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Il ruolo delleo sviluppo di comunita per la promozione della salute e stato problematico, anche a causa di una mancanza di fiducia tra governo e societa civile e di programmi top-down che hanno contribuito a un basso coinvolgimento della comunita. Questo contributo riflette sulla necessita di reintepretare lo sviluppo di comunita per la promozione della salute nel 21o secolo. Esso affronta la comprensione delle sue origini, il ruolo delle organizazioni basate sulla comunita e il loro rapporto con lo sviluppo delle capacita e l’empowerment di comunita. La promozione della salute e politica e una reinterpretazione dello sviluppo di comunita deve ri-flettere sino a che punto le comunita possono essere politicizzate al fine di avere un maggiore controllo sui determinanti delle loro vite e della loro salute. In breve, nel 21o secolo possiamo sostituire il termine "sviluppo di comunita" con quello di "empowerment di comunita" sia nel discorso sia nella pratica nella promozione della salute.

Health systems all over the world are in a process of transition and may even need a paradigm shift for sustainable development. This is where activism may play a role. This study focused on why some physicians become activists and how these physicians have either achieved successes or failed to do so. This study is inspired by grounded theory. Semi-structured, in-depth interviews were conducted to evaluate the experiences of seven purposefully sampled physician-activists from the Netherlands. Our research suggests that activism originates from an awareness of problems in the area of health inequalities, resulting in moral discomfort combined with a strong drive to speak up against perceived failings, even when personal risks may be involved. Activists that were most successful in achieving political and health changes meandered effectively along the borders of the system, taking care to preserve ties with supporters within that system and, at the same time, taking a relatively isolated position while using strategies to oppose the system. Diverging too much from the system resulted in measures taken by the system to silence them. Successful activism may be regarded as a social and professional skill that may be learned.

International migration is a complex phenomenon that touches on a multiplicity of economic, social and security aspects affecting our daily lives. In the Nordic countries’ migration is a contentious political topic as the number of migrants has significantly increased in recent decades. The aim of this study is to analyse governmental policy documents on migrants in Denmark, Finland, Norway and Sweden and to identify and compare how they are described within an empowerment perspective. A critical discourse analysis was undertaken of each Nordic country. The findings revealed that all four documents placed migrants in a passive position in regard to decision-making and that an empowerment perspective was lacking. Migrants are similarly treated in each Nordic country as a problem to deal with rather than as a possible resource for the society and the approach seeks to protect the welfare state and the culture of the country. The lack of empowerment perspective may be having a negative impact on the health and well-being of migrants and on their integration in the Nordic society. The article concludes by raising several questions in regard to migration and empowerment in the Nordic context.

BACKGROUND: As the core of health promotion, proper assessment of empowerment is a base for planning for a process that increases people's control on their decisions, lifestyle, and effective activities for their health.OBJECTIVE: To design and develop a special tool to assess the empowerment of NGO women in Iran.METHODS: This successive exploratory study of combinational type was conducted in 2015 in two steps. In the first step, using comments of participants and the help of authentic texts related to this field, dimensions of psychological empowerment were developed. In the second step, psychometric properties of the scale or tool were determined using formal content, and structural validity and reliability were determined using internal consistency and stability via SPSS version 21.RESULTS: In the first step, the initial tool including 58 items was developed in the form of eight domains. In the second step, based on exploratory factor analysis (EFA), the number of items was reduced to 37. Considering the eigenvalues of higher than one, items were classified into eight factors. KMO index was 0.896 in this study. Reliability of the tool was 0.81 using Cronbach's alpha. This tool is able to predict 66.1% of total changes in psychological empowerment.CONCLUSION: A questionnaire with relevant reliability and validity, including eight domains of participation, motivation, cognitive thinking, critical thinking, self-efficacy, intention, perceived control and social support was developed to measure psychological empowerment of NGO women in Iran.

