Local perspectives on empowerment and responsibility in the new public health

The new public health is compelling because it uses the discourse of empowerment and participatory methodologies to promote health citizenship, but it has also been criticized for reinforcing an individual locus of responsibility while overlooking the role of the state in providing healthy environments. Thus far, much of the discourse surrounding the new public has tended to be the purview of public health experts and professionals. This study uses the interpretive approach to health communication to understand how debates regarding rights and responsibilities inherent in the new public health are appropriated by six employees at two community-based organizations that provide support to HIV-positive (HIV+) people in South India. I ask the question: How is the term "empowerment" understood by these individuals? Three primary dimensions of power emerged from my study: power from self-acceptance and inner strength, power from family and society, and power from self-reliance. In talking about empowerment, participants implicitly and explicitly made assumptions about who was responsible for health and health care; they argued that the individual and community were responsible for health, and reframed "rights" in terms of duty and citizenship. The discussion speculates on reasons for the heightened sense of personal responsibility, as well as implications it has for community health practice.