Exploring the effects of government funding on community-based organizations: 'top-down' or 'bottom-up' approaches to health promotion?

Community-based organizations hold an increasingly central role in the representation and advocacy of marginalized groups and individuals. In these capacities, such organizations make significant contributions to the areas of health and health services. In particular, they are considered well-positioned to operationalize 'bottom-up' approaches to health promotion. In this article we use a case study to illuminate unforeseen consequences of government funding of community-based organizations involved in health promotion and health service work. Previous research has found that many health promotion practitioners are engaged in a shift towards 'bottom-up' approaches to health promotion (1). In contrast, our findings suggest that due to government funding, those best positioned to promote community participation and empowerment may be experiencing a converse shift away from 'bottom-up' approaches.