Section 4: Media Literacy and Health

Empowerment Education
The Link Between Media Literacy and Health Promotion

LYNDA J. BERGSMA
University of Arizona

Within a framework of media literacy and health promotion for youth, this article reviews the
literature establishing that population health and well-being are intimately tied to, and con-
sequences of, power and powerlessness, and that empowerment education is an effective
model for achieving personal and social change. A comparison of the components of the
empowerment education constructs of Freire, public health, and media literacy establishes
the pedagogical links between public health and media literacy. An examination of the
community-based and universalistic foundations of the media literacy and public health
movements, and the dominant systems that oppose them, suggests strength in working
together.

Keywords: empowerment education; media literacy; public health

POWERLESSNESS AND POOR HEALTH

Abundant research evidence demonstrates that powerlessness is a significant

health risk factor and conversely, opportunities to experience power and control
in one’s life contribute to health and wellness. Some of the research confirms
that actual and perceived control enhance quality of life for disadvantaged popu-
lations that lack power, as well as for more advantaged populations (Nelson,
Lord, & Ochocka, 2001; Spacapan & Thompson’s study as cited in
Prilleltensky, Nelson, & Peirson, 2001). Powerlessness has emerged as a key
risk factor for disease, emphasizing the role of the social environment in deter-
mining the health of individuals (Syme, 1988; Wallerstein, 1992). Research
with minorities confirms that numerous stressful life events are associated with
their diminished health and social status and conditions of oppression (Moane,
1999). The literature provides many examples of the correlation between con-
trol and mental health (Ryan & Deci, 2000; Spacapan & Thompson’s study as
cited in Prilleltensky et al., 2001), including loss of power as a causal factor in
AMERICAN BEHAVIORAL SCIENTIST, Vol. 48 No. 2, October 2004 152-164
DOI: 10.1177/0002764204267259
© 2004 Sage Publications

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 Bergsma / EMPOWERMENT EDUCATION 153

the onset of depression (Seeman & Seeman, 1983; Zimmerman & Rappaport,
1988). Social epidemiological research in the workplace has identified lack of
control, such as having low decision authority with high job demands, as a risk
factor for coronary heart disease (Karasek, Baker, Marxer, Ahlbom, & Theorell,
1981; Marmot & Theorell, 1988). All of this literature contributes to our under-
standing of how population health and well-being are intimately tied to, and are
consequences of, power and powerlessness.
A substantial body of health education and prevention literature makes the
case that empowerment education is an effective health education and preven-
tion model for personal and social change (Kendall, 1998; Wallerstein &
Bernstein, 1994), particularly with marginalized, disadvantaged, and poten-
tially vulnerable groups (Minkler & Cox, 1980; Wallerstein, 1992, 2002;
Wallerstein & Bernstein, 1988) such as the mentally ill (Fitzsimons & Fuller,
2002; Nelson et al., 2001), aboriginal peoples (Tsey, Whiteside, Deemal, & Gib-
son, 2003), ethnic and other minority groups (Braithwaite & Lythcott, 1989;
Crossley, 2001), women (Kar & Pascual, 1999; Stein, 1997), and children and
adolescents (Prilleltensky et al., 2001; Rissel et al., 1996; Ungar & Teram,
2000). Some initiatives to empower children and youth to take control of some
aspects of their life in general, and some determinants of health in particular,
have shown positive effects (Igoe, 1991; Wallerstein, 2002).
Within all this literature, however, there is a relative paucity of explicit mate-
rial dealing with the problematic effects of powerlessness on children’s lives.
What does exist also tends to be adultcentric in that most of it interprets chil-
dren’s realities from an adult point of view, and psychocentric in that most of it
focuses on the emotional and cognitive dimensions of powerlessness to the rela-
tive neglect of social and political power (Prilleltensky et al., 2001).

