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Health promotion often comprises a tension between 'bottom-up' and 'top-down' programming. The former, more associated with concepts of community empowerment, begins on issues of concern to particular groups or individuals, and regards some improvement in their overall power or capacity as the important health outcome. The latter, more associated with disease prevention efforts, begins by seeking to involve particular groups or individuals in issues and activities largely defined by health agencies, and regards improvement in particular behaviours as the important health outcome. Community empowerment is viewed more instrumentally as a means to the end of health behaviour change. The tension between these two approaches is not unresolvable, but this requires a different orientation on the part of those responsible for planning more conventional, top-down programmes. This article presents a framework intended to assist planners, implementers and evaluators to systematically consider community empowerment goals within top-down health promotion programming. The framework 'unpacks' the tensions in health promotion at each stage of the more conventional, top-down programme cycle, by presenting a parallel 'empowerment' track. The framework also presents a new technology for the assessment and strategic planning of nine identified 'domains' that represent the organizational influences on the process of community empowerment. Future papers analyze the design of this assessment and planning methodology, and discuss the findings of its field-testing in rural communities in Fiji.

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In 1986, the Ottawa Charter identified community empowerment as being a central theme of health promotion discourse. Community empowerment became a topical issue in the health promotion literature soon afterwards, though its roots also come from earlier literature in community psychology, community organizing and liberation education. Subsequent international conferences to address health promotion in Sundsvall, Adelaide and Jakarta have acted to reinforce this concept. It is as relevant today as it was more than a decade ago. The literature surrounding health promotion has since moved onto other overlapping theoretical perspectives, such as community capacity and social capital. And yet the critical issue of making community empowerment operational in a programme context remains thorny and elusive. Community empowerment is still difficult to measure and implement as a part of health promotion. This article offers a fresh look at key theoretical and practical questions in regard to the measurement of community empowerment. The theoretical questions help to unpack community empowerment in an attempt to clarify how the application of this concept can be best approached. The practical questions address the basic design characteristics for methodologies to measure community empowerment within the context of international health promotion programming. The purpose of this article is to allow researchers and practitioners to address again the important issue of making community empowerment operational.

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