We need to deepen our understanding of power.
In our view at Human Impact Partners, power is a central component to advance health equity, as we’ve said in other blog posts and in the work we do with health departments who are serious about advancing health equity. Others believe this too, and are calling for public health to “evolve our research, conceptual frameworks, and metrics” to advance power-building strategies.
One thing that has come up for me recently is how the 4 dimensions of racism — internalized, interpersonal, institutional, and structural — are also dimensions of power. How so?
Internalized power is about whether people feel they have agency.
Many people facing inequities feel like their voice doesn’t matter and feel rather hopeless about change for the better. They then don’t engage in making change — by voting, by organizing, by participating in the political process.
In turn, those benefiting from inequities — the wealthy in particular — have no doubt about their ability to make change.
Interpersonal power is about “positional power” and is often linked to racism and other forms of oppression.
It’s typically about having power over someone, domination. Interpersonal power can come from named authority or positional power (the kind of power a boss has, or a police officer has). It can also come from power associated with social hierarchies such as those that come from race, gender, age, etc.
When we talk about “power and privilege,” we are generally talking about interpersonal power.
Institutional power is about what societal institutions have power and which do not.
Law enforcement agencies wield a great amount of power, as does the NRA. Health departments, less so.
Structural power is about how different structures that underlie society, across institutions, wield power.
A current example is how Republicans have the power to appoint a new Supreme Court Justice right now, even though they lost the popular vote in the last presidential election. Because of the electoral college, because small states have the same number of senators as large states, because of gerrymandering, because of systematic voter disenfranchisement through voter ID laws, incarceration, and other mechanisms, and because of dark money donations from the wealthy and corporations that stand to benefit, one person does not equal one vote currently and a wealthy few have manipulated those systems to maintain structural power.
One component of maintaining structural power currently is to use racism and other forms of oppression to maintain a social hierarchy in which White, cis-gender, heterosexual people benefit from the status quo.
My favorite framework about power is from the Grassroots Policy Project and focuses on this last dimension, structural power. It looks at 3 (or sometimes 4) faces of power:
- “Organizing people and resources for direct political involvement in visible decision-making arenas”
- “Building durable, long-term political infrastructure to control what is on the political agenda”
- “Making meaning on the terrain of ideology and worldview”
- The 4th face they sometimes include is state policing power that can shut down on dissent.
These dimensions are just a rubric to help us examine power. They are not truly distinct and are, in fact, deeply intertwined. For example, we need to organize people and change their internalized view of power so they engage in work together to gain institutional and structural power.
We need to make progress changing all these dimensions of power if we want to advance health equity.
Changing structural power must be our ultimate goal, though, to make the deep and enduring changes that will allow everyone to thrive.
Jonathan Heller is co-founder and co-director of Human Impact Partners. Jonathan co-directs the organization with Lili Farhang, setting its strategic direction and advancing its mission. He’s dedicated to advancing health equity by addressing the main causes of inequities — social, economic, and environmental policies — as well as the causes of inequities in those policies: power imbalances and racism and other forms of oppression. He’s thrilled to see public health starting to engage more deeply in social justice work these days.
When he’s not at HIP, Jonathan is likely hanging out with his wife, 2 kids, and/or dog, supporting social justice in other ways, or doing all of those things together.