INQUIRY AND ACTION

Similarly, the literature on media literacy and prevention focuses primarily

on teaching children and adolescents critical-thinking skills that are designed to
ameliorate individual behavior with regard to wise media use and reduced health
risk taking (Austin & Johnson, 1997; Bergsma, 2002; Bergsma & Ingram, 2001;
Wade, Davidson, & O’Dea, 2003). The construct of empowerment education in
media literacy and health promotion interventions deals with building individ-
ual resistance to unhealthy messages through inculcating critical-thinking skills
(inquiry) and seems to have missed the larger focus of empowerment education
on social change (action). In health education and promotion, program planners
and evaluators are often looking for the quick fix, prompted by the quick-fix ide-
ology of the medical model and the lack of funding for long-term approaches
that focus upstream, examine root causes, and provide ample time for the learn-
ing and practice of media literacy skills and action strategies that can ultimately
change the media. Media literacy and health promotion programs that truly
154 AMERICAN BEHAVIORAL SCIENTIST

embrace the construct of empowerment must include teaching activities for

achieving systemic social change. Children and youth can be powerful advo-
cates for social change through use of the media, as evidenced by the impact of
the American Legacy Foundation’s Truth Campaign, which uses youth to unveil
the deceitful tactics of the tobacco industry. Helping youth to channel their natu-
ral developmental rebellion, their fresh perspective, and their unique energy and
creativity toward accomplishing social change, based on youth-identified social
concerns, should be a primary focus of both media literacy and health promotion
programs. This would foster the powerful attributes of social competence,
problem-solving skills, autonomy, and sense of purpose that are in and of
themselves all protective factors that foster resiliency in youth (Benard, 1991).
Empowerment is often defined by its absence, leading to victim blaming,
learned helplessness, powerlessness, and alienation. This article defines em-
powerment as a process by which people gain control over their lives, demo-
cratic participation in the life of their community (Rappaport, 1987), and a
critical understanding of their environment (Zimmerman, Israel, Schulz, &
Checkoway, 1992). To study the consequences of the empowering process, it is
helpful to operationalize empowerment in terms of outcomes. Empowered out-
comes for individuals might include perceived control and resource mobiliza-
tion skills (Perkins & Zimmerman, 1995). In the area of health, we think in
terms of wellness versus illness, competence versus deficits, and power to take
action versus powerlessness. Empowerment research focuses on identify-
ing assets and capabilities, instead of cataloging risk factors, and on exploring
environmental influences of social problems instead of blaming victims.
Empowerment-oriented interventions focus on enhancing wellness as well as
improving problems, providing opportunities for participants to develop knowl-
edge and skills, and engaging professionals as collaborators instead of authori-
tative experts.

FREIRE’S EMPOWERING EDUCATION THEORY

Brazilian educator Paulo Freire (1970, 1973) developed a framework for

empowerment education that involves people in efforts to identify their own
issues, to critically assess the social and historical roots of these issues, to envi-
sion individual health and a healthier society, and to develop social action strate-
gies to overcome challenges and barriers in achieving their goals. McKnight
(1999) pointed out that real power is possessed by those who define the prob-
lem. Freire’s empowerment education process starts with the population to be
educated’s defining their own problems or issues and progresses through a pro-
cess by which they develop new beliefs in their ability to influence their personal
and social realms. Empowerment education, as Freire conceptualized it, in-
volves much more than simply improving self-esteem or self-efficacy or other
 Bergsma / EMPOWERMENT EDUCATION 155

behaviors that are independent from social change. The targets of Freire’s
empowerment education are individual, group, and systemic change.

EMPOWERMENT IN PUBLIC HEALTH

Empowerment education in health promotion “encompasses prevention as

well as other goals of community connectedness, self-development, improved
quality of life, and social justice” (Wallerstein & Bernstein, 1988, p. 380).
Rappaport (1987), who has been a leader in the conceptualization, research, and
practical application of empowerment, defined empowerment as a process by
which people, organizations, and communities gain mastery over issues of con-
cern to them. Although empowerment is a multilevel construct, Zimmerman
(1995) focused on psychological empowerment, which refers to empowerment
at the individual level of analysis, having to do with both thought and behav-
ior—the primary focal points of media literacy. Although public health is also
interested in community and organizational empowerment, it is at the level of
psychological empowerment where the links between public health and media
literacy can be found. The construct of psychological empowerment “integrates
perceptions of personal control, a proactive approach to life, and a critical
understanding of the sociopolitical environment” (Zimmerman, 1995, p. 581).
The result of psychological empowerment is social change, although such
change may take many forms and may not necessarily result in power struggle.
Participatory action research is an approach in public health that exemplifies
the empowering process (Chesler, 1991; Rappaport, 1990; Whyte, 1991; Yeich
& Levine, 1992), in which community participants become coequals in program
development and evaluation (Zimmerman, 1995). A definition of community is
needed here. For most public health issues, community is not simply a geo-
graphic construct but also refers to a group of people who share a sense of social
identity, common norms, values, goals, and institutions. To be considered a
community, a group must be characterized by the following elements:

