Empowerment Education - SAGE Journals - Sage Publications

Section 4: Media Literacy and Health

Empowerment Education The Link Between Media Literacy and Health Promotion

LYNDA J. BERGSMA University of Arizona

Within a framework of media literacy and health promotion for youth, this article reviews the literature establishing that population health and well-being are intimately tied to, and consequences of, power and powerlessness, and that empowerment education is an effective model for achieving personal and social change. A comparison of the components of the empowerment education constructs of Freire, public health, and media literacy establishes the pedagogical links between public health and media literacy. An examination of the community-based and universalistic foundations of the media literacy and public health movements, and the dominant systems that oppose them, suggests strength in working together. Keywords: empowerment education; media literacy; public health

POWERLESSNESS AND POOR HEALTH Abundant research evidence demonstrates that powerlessness is a significant health risk factor and conversely, opportunities to experience power and control in one’s life contribute to health and wellness. Some of the research confirms that actual and perceived control enhance quality of life for disadvantaged populations that lack power, as well as for more advantaged populations (Nelson, Lord, & Ochocka, 2001; Spacapan & Thompson’s study as cited in Prilleltensky, Nelson, & Peirson, 2001). Powerlessness has emerged as a key risk factor for disease, emphasizing the role of the social environment in determining the health of individuals (Syme, 1988; Wallerstein, 1992). Research with minorities confirms that numerous stressful life events are associated with their diminished health and social status and conditions of oppression (Moane, 1999). The literature provides many examples of the correlation between control and mental health (Ryan & Deci, 2000; Spacapan & Thompson’s study as cited in Prilleltensky et al., 2001), including loss of power as a causal factor in AMERICAN BEHAVIORAL SCIENTIST, Vol. 48 No. 2, October 2004 152-164 DOI: 10.1177/0002764204267259 © 2004 Sage Publications

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the onset of depression (Seeman & Seeman, 1983; Zimmerman & Rappaport, 1988). Social epidemiological research in the workplace has identified lack of control, such as having low decision authority with high job demands, as a risk factor for coronary heart disease (Karasek, Baker, Marxer, Ahlbom, & Theorell, 1981; Marmot & Theorell, 1988). All of this literature contributes to our understanding of how population health and well-being are intimately tied to, and are consequences of, power and powerlessness. A substantial body of health education and prevention literature makes the case that empowerment education is an effective health education and prevention model for personal and social change (Kendall, 1998; Wallerstein & Bernstein, 1994), particularly with marginalized, disadvantaged, and potentially vulnerable groups (Minkler & Cox, 1980; Wallerstein, 1992, 2002; Wallerstein & Bernstein, 1988) such as the mentally ill (Fitzsimons & Fuller, 2002; Nelson et al., 2001), aboriginal peoples (Tsey, Whiteside, Deemal, & Gibson, 2003), ethnic and other minority groups (Braithwaite & Lythcott, 1989; Crossley, 2001), women (Kar & Pascual, 1999; Stein, 1997), and children and adolescents (Prilleltensky et al., 2001; Rissel et al., 1996; Ungar & Teram, 2000). Some initiatives to empower children and youth to take control of some aspects of their life in general, and some determinants of health in particular, have shown positive effects (Igoe, 1991; Wallerstein, 2002). Within all this literature, however, there is a relative paucity of explicit material dealing with the problematic effects of powerlessness on children’s lives. What does exist also tends to be adultcentric in that most of it interprets children’s realities from an adult point of view, and psychocentric in that most of it focuses on the emotional and cognitive dimensions of powerlessness to the relative neglect of social and political power (Prilleltensky et al., 2001). INQUIRY AND ACTION Similarly, the literature on media literacy and prevention focuses primarily on teaching children and adolescents critical-thinking skills that are designed to ameliorate individual behavior with regard to wise media use and reduced health risk taking (Austin & Johnson, 1997; Bergsma, 2002; Bergsma & Ingram, 2001; Wade, Davidson, & O’Dea, 2003). The construct of empowerment education in media literacy and health promotion interventions deals with building individual resistance to unhealthy messages through inculcating critical-thinking skills (inquiry) and seems to have missed the larger focus of empowerment education on social change (action). In health education and promotion, program planners and evaluators are often looking for the quick fix, prompted by the quick-fix ideology of the medical model and the lack of funding for long-term approaches that focus upstream, examine root causes, and provide ample time for the learning and practice of media literacy skills and action strategies that can ultimately change the media. Media literacy and health promotion programs that truly