Migrants have disproportionately higher rates of morbidity and mortality when compared to the host population and this reflects the reality of health inequalities in many countries. It is imperative to engage with communities to identify their needs and to include these in the delivery of public health programs and health care services. The aim of this paper is to outline a new approach that systematically ensures that vulnerable groups, such as migrants, can become actively involved and are not simply the passive recipients of program activities. The community engagement framework is based on practical experiences of working in a cross-cultural context in both rural and urban settings and is implemented as seven key steps: 1. stakeholder connection; 2. communication; 3. needs assessment; 4. informing the wider community; 5. strengthening community capacity; 6. building partnerships; and, 7. follow-up. The framework offers a flexible template that can be used to engage with vulnerable groups in future public health programs. Migrants have disproportionately higher rates of morbidity and mortality when compared to the host population and this reflects the reality of health inequalities in many countries. It is imperative to engage with communities to identify their needs and to include these in the delivery of public health programs and health care services. The aim of this paper is to outline a new approach that systematically ensures that vulnerable groups, such as migrants, can become actively involved and are not simply the passive recipients of program activities. The community engagement framework is based on practical experiences of working in a cross-cultural context in both rural and urban settings and is implemented as seven key steps: 1. stakeholder connection; 2. communication; 3. needs assessment; 4. informing the wider community; 5. strengthening community capacity; 6. building partnerships; and, 7. follow-up. The framework offers a flexible template that can be used to engage with vulnerable groups in future public health programs.

This paper provides a rapid review of the literature on the current knowledge on health promotion for improved refugee and migrant health in the European region. The aim of the paper is to identify implications for future policy and practice. The literature review used standard systematic methodologies to search databases followed by data extraction and synthesis. General sources of grey literature were also included in the review as well as consultations with people working in the field. The paper identifies the lack of knowledge on how to engage with refugees and migrants in a culturally competent way, to address fear and violence and the application of health literacy. The review of the literature also identifies evidence to support peer education, working with community-based organisations and the tailoring of interventions to the needs of refugees and migrants. The paper concludes with a discussion of the technical content and future implications for the implementation of health promotion programs.

Health activism is an action on behalf of a cause, action that goes beyond what is conventional or routine in society. It involves a challenge to the existing order whenever it is perceived to lead to a social injustice or inequality. Today social injustice is killing people on a grand scale and it is timely for health activism to be used as a way forward to improve health during difficult economic and political times. Health activism is essential because it can create the necessary conditions for people to take control over their own lives when others cannot or will not act on their behalf. Health promotion agencies and the practitioners that they employ, professional organisations and researchers can also play an important role. What is clear is that if greedy corporations and complacent governments are not challenged, we will continue to have limited success in improving health.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited., The prevalence of Female Genital Mutilation (FGM) is reducing in almost all countries in which it is a traditional practice. There are huge variations between countries and communities though, ranging from no change at all to countries and communities where the practice has been more than halved from one generation to the next. Various interventions implemented over the last 30–40 years are believed to have been instrumental in stimulating this reduction, even though in most cases the decrease in prevalence has been slow. This raises questions about the efficacy of interventions to eliminate FGM and an urgent need to channel the limited resources available, where it can make the most difference in the abandonment of FGM. This paper is intended to contribute to the design of more effective interventions by assessing existing knowledge of what works and what does not and discusses some of the most common approaches that have been evaluated: health risk approaches, conversion of excisers, training of health professionals as change agents, alternative rituals, community-led approaches, public statements, and legal measures.

The ongoing outbreak of the Ebola virus in West Africa is the largest on record; it has undermined already fragile healthcare systems and presented new challenges to contain the spread of the disease. Based on our observations in the field and insights from referenced sources, we aimed to identify key experiences of community engagement and social mobilization efforts in the current Ebola response. We concluded that there is no excuse not to actively involve local people and that the United Nations (UN) agencies and other partners did learn from their earlier mistakes to make a genuine attempt to better engage with communities. However, bottom-up approaches have not been widely implemented during the response and the reasons for not doing so must be further assessed. Health promotion can make an important contribution, because it shows how to enable people to take more control over their lives and health. This commentary can provide a guide to agencies to understand an appropriate way forward when the next Ebola outbreak inevitably occurs. © The Author(s) 2015. The ongoing outbreak of the Ebola virus in West Africa is the largest on record; it has undermined already fragile healthcare systems and presented new challenges to contain the spread of the disease. Based on our observations in the field and insights from referenced sources, we aimed to identify key experiences of community engagement and social mobilization efforts in the current Ebola response. We concluded that there is no excuse not to actively involve local people and that the United Nations (UN) agencies and other partners did learn from their earlier mistakes to make a genuine attempt to better engage with communities. However, bottom-up approaches have not been widely implemented during the response and the reasons for not doing so must be further assessed. Health promotion can make an important contribution, because it shows how to enable people to take more control over their lives and health. This commentary can provide a guide to agencies to understand an appropriate way forward when the next Ebola outbreak inevitably occurs.