1) membership—a sense of identity and belonging; 2) common symbol systems—

similar language, rituals, and ceremonies; 3) shared values and norms; 4) mutual
influence—community members have influence and are influenced by each
other; 5) shared needs and commitment to meeting them; 6) shared emotional con-
nection—members share common history, experiences, and mutual support.
(Israel, Checkoway, Schulz, & Zimmerman, 1994, p. 151)

Participatory action research provides an opportunity for community partici-

pants to work together to define and solve problems, develop necessary skills,
critically analyze their sociopolitical environment, and create mutual support
systems. Participatory action research is designed to help community partici-
pants develop the knowledge they need to improve their quality of life and
156 AMERICAN BEHAVIORAL SCIENTIST

influence relevant policy, as well as build competent communities to effect

social change. Sometimes a consciousness-raising experience may need to take
place before participants can become empowered, such as a media literacy edu-
cation intervention. Participatory action research not only is an example of an
empowering process but also provides a mechanism for developing outcome
measures that are relevant and appropriate for the specified community popula-
tion and context of the intervention (Zimmerman, 1995). In the framework of
this article, the proposed community population is youth and the intervention
context is one of media literacy and prevention education.

EMPOWERMENT IN MEDIA LITERACY

Often when dealing with media issues or topics, we can sometimes be intimidated
by the complex technological and institutional structures that dominate our media
culture. We can feel powerless against the psychological sophistication of adver-
tising messages and pop culture icons.
—Center for Media Literacy (2003, p. 19)

Elizabeth Thoman, pioneer media literacy educator and founder of the Cen-
ter for Media Literacy, advocates a philosophy of empowerment through media
literacy education based on the work of Freire (see her article with Tessa Jolls,
which appears in Part I of this double issue). At the heart of this philosophy is an
inquiry process developed into a construct called the empowerment education
spiral and that consists of four components—awareness, analysis, reflection,
and action—all designed to enable students to fully comprehend and act on the
content, form, purpose, and effects of media messages. The Alliance for a Media
Literate America (2001) said, “Being literate in a media age requires critical
thinking skills which empower us as we make decisions, whether in the class-
room, the living room, the workplace, the board room or the voting booth” (A
Broader Definition sect., para. 3).
From the comparison in Table 1 of the components of the empowerment edu-
cation constructs of Freire (1970, 1973), public health, and media literacy, it is
evident that the pedagogical links between public health and media literacy can
be traced to Freire’s empowerment education model.
The media literacy education movement and the public health movement in
the United States have much in common. Although the public health movement
is considerably older than the media literacy movement, there is a great deal to
be learned and gained from their commonalities. The remainder of this article
examines three questions:
 TABLE 1: Components of the Empowerment Education Constructs of Paulo Freire, Public Health, and Media Literacy

Freire Public Health Media Literacy

People (not professionals) define problems
Critically assess social roots (co-learning process
among people and professionals)
Envision improvement
Develop social actions
Awareness and problem definition
by people (not professionals)
Critically analyze sociopolitical environment
(co-learning process among people and
professionals)
Improve quality of life
Influence policy and effect social change
Awareness by students (not imposed by teachers)
Critical analysis (co-learning process among students
and teachers)
Reflection on other/better ways
Action (personal or collective) through media
creation and advocacy

157
158 AMERICAN BEHAVIORAL SCIENTIST

1. What are the primary common links between the two movements beyond the
foundation of empowerment education documented above?
2. How are both movements severely diminished by dominant systems?
3. How can they work together to achieve synergy?

