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Reduce Differences in Health Status Build Healthy Public Policy Strengthen Community and Personal Action
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Empowerment in the Context of Poverty: Low-income Mothers in Saskatoon Kathryn Green, Department of Community Health and Epidemiology, University of Saskatchewan, Prairie Women’s Health Centre of Excellence
Power or control over the factors that shape one’s life is increasingly recognized as a fundamental determinant of health. In fact, health promotion is commonly defined as "the process of enabling people to increase control over the determinants of health and thereby improve their health."¹ However, health promotion programs for low-income mothers tend to focus on skill development in areas such as parenting and cooking. While important, these programs do not address the more fundamental determinants of health that are found in the social, economic and physical environment, nor do they address the determinant of power or control. Developing skills to not only cope with one’s environment, but also work collectively to change it, is an essential aspect of women’s empowerment. In addition, research has shown that support from others—practical and moral, as well as mentoring—is critical in expanding empowerment.² Participation in activities, groups or social actions are key processes. A project that brought together low-income mothers of preschool children in Saskatoon facilitated a process to support women who urgently wanted to move beyond coping with the conditions that affected their families’ health to changing those conditions. In May 2000, two groups of low-income mothers who had previously taken part in skill-building programs began meeting with two facilitators. The participants ranged in age from the early twenties to the late thirties. Most had two or three children. About two-thirds of the women were single parents; about half were members of First Nations. In weekly meetings the women talked about their communities and the changes they would like to see to make the community and its members healthier. In describing these changes, women spoke of having more control over their communities, including greater safety, adequate incomes and affordable housing. In order to express their vision of health, they took photos of their communities and created two large murals depicting community influences on health that they presented to invited guests. Onsite childcare and transportation were provided at each meeting and were critical to enabling participation. One participant said, "Everything we did in the group was beneficial; it was a stress-reliever to have someone hear my concerns, to feel understood." Another woman said, "When I first started, I didn’t really know what we were going to accomplish but I knew I needed the support." After creating the murals, the women decided to focus on poverty as a key determinant of the problems they were experiencing in their own lives and in their communities. In September 2000 when the women resumed meeting as a single group, they examined information about the prevalence and causes of poverty and shared their own stories about living in poverty. They found that the path that led to poverty usually, but not always, began with the woman’s own upbringing. The effects of poverty that the women described included physical and mental health consequences: an inadequate diet for themselves and their children, having few opportunities for respite as parents, and poor self-esteem. The social action that resulted from this examination was the creation of a book about poverty. The introduction to Telling It Like It Is: Realities of Parenting in Poverty states that, "Most Canadians agree it is a disgrace for one in five children to live in poverty. Something that may be overlooked is the fact that children are poor because their parents are poor. To end child poverty, we must address the bigger problem of parents in poverty."³ The book goes on to tell the stories of the women and provides facts about the causes and effects of poverty and parenting in poverty. Women said that they felt proud of the book, a tangible accomplishment, "something I can hold in my hand," as one woman put it. Another woman commented, "We did it together, from different walks of life, different ancestries or backgrounds…We can all pull together and accomplish things." One of the purposes of Telling It Like It Is is to dispel some of the myths and negative stereotypes about low-income mothers. The story about Tracy, for example, describes a stay-at-home mother of two children whose husband works full-time for minimum wage. "We do not live from paycheck to paycheck: we live from payday to three days after payday, at best," Tracy says. "Before we had children, my husband and I decided that when the time came, one of us would stay at home, at least until the children reached school age...I still believe we made the right decision, but it comes with a price... My husband has partial medical and dental benefits. My children are included in this plan, but I am not...I constantly worry about how I’m going to pay the bills, or what I am going to do if one of our kids gets sick and the prescription isn’t covered." A statistic from The Canadian Fact Book on Poverty that concludes this story states: "In Saskatchewan, over one-third (39%) of poor families are working poor." 4 While all of the participants in this project wanted to take more direct action—beyond the creation of the book—to help move their communities toward the vision of health they had created, they found this to be a challenge. Lack of awareness of opportunities, time, and skills was identified as a reason, as well as more complex psychological factors, including self-confidence, believing one has the right to ask for better treatment and that change is possible, and having a stable enough life to free up energy for social action. This study shows that opportunities should be provided for low-income mothers to develop not only personal coping skills, but also those required for social action. However, this should not preclude government’s obligation to raise minimum wage and social assistance rates to a liveable standard, or to help provide affordable, safe housing for all families. Nor should the onus to develop healthy communities be solely on those who are most disadvantaged. Individuals and groups with more resources and greater capacity for social action share this responsibility. For a copy of the full report, "’We Did It Together:’ Low-
Income Mothers Working Toward a Healthier Community"
and for information about the book, contact:
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