Wright M T, Block M, von Unger H
Wissenschaftszentrum Berlin für Sozialforschung (WZB), Berlin.
Gesundheitswesen. 2008 Dec;70(12):748-54. doi: 10.1055/s-0028-1102955. Epub 2008 Dec 11.
The intrinsic connection between empowerment and participation is apparent in the Ottawa Charter on Health Promotion. In order for citizens to reach a higher degree of autonomy and control over health-related factors (empowerment) they need to have an active role in the decision-making processes affecting their lives and the environment in which they live (participation). This implies that many decisions are made affecting the health of citizens over which they have no influence. The question is: Who has the power to make such decisions and how can this power be shared more equitably? This question can be raised not only at the highest political level, but also locally in the context of the collaboration between various stake-holders. The local level plays a key role in deciding which health promotion measures are developed and funded, thus contributing in an important way to strengthening communities. In this article the method "Circles of Decision-Making" is presented as a tool for assisting those working at the local level in determining to what degree the active participation of the various stake-holders has been achieved and in what ways the participation of those "on the outside" of decision-making processes can be strengthened. This method is based on the concept of Participatory Quality Development (PQD) created by the authors and their community partners. PQD uses methods from community-based research to address issues of quality in community-level health promotion and prevention.
赋权与参与之间的内在联系在《渥太华促进健康宪章》中显而易见。为了让公民在与健康相关的因素方面实现更高程度的自主和掌控（赋权），他们需要在影响其生活及生活环境的决策过程中发挥积极作用（参与）。这意味着做出了许多影响公民健康但他们却无法施加影响的决策。问题在于：谁有权做出此类决策，以及如何能更公平地分享这种权力？这个问题不仅可以在最高政治层面提出，在地方层面，在各类利益相关者之间的合作背景下也可以提出。地方层面在决定制定和资助哪些健康促进措施方面发挥着关键作用，从而以重要方式为加强社区做出贡献。在本文中，“决策圈”方法作为一种工具被呈现出来，用于协助地方层面的工作人员确定各类利益相关者的积极参与在何种程度上得以实现，以及如何加强决策过程“外部”人员的参与。该方法基于作者及其社区伙伴创建的参与式质量发展（PQD）概念。PQD运用基于社区的研究方法来解决社区层面健康促进和预防中的质量问题。
