2016;18:381‑400.
18. Kloos B, Hill J, Thomas E, Wandersman A, Elias MJ. Community
Psychology: Linking Individuals and Communities: Cengage
Advantage Books. 3rd ed.. Wadsworth Publisher: United States;
2012. ISBN‑13 : 978‑1111830380
19. Guareschi PA, Jovchelovitch S. Participation, health and the
development of community resources in Southern Brazil. J Health
Psychol 2004;9:311‑22.
20. Rana M, Piracha A. Supplying water to the urban poor: Processes
and challenges of community‑based water governance in Dhaka
city. Manage Environ Qual 2018;29 (4):608‑22. DOI: 10.1108/
MEQ‑11‑2017‑0127
21. Ratna J, Rifkin S. Equity, empowerment and choice: From theory
to practice in public health. J Health Psychol 2007;12:517‑30.
22. Sheuya SA. Improving the health and lives of people living in
slums. Ann N Y Acad Sci 2008;1136:298‑306.
23. Corburn J. Urban place and health equity: Critical issues and
practices. Int J Environ Res Public Health 2017;14:117.
24. Rahim RM, Maesome T. A comparative study of marginalization
in the cities of Sabzevar, Neyshabur and Gonabad and Torbat
Heydarieh. J Geogr Reg Dev 2008;11:12‑7
25. Laverack G, Labonte R. A planning framework for community
empowerment goals within health promotion. Health Policy Plan
2000;15:255‑62.
26. WoodallJ, Raine G, South J, Warwick‑Booth L. Empowerment and
Health and Well‑Being: Evidence Review. Project Report. Centre
for Health Promotion Research, Leeds Metropolitan University;
2010. Available from: http://eprints.leedsbeckett.ac.uk/2172/1/
FINAL%20EMPOWERMENT%20EVIDENCE%20REVIEW.pdf.
[Last accessed on 2021 Jan 05].
27. South J, Button D, Quick A, Bagnall AM, Trigwell J, Woodward J,
et al. Complexity and community context: Learning from the
evaluation design of a national community empowerment
programme. Int J Environ Res Public Health 2019;17:91.
28. Corburn J, Sverdlik A. Slum upgrading and health equity. Int J
Environ Res Public Health 2017;14:342.
29. Ferrari R. Writing narrative style literature reviews. Med Writ
2015;24:230‑5.
30. Heale R, Forbes D. Understanding triangulation in research. Evid
Based Nurs 2013;16:98.
31. Noblit GW, Hare RD. Meta‑Ethnography: Synthesizing
Qualitative Studies. Newbury Park, California: Sage; 1988.
ISBN‑13: 978‑0803930230
32. HagenE. Mapping change: Community information empowerment
in Kibera (innovations case narrative: Map Kibera. Innov Technol
Gov Global 2011;6:69‑94.
33. Ali M, Stevens L. Integrated approaches to promoting sanitation:
A case study of Faridpur, Bangladesh. Desalination 2009;248:1‑7.
https://doi.org/10.1016/j.desal. 2008.05.030
34. Winayanti L, Lang HC. Provision of urban services in an informal
settlement: A case study of Kampung Penas Tanggul, Jakarta.
Habitat Int 2004;28:41‑65.
35. Walters P. The limits to participation: Urban poverty and
community driven development in Rajshahi City, Bangladesh.
Community Dev 2018;49:539‑55. 36. Okihiro M, Sehgal V, Wilkinson T, Voloch KA, Enos R, O’Brien J.
Addressing Health Disparities by Building Organizational
Capacity in the Community: A case study of the Wai’anae Coast
Comprehensive Health Center. Hawai’i J Med Public Health
2014;73 12 Suppl 3:34.
37. Wilson N, Minkler M, Dasho S, Wallerstein N, Martin AC. Getting
to social action: The Youth Empowerment Strategies (YES!)
project. Health Promot Pract 2008;9:395‑403.
38. Espinosa L, Rivera OA. UNICEF’s Urban Basic Services
Programme in Illegal Settlements in Guatemala City. Urbanisation
2018;3:33‑49.
39. Mukherjee S, Rashmi C. NGO’s Role in Community Based
Monitoring of Primary Health Care Services for Dalit Women in
Urban Slums. Rupkatha J Interdisc Stud Humanit 2017;9:250‑62.
40. Walker APP. Self‑help or public housing? Lessons from
co‑managed slum upgrading via participatory budget. Habitat
Int 2016;55:58‑66.
41. Obinani FC. Planning education in the environment of poverty:
Training resident planners in Bedford‑Stuyvesant. J Am Inst Plann
1970;36:8‑261.