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embrace the construct of empowerment must include teaching activities for achieving systemic social change. Children and youth can be powerful advocates for social change through use of the media, as evidenced by the impact of the American Legacy Foundation’s Truth Campaign, which uses youth to unveil the deceitful tactics of the tobacco industry. Helping youth to channel their natural developmental rebellion, their fresh perspective, and their unique energy and creativity toward accomplishing social change, based on youth-identified social concerns, should be a primary focus of both media literacy and health promotion programs. This would foster the powerful attributes of social competence, problem-solving skills, autonomy, and sense of purpose that are in and of themselves all protective factors that foster resiliency in youth (Benard, 1991). Empowerment is often defined by its absence, leading to victim blaming, learned helplessness, powerlessness, and alienation. This article defines empowerment as a process by which people gain control over their lives, democratic participation in the life of their community (Rappaport, 1987), and a critical understanding of their environment (Zimmerman, Israel, Schulz, & Checkoway, 1992). To study the consequences of the empowering process, it is helpful to operationalize empowerment in terms of outcomes. Empowered outcomes for individuals might include perceived control and resource mobilization skills (Perkins & Zimmerman, 1995). In the area of health, we think in terms of wellness versus illness, competence versus deficits, and power to take action versus powerlessness. Empowerment research focuses on identifying assets and capabilities, instead of cataloging risk factors, and on exploring environmental influences of social problems instead of blaming victims. Empowerment-oriented interventions focus on enhancing wellness as well as improving problems, providing opportunities for participants to develop knowledge and skills, and engaging professionals as collaborators instead of authoritative experts. FREIRE’S EMPOWERING EDUCATION THEORY Brazilian educator Paulo Freire (1970, 1973) developed a framework for empowerment education that involves people in efforts to identify their own issues, to critically assess the social and historical roots of these issues, to envision individual health and a healthier society, and to develop social action strategies to overcome challenges and barriers in achieving their goals. McKnight (1999) pointed out that real power is possessed by those who define the problem. Freire’s empowerment education process starts with the population to be educated’s defining their own problems or issues and progresses through a process by which they develop new beliefs in their ability to influence their personal and social realms. Empowerment education, as Freire conceptualized it, involves much more than simply improving self-esteem or self-efficacy or other


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behaviors that are independent from social change. The targets of Freire’s empowerment education are individual, group, and systemic change. EMPOWERMENT IN PUBLIC HEALTH Empowerment education in health promotion “encompasses prevention as well as other goals of community connectedness, self-development, improved quality of life, and social justice” (Wallerstein & Bernstein, 1988, p. 380). Rappaport (1987), who has been a leader in the conceptualization, research, and practical application of empowerment, defined empowerment as a process by which people, organizations, and communities gain mastery over issues of concern to them. Although empowerment is a multilevel construct, Zimmerman (1995) focused on psychological empowerment, which refers to empowerment at the individual level of analysis, having to do with both thought and behavior—the primary focal points of media literacy. Although public health is also interested in community and organizational empowerment, it is at the level of psychological empowerment where the links between public health and media literacy can be found. The construct of psychological empowerment “integrates perceptions of personal control, a proactive approach to life, and a critical understanding of the sociopolitical environment” (Zimmerman, 1995, p. 581). The result of psychological empowerment is social change, although such change may take many forms and may not necessarily result in power struggle. Participatory action research is an approach in public health that exemplifies the empowering process (Chesler, 1991; Rappaport, 1990; Whyte, 1991; Yeich & Levine, 1992), in which community participants become coequals in program development and evaluation (Zimmerman, 1995). A definition of community is needed here. For most public health issues, community is not simply a geographic construct but also refers to a group of people who share a sense of social identity, common norms, values, goals, and institutions. To be considered a community, a group must be characterized by the following elements: 1) membership—a sense of identity and belonging; 2) common symbol systems— similar language, rituals, and ceremonies; 3) shared values and norms; 4) mutual influence—community members have influence and are influenced by each other; 5) shared needs and commitment to meeting them; 6) shared emotional connection—members share common history, experiences, and mutual support. (Israel, Checkoway, Schulz, & Zimmerman, 1994, p. 151)

