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Disempowering socioeconomic and political structures to empower people


Ines Urieta Guijarro ,

Comarca Uribe Kosta de Salud Pública, ES
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Amaia Ajuria Lekerika

Comarca Uribe Kosta de Salud Pública, ES
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The “social determinants of health model” is a way to explain inequalities in health. It places socioeconomic, cultural and environmental conditions at the highest level, which means that people have more difficulty to impact on them, although those conditions have great influence on their lives and health.

There is a need to re-think the present model. Political, socio-economic and cultural structures should be closer to people. There should be ways to enable people participation not only when parliament elections take place.

There is a need to disempower political, socio-economic and cultural structures in favour of the empowerment of the persons and the community.

In the last seven years we have been involved in several local community processes that have tried to integrate agents from various sectors. We have made an attempt to place “the Person” at the center of the model and faced many difficulties. We are now in the position to provide the main conclusions of our reflection and to set the basis for future processes that may arise from the community.

This poster will present a proposal for a change of paradigm towards empowering people, the conclusions of various processes implemented in the Basque Country and the foundations for future community processes.

In 2012 we initiated a process of facilitating the creation of “Local Health Networks”. The main aspect that should change for future networks is participation. Political sensitization and real will to listen to people is crucial.

These networks are directed towards the general population including disadvantaged groups and usually require a minimum of 5 years to be fully implemented. Health results are not foreseen before 10 years.

The main innovative aspect of the work presented is the change from individualism to integration.

The main expected outcomes are healthier communities with less inequality in health.

At political level, there must be a clear bet towards facilitating participation and providing appropriate resources. At technical level, there should be a clear strategy to capacitate on participation and, at community level participation should be eased as much as possible.

The methodology is ready to be transferred to other environments. The key point is the political will.

The Health Department of the Basque Government has its own strategy to reduce health inequalities and local governments should adopt it. Health networks created with the only impulse of the health sector will not become real community networks. The present model not only does not contribute to reduce inequalities but it could promote them.

The creation of health networks should have a clear aim for active listening to people. The purpose is not “doing” things for the community but “providing” opportunities for participation and making decisions based on the real needs of the people.

There should be a change of model towards a real integration between administrations, technical resources and people.

The assets model is completely in force, but we cannot expect significant progress without providing the necessary resources to lay the foundations for future community networks.

How to Cite: Urieta Guijarro I, Ajuria Lekerika A. Disempowering socioeconomic and political structures to empower people. International Journal of Integrated Care. 2019;19(4):150. DOI:
Published on 08 Aug 2019.


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