42. Grassini L. Participatory water governance between theories and
practices: learning from a community‑based initiative in India.
Int J Water Resour Dev 2019;35:404‑29.
43. Goodman LA, Smyth KF, Banyard V. Beyond the 50‑minute
hour: Increasing control, choice, and connections in the lives of
low‑income women. Am J Orthopsychiatry 2010;80:3‑11.
44. Baptist C, Bolnick J. Participatory enumerations, in situ upgrading
and mega events: The 2009 survey in Joe Slovo, Cape Town.
Environ Urban 2012;24:59‑66.
45. Amir S. Challenges and Opportunities for Successful Participation
in Slum Upgrading in India, Case of Slum Networking Project,
Ahmedabad; 2015.
46. Wilkinson C, Fumagalli I, Rossetti S. Rebranding a district: The
Breiðholt Project in Reykjavik. TeMA J Land Use Mobil Environ
2016;9:257‑68.
47. Daniere AG, Takahashi LM. Environmental policy in Thailand:
Values, attitudes, and behavior among the slum dwellers of
Bangkok. Environ Plann C Gov Policy 1997;15:305‑27.
48. Karimi N, Saadat‑Gharin S, Tol A, Sadeghi R, Yaseri M,
Mohebbi B. A problem‑based learning health literacy intervention
program on improving health‑promoting behaviors among girl
students. J Educ Health Promot 2019;8:251.
49. Amiresmaili M, Yazdi‑Feyzabadi V, Heidarijamebozorgi M.
Health services utilization among slum dwellers: An experience
from Iran. J Educ Health Promot 2019;8:210.
50. Otiso KM. State, voluntary and private sector partnerships for
slum upgrading and basic service delivery in Nairobi City, Kenya.
Cities 2003;20:221‑9.
51. Wolfe R. Regulatory transparency, developing countries and the
WTO. World Trade Rev 2003;2:157‑82.
52. Farmer P. Pathologies of power: Health, human rights, and the
new war on the poor. North Am Dialogue 2003;6:1‑4.
53. Stall S, Stoecker R. Community organizing or organizing
community? Gender and the crafts of empowerment. Gend Soc
1998;12:729‑56.
54. Mwiti F, Goulding C. Strategies for community improvement to
tackle poverty and gender issues: An ethnography of community
based organizations (‘Chamas’) and women’s interventions in the
Nairobi slums. Eur J Oper Res 2018;268:875‑86.
55. Eisen A. Survey of neighborhood‑based, comprehensive
community empowerment initiatives. Health Educ Q
1994;21:235‑52.
56. Ha SK. Developing a community‑based approach to urban
redevelopment. GeoJournal 2001;53:39‑45.
57. Larson C, Schlundt D, Patel K, Goldzweig I, Hargreaves M.
Community participation in health initiatives for marginalized
populations. J Ambul Care Manage 2009;32:264‑70.
58. Mitchell A. Civil society organizations in the informal settlements
of Buenos Aires: Service providers and forces for change. Voluntas
2016;27:37‑60.
59. Devas N. Does city governance matter for the urban poor? Int
Plann Stud 2001;6:393‑408.
60. Chang T. Improving Slum Conditions with Public Private
Partnerships: Na; 2009. Available from: http://www.shramorg/
uploadFiles/20140609033101.pdf. [Last accessed on 2021 Jan 04]
61. Tukahirwa J, Mol A, Oosterveer P. Access of urban poor to NGO/
CBO‑supplied sanitation and solid waste services in Uganda: The
role of social proximity. Habitat Int 2011;35:582‑91.
62. Nikkhah HA, Redzuan M. Participation as a medium of
empowerment in community development. Eur J Soc Sci
2009;11:170‑6.
63. Fetterman DM, Wandersman A. Empowerment Evaluation
Principles in Practice. New York City: Guilford Press, It is a
Chapter Excerpt from Guilford Publications; 2005. Available
from: https://www.guilford.com/excerpts/fetterman.pdf?t.
[Last accessed on 2021 Jan 20].
64. Carr A. Community project workers scheme crime prevention
projects: Evaluation report: Department of Internal Affairs; 2000.
Available from: https://citeseerx.ist.psu.edu/viewdoc/downlo
ad?doi=10.1.1.125.6875&rep=rep1&type=pdf. [Last accessed on
2021 Jan 20].
65. Laverack G. Improving health outcomes through community
empowerment: A review of the literature. J Health Popul Nutr
2006;24:113‑20.
)