Participatory action research provides an opportunity for community participants to work together to define and solve problems, develop necessary skills, critically analyze their sociopolitical environment, and create mutual support systems. Participatory action research is designed to help community participants develop the knowledge they need to improve their quality of life and

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influence relevant policy, as well as build competent communities to effect social change. Sometimes a consciousness-raising experience may need to take place before participants can become empowered, such as a media literacy education intervention. Participatory action research not only is an example of an empowering process but also provides a mechanism for developing outcome measures that are relevant and appropriate for the specified community population and context of the intervention (Zimmerman, 1995). In the framework of this article, the proposed community population is youth and the intervention context is one of media literacy and prevention education. EMPOWERMENT IN MEDIA LITERACY

Often when dealing with media issues or topics, we can sometimes be intimidated by the complex technological and institutional structures that dominate our media culture. We can feel powerless against the psychological sophistication of advertising messages and pop culture icons. —Center for Media Literacy (2003, p. 19)

Elizabeth Thoman, pioneer media literacy educator and founder of the Center for Media Literacy, advocates a philosophy of empowerment through media literacy education based on the work of Freire (see her article with Tessa Jolls, which appears in Part I of this double issue). At the heart of this philosophy is an inquiry process developed into a construct called the empowerment education spiral and that consists of four components—awareness, analysis, reflection, and action—all designed to enable students to fully comprehend and act on the content, form, purpose, and effects of media messages. The Alliance for a Media Literate America (2001) said, “Being literate in a media age requires critical thinking skills which empower us as we make decisions, whether in the classroom, the living room, the workplace, the board room or the voting booth” (A Broader Definition sect., para. 3). From the comparison in Table 1 of the components of the empowerment education constructs of Freire (1970, 1973), public health, and media literacy, it is evident that the pedagogical links between public health and media literacy can be traced to Freire’s empowerment education model. The media literacy education movement and the public health movement in the United States have much in common. Although the public health movement is considerably older than the media literacy movement, there is a great deal to be learned and gained from their commonalities. The remainder of this article examines three questions:

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Envision improvement Develop social actions

Critically assess social roots (co-learning process among people and professionals)

Awareness and problem definition by people (not professionals) Critically analyze sociopolitical environment (co-learning process among people and professionals) Improve quality of life Influence policy and effect social change

Public Health

Reflection on other/better ways Action (personal or collective) through media creation and advocacy

Critical analysis (co-learning process among students and teachers)

Awareness by students (not imposed by teachers)

Media Literacy

Components of the Empowerment Education Constructs of Paulo Freire, Public Health, and Media Literacy

People (not professionals) define problems

Freire

TABLE 1:

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1. What are the primary common links between the two movements beyond the foundation of empowerment education documented above? 2. How are both movements severely diminished by dominant systems? 3. How can they work together to achieve synergy?

