ControlHealth, the evidence and place based action
The impact of control for health
Much of the existing research has looked at the ways in which control has a bearing on individuals’ health (personal control). Research conducted in the paid work environment found, for example, that employees who experienced high job demands but low control in their work were at higher risk of stress. Such work related stress has been linked to physical health conditions such as coronary heart disease.
When it comes to control at a community or collective level, existing evidence and theory suggests that the greater the emphasis on giving communities more control over decisions that affect their lives, the more likely there are to be positive impacts on a range of outcomes. This includes service quality, social cohesion, socioeconomic circumstances, community empowerment and ultimately population health and health inequalities. Yet, surprisingly few studies have tested this link by assessing health outcomes. One exception is a major study of youth suicide conducted by researchers in British Columbia, as the box below describes.
Chandler and Lelonde investigated the link between collective control and suicides in First Nation young people in British Columbia. The studies looked at the rates of suicide among First Nation communities, and identified a set of culturally derived factors, which were protective against suicide. These included where communities were successful in re-establishing local political control over a host of services and rights of self governance (see Box 1 Cultural Continuity). Communities with any one of these factors had lower suicide rates than communities with none of these factors.
Addressing the evidence gap
To inform future decision-making, evidence is needed on effective ways to enable individuals and communities to gain greater control in ways that enhances health and reduces inequalities.
In this video, Margaret Whitehead and Jennie Popay discuss some of the challenges of evaluating complex community programmes rolled out in a diverse range of geographical settings.