Introduction
While not as broad as a right to health, the right to health protection encompasses attention to the public health context of curative medicine. Thus a right to health protection goes beyond medical interventions to include preventive measures, such as the provision of potable water and improvement of environmental conditions. Sometimes the distinction is that the right to health care applies when one is sick and the right to health protection seeks to prevent the population from becoming sick. Clearly there are regions of the world in which the most valuable steps toward improvement of health are not medical services but public health protection (Chapman 1994). Poor countries with limited resources would better improve health standards by investing scarce resources in clean water and environmental clean-up rather than by offering curative health care to a small fraction of the population. Moreover, even within an advanced industrialized country, health status will continue to deteriorate and health care costs will continue to escalate unless there is greater attention to promoting more favorable health conditions. Accordingly, it is reasonable to conclude that a basic standard of health care cannot be achieved, even in a more affluent society, apart from a commitment to health protection (Chapman 1994).
The dual goals of universal coverage and cost containment cannot be achieved within a health care system that focuses on expensive curative medicine delivered by specialist physicians. Moreover, to promote the general health of the population as a whole, public policies need to place a priority on improving health conditions. Comprehensive health protection would include measures to improve air quality, significantly reduce exposure to toxic substances, assure greater workplace safety, discourage substance abuse, eliminate the availability of guns and weapons, and cleanup water supplies. Major investments in preventive health services, such as inoculations, early detection screening for disease, and regular checkups, would be another component of the strategy. One aspect of individual and collective responsibility is to have realistic and appropriate expectations regarding health care. The right to health care is not an unlimited and open-ended entitlement. A societal commitment to health protection and improvement does not necessitate a constantly increasing investment of the gross national product to health care at the expense of other goals. Nor does it imply that the goal is perfect or optimal health for each of its members. It most likely means that the standard for treatment of chronic illness be care rather than cure (Auhagen & Bierhoff 2001). Health protection is an issue in most countries not only because of its social implications but the expenses it entails. In health protection service there are varying components one of which is the public health component. The public health component needs to be managed well so that the goals of such component are achieved. To make sure that proper management strategies are used empowerment becomes involved. This paper intends to critically discuss to what extent empowerment is a key issue in leading and managing the public health component of a health protection service.
Main body
The role of public health is to assure the conditions for people to be healthy. These conditions include a variety of educational, economic, social, and environmental factors that are necessary for good health. Most definitions share the premise that the subject of public health is the health of populations and that this goal is reached by a generally high level of health throughout society, rather than the best possible health for a few (Gostin 2002). The field of public health is concerned with health promotion and disease prevention throughout society. Consequently, public health is interested in devising broad strategies to prevent or ameliorate injury and disease. Scholars and practitioners are conflicted about the reach or domain, of public health. Some prefer a narrow focus on the proximal risk factors for injury and disease. The role of public health agencies is to identify risks or harms and intervene to prevent or reduce them. This has been the traditional role of public health exercising discrete powers such as surveillance or screening and reporting, injury prevention and infectious disease control or vaccination, partner notification, and quarantine (Gostin 2002).
The expansive view of public health may well be justified by the populations. Around the world, health care is provided through many diverse public and private mechanisms. However, the responsibilities of public health are carried out in large measure through policies and programs promulgated, implemented, and enforced by, or with support from, the state. Therefore, this first linkage may be best explored by considering the impact of public health policies, programs, and practices on human rights. The three central functions of public health are: assessing health needs and problems; developing policies designed to address priority health issues; and assuring programs to implement strategic health goals (Evans 2001). Potential benefits to and burdens on human rights may occur in the pursuit of each of these major areas of public health responsibility. Members of the public health professions, practitioners and academicians alike, traditionally hold as their primary goals the development and dissemination of practices that will prevent disease and disability. Other aspects of public health, such as those relating to medical care access and costs, wax and wane in importance but remain secondary to disease prevention (Evans 2001). Assessing the needs of populations is a complex Endeavour. Purchasers have to develop methods alongside the traditional existing approaches of public health departments if they are to understand the totality of need. Moreover, as they are compelled by government guidance to involve users in this process they have to respond with creative methods to make this. Many public health problems, because of the social and behavioral factors which influence their origins and their effects, require much more flexible definitions of research, science and data (Popay & Williams1994).