IntroductionThe purpose of this commentary is to discuss how toaccommodate top-down and bottom-up approaches at eachphase of chronic disease prevention programmes. Thecommentary uses a theoretical example of targeting a highrisk group in New Zealand.Chronic disease prevention programmes are typicallydesigned to address changes in lifestyle and behaviourcentred on, for example, diabetes prevention. There isevidence to suggest that lifestyle and behaviour pro-grammes that include multi-risk factor interventions suchas increasing physical activity, dietary modifications andweight loss can significantly reduce the incidence of dia-betes in persons at high risk (Knowler et al. 2002;Tuomilehto et al. 2001). In practice, chronic disease pre-vention programmes are most commonly implemented asactivities set within the context of a programme. Profes-sionally led, it is the practitioner or their agency thatchooses the design, the means of implementation andevaluation of the programme. This includes the selection of‘targeted groups’ and the methods to be used to reach them.The issues to be addressed are traditionally based on epi-demiological evidence, rather than on the concerns of theindividuals and communities to whom it should concern.This style of programming is called ‘top-down’. Bottom-upprogrammes are fewer in design and address the concernsof the beneficiaries based on discussions with them prior toimplementation. The concerns are prioritised and thendeveloped into a form that makes sense to all the pro-gramme stakeholders (Laverack and Labonte 2000).It is important to remember that the terms ‘top-down’and ‘bottom-up’ are ideal types of practice. ‘Top-down’describes programmes where problem identification comesfrom those in top structures ‘down’ to the community.‘Bottom-up’ is the reverse, where the community identifiesits own problems and communicates these to those whohave the decision making authority. The practitioner willtry to use their influence to ‘push-down’ a predefinedagenda onto the community through top-down program-ming. The community attempts to ‘push-up’ an agendabased on their immediate concerns that are often not thesame as those identified by the practitioner. The failure oftop-down programming to accommodate bottom-up con-cerns may have a detrimental effect on outcomes. Forexample, the modest success of top-down programminghas only been with higher socio-economic groups: between1998 and 2004 there was a 9% decrease in smoking in thelowest quintile in Australia compared to a 35% decrease inthe highest quintile (Baum 2007). This is because top-downprogramming uses strategies that are effective at reachingthe educated and self-motivated sectors of society and arenot specifically tailored for low socio-economic or mar-ginalised groups.The challenge is how to accommodate bottom-upapproaches within the dominant top-down styles of pro-gramming. This requires a fundamental change in the waywe think about chronic disease prevention programmes.Rather than viewing the issue as a bottom-up versus top-down tension, accommodating both can be better viewed asa ‘parallel track’. The tensions between the two then occurat each stage of the programme cycle making their reso-lution much easier to achieve (Laverack 2004). The mainpurpose of the programme remains unchanged with a focuson the more conventional top-down issues and so fitswithin the expectations of, and is therefore acceptable to

Objectives and Settings: A growing Asian population currently resides in New Zealand, yet under half of this population claim the support they are entitled to in the face of an accident and injury. This research is focused on identifying ways of effectively engaging the Chinese community in health-promotion programmes to prevent and/or reduce injuries. Methods: Research field work was conducted based on a qualitative approach. Interviews were carried out with 32 members of the Chinese community and six experts from six different organizations working with the Chinese community in Auckland, New Zealand. Results: Interviews revealed that issues of resettlement and relocation, lack of communication, community readiness and community capacity all impacted on the delivery of health-promotion activities within the Chinese community. Conclusion: The findings led to a series of seven steps as guidelines to engage the Chinese community to prevent and/or reduce injuries towards improving the quality of their lives. The underlying principles of the guidelines helped in the development of a community engagement approach for Chinese communities in Auckland, New Zealand.

Aim The aim of this paper is to provide a discussion on how the public health policy process can be influenced by both civil society groups and by public health practitioners.