INTRODUCTION TO HEALTH PROMOTION

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INTRODUCTION TO HEALTH PROMOTION Jennie
Naidoo Nick de Viggiani
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UNDERSTANDING HEALTH PROMOTION its contested
meaning its relationship to public
health underlying theories and approaches
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• KEY UNDERPINNING PRINCIPLES
• It has a multidisciplinary basis
• It is multi-sectoral (many actors / agents)
• It involves individual and collective effort
• It is value belief driven, in terms of
• What is perceived to be real or true
  (philosophical orientation)
• The limits to our knowledge / available evidence
• Ethical and Moral concerns / boundaries
• Tensions between different disciplines, interest
  groups, political persuasions, traditions

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• certainties perspective (fundamentalism /
  positivism)
• health is a positive value ( goodness, life,
  positive wellbeing)
• health promotion is underpinned by these core
  values of health
• the duty of professionals is to promote core
  values of health via their work
• the lay public needs support in deciding what is
  good for them

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• relativist perspective
• health is personal, subjective (in meaning)
  relative to context (space time)
• health knowledge is culturally derived (from
  beliefs, traditions, norms, etc.)
• health behaviour shares this cultural basis
• universal values about health can have little
  relevance, meaning or priority
• universalised health promotion can hold little
  value for communities
• Seedhouse (1997) Health Promotion philosophy,
  prejudice and practice.

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• Assumptions
• Health promotion leads unquestionably to health
  improvement.
• Health promoters have specialist health
  knowledge
  
• (based on their training or education).
• However
• The hard-line claim to know the nature of
  objective well-being is equivalent to the claim
  to know objectively correct ways of living.
  (Seedhouse 1997)
• The implicit assumption underlying health
  promotion is that it is a worthwhile activity
  that is in some way good for people. (Tones
  Tilford 2001)

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So perhaps the health risk agenda is
communicating underlying fundamentalist
values The highly publicized obesity debate
often focuses upon solutions to a
taken-for-granted problem (or apocalyptic
problem in the making) rather than questioning
the construction of fatness as a public health
problem. Monaghan (2005)
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• health some contested areas
• What are the known facts or truths about health,
  wellbeing, illness or disease?
• Can we truly understand peoples health or
  illness experiences?
• Do we really understand the essential nature of
  individuals or their identities?
• Do we classify, categorise and diagnose people
  appropriately?
• What constitutes good evidence or proof?
• What is the value and nature of communities,
  groups, societies, participation?
• What does health improvement mean?
• What do allied key concepts actually mean (e.g.
  equity, social justice, deprivation?)