OTHER COMMON LINKS

If we consider that a principal focus of both media literacy and public health
is to foster social criticism and social action among a community of people, then
both can be classified as community based, whether a community of teenagers,
public health professionals, media educators, language arts teachers, parents, or
prevention specialists.
Both media literacy and public health use a “universalistic” as opposed to
“exceptionalistic” approach (Ryan, 1976), asserting that problems lie in the sys-
tem rather than individuals. Public health advocates recognize that although it is
reflected in the problems of individuals, poor health is not caused by them. Poor
health is a systemic problem caused by differential access to health care. Simi-
larly, media literacy advocates argue that the inability to understand our media
culture, to critically analyze the media, and to gain access to the media consti-
tutes a systemic problem that although reflected in individuals, is not caused by
them. Because both poor health and media illiteracy are systemic problems, the
solutions must also be systemic; they are economic, political, and social in
scope; and they have regional, national, and global dimensions (Bergsma, 1999).

SHARED CHALLENGES

Both the media literacy and public health movements face powerful forces
that oppose systemic reform. In public health, there is constant tension with the
dominant system of the medical model that focuses on individual disease or
deficiency. The medical model employs a simple triadic credo: (a) the problem
is you, (b) the resolution of your problem is my professional control, and (c) my
control is your help. McKnight (1995) claimed that the essence of the medical
model is “its capacity to hide control behind the magic cloak of therapeutic
help” and that the “power of this mystification is so great that the therapeutic
ideology is being adopted and adapted by other interests that recognize that their
control mechanisms are dangerously overt. Thus, medicine is the paradigm for
modernized domination” (p. 61).
Media literacy is in conflict with two powerful systems: the media and educa-
tion. The focus of the U.S. media is to make money through advertising
designed to produce consumers. To do this, the function of advertising has
become the production of discontent in human beings, according to sociologist
Bernard McGrane (see Boihem & Emmanouilides, 1997). Advertising is design-
 Bergsma / EMPOWERMENT EDUCATION 159

ed to generate endless self-criticism, anxieties, and doubts and then to offer the
entire world of consumer goods as salvation (Boihem & Emmanouilides, 1997).
The focus of our educational system is what Freire (1970) called the “bank-
ing” concept of education, in which the teacher’s task is to fill the students with
predetermined sets of knowledge, none of which are necessarily identified by
the students themselves. From Freire’s work come the following critical ques-
tions: Who does education serve and for what purpose? and Does it serve to
socialize students to be objects and accept their limited roles within the status
quo (Bergsma, 1999)? Gatto (2003) pointed out that our educational system is
based on a 19th-century Prussian model and is “deliberately designed to pro-
duce mediocre intellects, to hamstring the inner life, to deny students apprecia-
ble leadership skills, and to ensure docile and incomplete citizens—all in order
to render the populace ‘manageable’” (p. 36). Gatto suggested that men such as
George Peabody, who funded the cause of mandatory schooling throughout the
South, understood that this system was “useful in creating not only a harmless
electorate and a servile labor force, but also a virtual herd of mindless consum-
ers” (p. 37). Finally, Gatto asserted that the actual purpose of education is the
adjustive or adaptive function designed to establish fixed habits of reaction to
authority, which precludes critical judgment completely.
All three of these social systems—medical, media, and education—are
antagonistic to critical thinking and collective action, two essentials of both
media literacy education and public health. Indeed, the interests of the medical,
media, and educational establishments lie not in changing the systems but in
controlling individuals in the ways necessary to adapt them to the systems,
resulting in poor health, rampant consumerism, and cultural illiteracy
(Bergsma, 1999).
Both the media literacy education and public health movements work to
develop critical consciousness to create a community of individuals who can be
transformers of their world. As such, both movements are subversive activities
from the standpoint of the dominant systems, and medicine, media, and educa-
tion react almost instinctively against stimulating critical thinking.
The tools of the medical, media, and educational systems are primarily hier-
archical, designed to work from the top down. They allow a few people to con-
trol many other people to produce standardized outcomes. Because these sys-
tems use sophisticated technology and complex professional languages, only
experts within the systems have the necessary knowledge to define the ques-
tions. All others are disenfranchised. The critical disabling consequence of this
professional coding is its impact on citizen capacities to deal with cause and
effect. If one cannot understand the question or the answer—the need or the
remedy—one exists at the mercy of expert systems. Instead of the world being a
place where one does or acts with others, it is a mysterious place beyond one’s
comprehension or control (McKnight, 1995).
160 AMERICAN BEHAVIORAL SCIENTIST