OTHER COMMON LINKS If we consider that a principal focus of both media literacy and public health is to foster social criticism and social action among a community of people, then both can be classified as community based, whether a community of teenagers, public health professionals, media educators, language arts teachers, parents, or prevention specialists. Both media literacy and public health use a “universalistic” as opposed to “exceptionalistic” approach (Ryan, 1976), asserting that problems lie in the system rather than individuals. Public health advocates recognize that although it is reflected in the problems of individuals, poor health is not caused by them. Poor health is a systemic problem caused by differential access to health care. Similarly, media literacy advocates argue that the inability to understand our media culture, to critically analyze the media, and to gain access to the media constitutes a systemic problem that although reflected in individuals, is not caused by them. Because both poor health and media illiteracy are systemic problems, the solutions must also be systemic; they are economic, political, and social in scope; and they have regional, national, and global dimensions (Bergsma, 1999). SHARED CHALLENGES Both the media literacy and public health movements face powerful forces that oppose systemic reform. In public health, there is constant tension with the dominant system of the medical model that focuses on individual disease or deficiency. The medical model employs a simple triadic credo: (a) the problem is you, (b) the resolution of your problem is my professional control, and (c) my control is your help. McKnight (1995) claimed that the essence of the medical model is “its capacity to hide control behind the magic cloak of therapeutic help” and that the “power of this mystification is so great that the therapeutic ideology is being adopted and adapted by other interests that recognize that their control mechanisms are dangerously overt. Thus, medicine is the paradigm for modernized domination” (p. 61). Media literacy is in conflict with two powerful systems: the media and education. The focus of the U.S. media is to make money through advertising designed to produce consumers. To do this, the function of advertising has become the production of discontent in human beings, according to sociologist Bernard McGrane (see Boihem & Emmanouilides, 1997). Advertising is design-


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ed to generate endless self-criticism, anxieties, and doubts and then to offer the entire world of consumer goods as salvation (Boihem & Emmanouilides, 1997). The focus of our educational system is what Freire (1970) called the “banking” concept of education, in which the teacher’s task is to fill the students with predetermined sets of knowledge, none of which are necessarily identified by the students themselves. From Freire’s work come the following critical questions: Who does education serve and for what purpose? and Does it serve to socialize students to be objects and accept their limited roles within the status quo (Bergsma, 1999)? Gatto (2003) pointed out that our educational system is based on a 19th-century Prussian model and is “deliberately designed to produce mediocre intellects, to hamstring the inner life, to deny students appreciable leadership skills, and to ensure docile and incomplete citizens—all in order to render the populace ‘manageable’” (p. 36). Gatto suggested that men such as George Peabody, who funded the cause of mandatory schooling throughout the South, understood that this system was “useful in creating not only a harmless electorate and a servile labor force, but also a virtual herd of mindless consumers” (p. 37). Finally, Gatto asserted that the actual purpose of education is the adjustive or adaptive function designed to establish fixed habits of reaction to authority, which precludes critical judgment completely. All three of these social systems—medical, media, and education—are antagonistic to critical thinking and collective action, two essentials of both media literacy education and public health. Indeed, the interests of the medical, media, and educational establishments lie not in changing the systems but in controlling individuals in the ways necessary to adapt them to the systems, resulting in poor health, rampant consumerism, and cultural illiteracy (Bergsma, 1999). Both the media literacy education and public health movements work to develop critical consciousness to create a community of individuals who can be transformers of their world. As such, both movements are subversive activities from the standpoint of the dominant systems, and medicine, media, and education react almost instinctively against stimulating critical thinking. The tools of the medical, media, and educational systems are primarily hierarchical, designed to work from the top down. They allow a few people to control many other people to produce standardized outcomes. Because these systems use sophisticated technology and complex professional languages, only experts within the systems have the necessary knowledge to define the questions. All others are disenfranchised. The critical disabling consequence of this professional coding is its impact on citizen capacities to deal with cause and effect. If one cannot understand the question or the answer—the need or the remedy—one exists at the mercy of expert systems. Instead of the world being a place where one does or acts with others, it is a mysterious place beyond one’s comprehension or control (McKnight, 1995).