Corporate discussions about health needs assessment and other public health issues involve ethical and political challenges to those who make the environment unhealthy and those who, in the past, have decided health care priorities. But they also carry with them an epistemological challenge to epidemiologists and other experts in public and environmental health, including managers. The current restructuring of community health services assumes and relies on the commitment of generalist community nurses to their nursing and to primary health care principles (Hancock 1999). Much of their contribution goes unrecognized and undervalued, due to the managerialist, output-focused objectives of current health policy, and is therefore not achieving its full potential. These findings point to a conclusion that economic policies aimed at reducing health costs, such as output-based funding, consumer co-payments for community health services, integration and compulsory competitive tendering are adding to the administrative workload of generalist community nurses and are diverting community health away from important aspects of public health care. As a consequence, such trends are counterproductive in terms of raising the health status of the community or improving health service delivery (Hancock 1999). Public health has many concerns; it deals with prevention rather than finding or providing cure. Public health focuses on a population and not on a certain individual. Public health makes sure that plagues, viruses and diseases do not easily spread. It does this through stopping any spread of a health problem or careful security of basic necessities. Public health is usually funded by governments but some non government institutions provide some support or assistance. Public health like most concepts needs managing and leading. Leadership and management make sure that public health acts according to the demands of the environment. It makes sure that public health attains it current or new goals.
Human service executives in both nonprofit and governmental organizations, like corporate executives, are usually active participants in the process of organizational policy formation as well as in policy implementation, even though the executive position is not formally defined as a policy-determining position. Most policy action issues in human service organizations come to a policy board or a legislative body as a recommendation from the executive, and with the executive as participant in the policy discussion (Austin 2002). Like the generalist public administrator, human service executives are responsible for the congruence of implementation to enacted policy, whether or not it is the policy that they have recommended. They are also responsible for organizational continuity, and for break-even financial performance. And, like the generalist public administrator, the human service executive has no direct personal economic stake in the financial performance of the organization. There is no single, universal definition of the characteristics of the human service executive position (Austin 2002).
Human service organizations producing similar products but in different environments may require different mixes of elements in the executive position. In many human service organizations, the employed staff includes members of one or more professional disciplines, an important factor in the decentralized pattern of interpersonal relationships to be dealt with. One of the important internal dynamics may be competition among professional groups for control over power positions within the organization and, therefore, for access to resources. Perceived distinctions between organizational employees and members of organized professions, or between service providers and support staff, may also be important factors that must be dealt with in the effective mobilization of personnel resources for service production. Even more critical may be perceived distinctions between employees and service users, including gender, ethnic, income status, or wellness distinctions that may constitute barriers to effective service co-production (Baum, Revenson & Singer 2001). In the human service organization, the quality of service often depends on the competence and commitment of individual service providers interacting with individual service users in a co-production process, rather than on the work group or work team. Indeed, decentralized individual responsibility, or professional autonomy, may be more important in motivation than elaborate group participation processes in an organization in which ultimate authority is, in reality, highly centralized. The executive has responsibility for making certain that there are established procedures for determining if the service production activities within the organization are consistent with the mission and goals of the organization, with applicable professional and regulatory standards, and with the requirements and expectations of funding and policy-making sources (Baum, Revenson & Singer 2001).
Procedures for establishing financial accountability are particularly critical as human service organizations become increasingly dependent on multiple external funding sources, each with distinctive accountability requirements. Failure to deal with financial accountability effectively can lead to the dismissal of the executive and the collapse of the service organization. Given the complexities and uncertainties of professional production activities in human service organizations, executive performance in this sector is often viewed as being based primarily on the background of professional experience of the executive rather than on knowledge about more general management technologies, including financial management (Macdonald 1998). Executives in human service organizations, including social service executives and educational executives, are often selected on the basis of professional education and previous professional experience. That is, the executive is viewed as the ultimate professional supervisor. However, although such a background may be a necessary qualification for a human services executive, it is often not a sufficient qualification. Also important is an understanding of the technical requirements involved in the systematic organization of service production and organizational accountability, as well as the competencies involved in the other three sectors of executive performance. However, in many instances, the appointment of a senior professional practitioner to an executive position is not accompanied by any systematic orientation to the particular requirements of the position (Macdonald 1998). Like the management of business organizations, public health management requires the executive to know how to plan, budget finances, make use of appropriate strategies and solve problems. An executive that manages the public health needs to make sure that aside from all those mentioned he/she has the right leadership skills and is empowered to decide on important issues.
