The ethics of Community Empowerment: tensions in health promotion theory and practice.

The concepts of community participation, empowerment and capacity building are central tenets of contemporary health promotion theory. They reflect the view that health and well-being are shaped by a wide range of social, economic, political and organisational forces that are outside the control of individuals.Despite its theoretical appeal, the practice of Community Empowerment is ethically contentious and can produce ethical dilemmas for health promotion practitioners. In this paper we relate these dilemmas to theoretical considerations, and argue that the empowerment of communities should be understood as a means rather than an end . This leads us to argue for the adoption of what we call a Reflective Equilibrium Community Empowerment approach, which draws on both "top-down" and "bottom-up" methods to help resolve the ethical tensions in health promotion programmes.