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TOWARD SYNERGISTIC COLLABORATION Unlike these systems, the community-based, empowering strategies of the media literacy and public health movements do not depend on people bending their uniqueness to a professional vision in exchange for money and security. The tools of the media literacy and public health movements are designed to build on the assets of a community of citizens to enable them to realize their power as free individuals who can join together in defining the questions and expressing and achieving their creative and common visions. Obviously, the tools of the system are antagonistic to the tools of the community. In fact, the work of Ivan Illich (1976) and McKnight (1995) demonstrate that the weakness of community tools is directly attributable to the increasing power of system tools. McKnight (1999) suggested this constitutes a paradox or zero-sum game: “As control magnifies, consent fades. As standardization is implemented, creativity disappears. As consumers and clients multiply, citizens lose power” (p. S14). Just as obviously, both media literacy and public health face a long, uphill battle to achieve expanded recognition and influence in the fields of education, media, and health care. Perhaps because of this and their shared goals of developing the critical consciousness of community, there appears to be a natural partnership that will, it is hoped, result in synergism. The leadership of both movements must establish new paradigms that invert the system models, direct the focus to capacities rather than needs and deficiencies, and teach the skills of critical thinking and collective action. There are no easy tricks or technical gimmicks that professionals in media literacy and public health can use to overcome the limits of the dominant system tools. There are, however, some hopeful experiments and initiatives in which professionals have helped to enhance the power of communities. Analysis of some of them reveals that they reflect at least four important values of a new breed of modest professionals and teachers who are interested in promoting social change. 1. They focus on the idea that community members/students are skilled and capable. 2. They have a deep respect for the capacities and wisdom of the people they are working with. They trust that the people can do it; they do not need to do it for them. 3. They understand that access to information will enable community members/ students to analyze and solve problems. They do not provide the answers, but they provide understandable information that empowers members to develop and implement solutions. 4. They are not trying to gain influence for themselves. Instead, they strengthen the community by asking how the system might enhance the actions of community members/students.


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SUMMARY Within a framework of media literacy and health promotion for youth, this article draws on literature in the fields of empowerment, public health, media literacy, and education, as well as the author’s extensive intervention, evaluation, and research experience with media literacy and health promotion/prevention programs for youth communities, to present an analysis of why media literacy is a potent health promotion and prevention strategy. An extensive review of the literature demonstrates that powerlessness is linked to poor health outcomes. An exposition of Freire’s (1970, 1973) empowering education theory establishes it as the linking foundation for health promotion and media literacy, with a reminder that sociopolitical action is an essential component of both. An analysis and comparison of the sociopolitical systemic challenges that confront media literacy and public health in the United States suggests the need for public health and media literacy advocates to work together to achieve empowerment education. The timing may be right for such a collaboration. A recent groundbreaking Institute of Medicine report (Gebbie, Rosenstock, & Hernandez, 2002) emphasized the importance of taking an ecological approach to public health and prevention. This approach is designed to go beyond the risk-factor approach to social and behavioral analysis, which has dominated the field in recent decades. Instead, this approach focuses on changing the social conditions underlying health through such activities as community-based participatory research, in which communities work with professionals to define issues, frame research questions, gather and analyze data, determine solutions to problems, and act to achieve change. This emergent paradigm in public health should open the door to increased interest in and receptivity to innovative strategies, such as media literacy, for achieving behavioral and social change and should pave the way for strong, collaborative empowerment education efforts that will result in healthier citizens able to think critically and act collectively. REFERENCES Alliance for a Media Literate America. (2001). What is media literacy? Retrieved from http:// www.amlainfo.org/medialit.html Austin, E. W., & Johnson, K. K. (1997). Effects of general and alcohol-specific media literacy training on children’s decision making about alcohol. Journal of Health Communication, 2(1), 17-43. Benard, B. (1991). Fostering resiliency in kids: Protective factors in the family, school, and community. Portland, OR: Western Center for Drug-Free Schools and Communities. Bergsma, L. J. (1999). Media literacy and public health: Both see the glass half full. Telemedium, 45(1), 20-21. Bergsma, L. J. (2002). Media literacy and prevention: Going beyond “just say no.” In Thinking critically about media: Schools and families in partnership (pp. 13-18). Alexandria, VA: Cable in the Classroom.