TOWARD SYNERGISTIC COLLABORATION

Unlike these systems, the community-based, empowering strategies of the

media literacy and public health movements do not depend on people bending
their uniqueness to a professional vision in exchange for money and security.
The tools of the media literacy and public health movements are designed to
build on the assets of a community of citizens to enable them to realize their
power as free individuals who can join together in defining the questions and
expressing and achieving their creative and common visions.
Obviously, the tools of the system are antagonistic to the tools of the commu-
nity. In fact, the work of Ivan Illich (1976) and McKnight (1995) demonstrate
that the weakness of community tools is directly attributable to the increasing
power of system tools. McKnight (1999) suggested this constitutes a paradox or
zero-sum game: “As control magnifies, consent fades. As standardization is
implemented, creativity disappears. As consumers and clients multiply, citizens
lose power” (p. S14).
Just as obviously, both media literacy and public health face a long, uphill
battle to achieve expanded recognition and influence in the fields of education,
media, and health care. Perhaps because of this and their shared goals of devel-
oping the critical consciousness of community, there appears to be a natural
partnership that will, it is hoped, result in synergism. The leadership of both
movements must establish new paradigms that invert the system models, direct
the focus to capacities rather than needs and deficiencies, and teach the skills of
critical thinking and collective action.
There are no easy tricks or technical gimmicks that professionals in media lit-
eracy and public health can use to overcome the limits of the dominant system
tools. There are, however, some hopeful experiments and initiatives in which
professionals have helped to enhance the power of communities. Analysis of
some of them reveals that they reflect at least four important values of a new
breed of modest professionals and teachers who are interested in promoting
social change.

1. They focus on the idea that community members/students are skilled and capable.
2. They have a deep respect for the capacities and wisdom of the people they are
working with. They trust that the people can do it; they do not need to do it for
them.
3. They understand that access to information will enable community members/
students to analyze and solve problems. They do not provide the answers, but they
provide understandable information that empowers members to develop and
implement solutions.
4. They are not trying to gain influence for themselves. Instead, they strengthen the
community by asking how the system might enhance the actions of community
members/students.
 Bergsma / EMPOWERMENT EDUCATION 161

SUMMARY

Within a framework of media literacy and health promotion for youth, this
article draws on literature in the fields of empowerment, public health, media lit-
eracy, and education, as well as the author’s extensive intervention, evaluation,
and research experience with media literacy and health promotion/prevention
programs for youth communities, to present an analysis of why media literacy is
a potent health promotion and prevention strategy. An extensive review of the
literature demonstrates that powerlessness is linked to poor health outcomes. An
exposition of Freire’s (1970, 1973) empowering education theory establishes it
as the linking foundation for health promotion and media literacy, with a
reminder that sociopolitical action is an essential component of both. An analy-
sis and comparison of the sociopolitical systemic challenges that confront
media literacy and public health in the United States suggests the need for public
health and media literacy advocates to work together to achieve empowerment
education.
The timing may be right for such a collaboration. A recent groundbreaking
Institute of Medicine report (Gebbie, Rosenstock, & Hernandez, 2002) empha-
sized the importance of taking an ecological approach to public health and pre-
vention. This approach is designed to go beyond the risk-factor approach to
social and behavioral analysis, which has dominated the field in recent decades.
Instead, this approach focuses on changing the social conditions underlying
health through such activities as community-based participatory research, in
which communities work with professionals to define issues, frame research
questions, gather and analyze data, determine solutions to problems, and act to
achieve change. This emergent paradigm in public health should open the door
to increased interest in and receptivity to innovative strategies, such as media lit-
eracy, for achieving behavioral and social change and should pave the way for
strong, collaborative empowerment education efforts that will result in healthier
citizens able to think critically and act collectively.

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164 AMERICAN BEHAVIORAL SCIENTIST

LYNDA J. BERGSMA is an assistant professor in the Mel and Enid Zuckerman Arizona
College of Public Health at the University of Arizona, associate director of the Rural Health
Office, and director of the Media Wise Initiative, which she established in 1992. She com-
bines her extensive background in mass communications, public health, education, and soci-
ology to plan and implement programs, develop curricula, provide training and consulting
services, and conduct research on the impact of our media culture on public health issues and
on media literacy as a critical prevention strategy. She is a founding board member and pres-
ident of the Alliance for a Media Literate America.