Unpacking Empowerment

How do you feel when you’re empowered?  I feel like I can do anything.  What is it that makes you feel empowered?  I feel empowered when I am supported, believed in, and respected.  

No one had to teach me that when a person feels empowered, they are more confident, make healthier decisions, and do things they used to be afraid to do.  That’s because we’ve all felt empowered or dis-empowered at some point in our lives.  It’s part of being a human.  Empowerment is one of my primary goals in development, in medicine, and in life.

 This woman gets it. 

This woman gets it. 

In recent decades, both medicine and development are shifting from a “top-down” to a “bottom-up” approach.  Admittedly the development world has shifted a little faster than the medical world, but we’re seeing it in mainstream medicine too.  For example, we are amassing evidence that giving the patient decision-making power in their treatment plans often leads to better outcomes. 

 These guys almost get it. 

These guys almost get it. 

In top-down relationships, the problem and the solution are described by the one with more power (the rich or the doctor), and delivered to the one with less power (the poor or the patient).  Empowerment doesn’t really have an appreciable role in this approach. 

In bottom-up relationships, the one with less power is EMPOWERED to be the one to describe their problem, and the one to make it better.  The one with more power aims to play a role as a facilitator or catalyst. 

To be honest, the evidence for one approach being more effective is inconclusive at best.  It really depends on the case and the context; there’s a time and place for both kinds of relationships.  I’m a bottom-up proponent because of my personal philosophy.  When I first felt compelled to write this blog, I was overwhelmed by the literature on empowerment and power that’s out there.  I’ve only scratched the surface of this huge and controversial topic, but here’s a little background:

You know how when someone uses a word over and over again it loses its oomph?  That’s happened with “empowerment”, rightfully accused as a buzzword.  That’s problematic because words have meaning, and this particular word has a lot of implications for vulnerable people.  Two big problems that come along with this word losing its oomph:

1.  It can be used to advance top-down agendas – The language of empowerment attracts donors (buzzword!), but we don’t have a good way to measure it, or even a standard way to do it.  So facilitation can easily become manipulation, and it’s back to business as usual but behind the warm and fuzzy mask of empowering local people.      

2.  It can be used to oversimplify a necessarily complex issue - Helping to alleviate poverty and heal disease are incredibly complex actions.  Empowerment may be part of the answer, but seldom the whole thing.

This is a discussion that should continue in both development and medicine, and I hope to have these conversations and evolve my understanding of empowerment forever.  But what do we do in the meantime?  My idea is to be aware of the pitfalls surrounding empowerment, and then don’t overthink it.  Back to the question, what makes you feel empowered?  Consider your answer, then go do those things for other people and see how that feels.  (spoiler alert: it's feels good)