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Bergsma, L. J., & Ingram, M. (2001, January). Blowing smoke: Project evaluation final report. Available from http://[email protected] Boihem, H. (Director/Producer), & Emmanouilides, C. (Producer). (1997). The ad and the ego [Video]. (Available from Parallax Pictures at http://www.parallaxpictures.org/AdEgo_bin/ AE000.01a.html) Braithwaite, R. L., & Lythcott, N. (1989). Community empowerment as a strategy for health promotion for Black and other minority populations. Journal of the American Medical Association, 261(2), 282-284. Center for Media Literacy. (2003). MediaLit kit: A framework for learning and teaching in a media age. Retrieved from http://www.medialit.org/pdf/mlk_orientationguide.pdf Chesler, M. A. (1991). Participatory action research with self-help groups: An alternative paradigm for inquiry and action. American Journal of Community Psychology, 19, 757-768. Crossley, M. L. (2001). The “Armistead” project: An exploration of gay men, sexual practices, community health promotion and issues of empowerment. Journal of Community & Applied Social Psychology, 11(2), 111-124. Fitzsimons, S., & Fuller, R. (2002). Empowerment and its implications for clinical practice in mental health: A review. Journal of Mental Health, 11(5) 481-499. Freire, P. (1970). Pedagogy of the oppressed. New York: Continuum. Freire, P. (1973). Education for critical consciousness. New York: Continuum. Gatto, J. T. (2003). Against school: How public education cripples our kids, and why. Harper’s, 307(1840), 33-40. Gebbie, C., Rosenstock, L., & Hernandez, L. M. (Eds.). (2002). Who will keep the public healthy? Educating public health professionals for the 21st century. Washington, DC: Institute of Medicine. Igoe, J. B. (1991). Empowerment of children and youth for consumer self care. American Journal of Health Promotion, 91, 55-65. Illich, I. (1976). Medical nemesis: The expropriation of health. New York: Pantheon. Israel, B. A., Checkoway, B., Schulz, A., & Zimmerman, M. (1994). Health education and community empowerment: Conceptualizing and measuring perceptions of individual, organizational, and community control. Health Education Quarterly, 21, 149-170. Kar, S. B., & Pascual, C. A. (1999). Empowerment of women for health promotion: A meta-analysis. Social Science & Medicine, 49(11), 1431-1461. Karasek, R., Baker, D., Marxer, F., Ahlbom, A., & Theorell, T. (1981). Job description latitude, job demands, and cardiovascular disease: A prospective study of Swedish men. American Journal of Public Health, 71, 694-705. Kendall, S. (Ed.). (1998). Health and empowerment: Research and practice. London: Arnold. Marmot, M., & Theorell, T. (1988). Social class and coronary heart disease: The contribution of work. International Journal of Health Services, 18, 659-674. McKnight, J. (1995). The careless society: Community and its counterfeits. New York: Basic Books. McKnight, J. (1999). Two tools for well-being: Health systems and communities. Journal of Perinatology, 19(6), S12-S15. Minkler, M., & Cox, K. (1980). Creating critical consciousness in health: Application of Freire’s philosophy and methods to the health care setting. International Journal of Health Services, 10(2), 311-323. Moane, G. (1999). Gender and colonialism: A psychological analysis of oppression and liberation. London: Macmillan. Nelson, G., Lord, J., & Ochocka, J. (2001). Empowerment and mental health in community: Narratives of psychiatric consumer/survivors. Journal of Community & Applied Social Psychology, 11, 125-142.


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AMERICAN BEHAVIORAL SCIENTIST LYNDA J. BERGSMA is an assistant professor in the Mel and Enid Zuckerman Arizona College of Public Health at the University of Arizona, associate director of the Rural Health Office, and director of the Media Wise Initiative, which she established in 1992. She combines her extensive background in mass communications, public health, education, and sociology to plan and implement programs, develop curricula, provide training and consulting services, and conduct research on the impact of our media culture on public health issues and on media literacy as a critical prevention strategy. She is a founding board member and president of the Alliance for a Media Literate America.