Under the empowerment model managers are required to provide the necessary conditions for people to flourish under their own energies. The focus is on cultivating a clear and guiding sense of individual worth, responsibility and commitment, as opposed to a dependency culture where the individual is unable to function without a manager directing proceedings. Of course broad direction still exists but the focus is on the individual becoming self directed. The manager’s role becomes that of coach (Thomas 1997). The empowerment approach is an integrated method of social work practice driven by the unified personal: political construct and a commitment to the unleashing of human potentialities toward the end of building the beloved community, where justice is the rule. It is therefore a clinical and community-oriented approach encompassing holistic work with individuals, families, small groups, communities, and political systems/ Empowerment practice seeks to create community with clients in order to challenge with them the contradictions faced as vulnerable, hurt, or oppressed persons in the midst of an affluent and powerful society. Practitioners must develop effective interventions to deal with individual pain by taking social forces into account (Thomas 1997).
Empowerment practice requires critical thinking as it addresses individual, familial, and organizational resource problems, problems of asymmetrical exchange relationships, problems of powerlessness and inhibiting or hindering power structures or constraining power structures, and problems related to arbitrary social criteria or values. To help empower people must first learn to speak openly about power with clients and then engage in examination of power bases stemming from personal resources, articulation power, symbolic power, positional power, or authority, and formal and informal organizational power. Unfair social stratification and unfair distribution of goods constitute the most difficult question facing most societies (Lee 2001). Empowerment helps leaders capture the hearts of their followers. It makes followers feel strong, forceful, and capable. The key to leader success in empowerment is trust. Leaders need to trust followers before they will delegate significant responsibility to them. This trust is encouraged by full and constant communication between leader and follower regarding techniques and vision. For the leader empowerment is exercising control on the basis of results, not activity, events, or methods as managers do. Empowerment involves releasing the power in others through collaboration. It is endowing others with the power required to perform a given act and granting another the practical autonomy to step out and contribute directly to his or her job. It does not mean the leader gives away power. Rather it involves adding to the power of co-workers by development of their talents (Lee 2001).
Empowered people are more self-confident, self-controlled, and self motivated. The key is self. People are empowered when they individually accomplish collaborative and participative efforts with a leader and co-workers. These accomplishments appeal to the innate values of independence, self-reliance, and individualism. Empowerment is allowing people to self-actualize on the job via interesting and challenging job assignments. Empowerment involves the creation of job situations in which workers can be self-motivated instead of intimidated. It is not suppressing data about work. It is allowing room for co-workers to take risks without undue controls. In a real sense, it is helping workers find their niche, which would allow them to make full use of their strengths for their own benefit and for the organization. Leaders empower people for three reasons. First, empowered people work harder. They work more independently when they can make use of multiple talents, capacities, and creative selves. Jobs that are fuller, more demanding, and more complex and that require more of the total self are attractive to employees. It increases personal motivation when leaders assign tasks that include some worker control over work environment and discretion about when and how the work is done. Second, people who feel their leaders have concern for their development and maturation as a human being are more committed to that leader. They will follow a leader whom they feel shows concern for them apart from what they can do for the organization. Third, empowered, committed people are more creative and innovative in their work. They produce new ways to do work that challenge past methods (Weissberg 1999).
Empowered people focus on their proven capacities and those of their co-workers. They are more open to change, more supportive of change, and more involved in determining the direction of changes made in the organization/The problem with empowerment is that it is powerful. Giving power to workers allows them to be more productive in group goal accomplishment. This power can also be used to move the organization away from desired goals. Also, not everyone wants, or is prepared to, receive power and use it wisely or effectively. Sometimes, people do not or cannot exert power because they fear it. There are physical, psychological, and sociological system barriers to empowerment that leaders often ignore in their rush to create a trust culture based on worker empowerment. These factors sometimes play out in dysfunctional ways in organizational relationships. Despite the leader’s best efforts, characteristics of the people worked with or the character of the current culture can sometimes dissipate collective energy. This can cause the leader’s explicit goals to become fuzzy and unclear and direct the work effort toward harmful, not helpful, activity (Fairholm 1994). Empowerment is making others act through the use of a good style of leadership. Empowerment is an important aspect of leading/managing the public health component of a health protection service. Leadership/management are the ones that will guide the public health component to achieve its goals, empowerment will be the driving force so that there would be movement. Empowerment doesn’t necessarily mean that the goals will be achieved but it will initiate the movement to achieve the goals. Empowerment may cause some individuals in the public health component to lose their focus; good leadership styles will solve such issue. Empowerment without good management cannot help the public health component reach its goals. On the other hand if leaders are not empowered they cannot initiate acts that will lead to the achievement of pubic health component’s goals.
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