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Healthism and EugenicsImre Loefler (2005) BMJ
331411Healthism resembles moral rearmament.
It wishes to change mankind by controlling
peoples lifestyles. As healthism gets
increasingly coercive, eugenic considerations may
crowd out reproductive choice.Versions of
healthism have surfaced before. Two examples are
Sparta and the Third Reich, both of which
practised genetic selection. In Sparta, if an
infant was considered to be defective it was
discarded taken to the mountain where hyenas
lurked. Under Hitler, genetic selection was
administered at many levels and according to
multiple criteria ...Contemporary healthism
employs eugenic manipulations of the Spartan
kind, except that selection and discarding do not
have to wait until birth. Prenatal genetic
selection has become an important branch of
healthcare Unlike Hitlers methods, the modern
approach includes screening for undesirable
genetic combinations, to be followed by
compulsory genetic counselling. Soon coercive
practices such as denying insurance to those
who do not comply will be introduced. People
will forfeit their reproductive rights if the
cost of letting them wantonly broadcast bad genes
will further burden health budgets. The logic of
healthism is likely to mean that the practice of
risk avoidance will begin before
conception.Liberals do not object to eugenic
manipulations as long as parental choice is
upheld. But it is unlikely that this notion can
hold out against the diktats of healthism, for
healthism is anti-liberal, anti-choice,
anti-risk, and, ultimately, anti-human one
cannot have a healthy society if people are
allowed to eat what they want, drink as much as
they like, smoke, engage themselves in risky
behaviour, and then produce children with bad
genes.
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HEALTH as a multidisciplinary (contested)
concept Biomedicine health as absence of
disease Humanism health as achieving personal
potential Human Social Ecology health as a
functioning system of relationships Holism hea
lth as wholeness (Neo) Marxism health as
product (commodification materialism)
Utopianism/Idealism health as an optimum
state Structural Functionalism health as
ability to adapt to the social system Feminism
health as empowerment or freedom from
oppression Disciplinary territories
psychology, education, medicine, psychiatry,
epidemiology, sociology, social policy, human
social geography, human social ecology, gender
studies feminism, etc.
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Definitions of Health WHO 1946 a state of
complete physical mental and social wellbeing and
not merely the absence of disease or
infirmity Dubos 1959 the concept of perfect
and positive health is a utopian creation of the
human mind. It cannot become reality because we
will never be so perfectly adapted to our
environments that our lives will not involve
struggles, failures and sufferings WHO 1984
the extent to which individuals or groups can
realise their aspirations, satisfy their needs
and change or cope with the environment
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a multidisciplinary perspective means there may
be more than one objective health of the
individual the group / community the
organisation / setting the society / nation
state the system / infrastructure the
physical environment the planet / biosphere
anthropocentric ecological
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Source Hancock T. Perkins F. (1985). The
Mandala of health a conceptual. model and
teaching tool. Health Education, 24, 8-10.
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Source Hancock, T. (1993). ' Health, human
development and the community ecosystem three
ecological models. Health Promotion
International, 8 (1), 41-47
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WHO 1999 environmental model of health The
new ecological public health has led to a focus
on settings as environments or habitats within
which people live and work. from vertical
thinking (individual, compartmentalised public
health problems) to horizontal thinking
(explicit links and interactions synergistic,
coordinated action on range of health
determinants).
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Swimming Upstream analogy (Irving Zola, cited
by McKinlay, J.B. "A case for refocusing
upstream The political economy of illness." In
Conrad and Kern, 2nd edition, 1986, The Sociology
of Health and Illness Critical Perspectives. pp.
484-498.) Metaphor for prevention illness
environmental pollution poverty inequality
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CORONARY HEART DISEASE
Physiological Risk Factors Raised
Cholesterol Hypertension Obesity Lifestyle Risk
Factors High Fat Diet Smoking Physical
Inactivity Socio-cultural Risk Factors Rituals Fam
ily/Peer Norms Religion Occupational
Factors Environmental Risk Factors Access to
Facilities/Services Employment, Education,
Income Hazards, Pollution, etc.
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Policies, Principles Approaches of Health
Promotion
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HEALTH PROMOTION POLICY World Health
Organisation 1977 Alma Ata Declaration Primary
Care 1978 Health For All 2000 Determinants of
Health 1986 Ottawa Conference Empowerment
Participation 1988 Adelaide Conference Healthy
Public Policies 1991 Sundsvall
Conference Supportive Environments 1997 Jakarta
Conference Social Responsibility 2000 Mexico
City Conference Inequality 2005 Bangkok
Conference Globalization UK Department of
Health 1980 The Black Report Inequalities in
Health 1987 The Griffiths Report NHS Internal
Market 1992 The Health of the Nation Lifestyle
Approach (individualism) 1999 Saving Lives
OHN Widening Health Opportunity 2000 The
Acheson Report Health Inequalities 2001 Tackling
Inequalities 2004 Choosing Health Lifestyle
Approach
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enabling people to increase control over and
improve their health
WHO principles Empowerment Participation Enablem
ent Mediation Advocacy Healthy Settings Social
Responsibility
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to conclude

• Health ( health promotion) are contested
  concepts.
• HP is multi / inter-disciplinary multi /
  inter-sectoral.
• It engages at different levels (micro-macro /
  individual-system)
• Core principles arise from WHO (liberal
  democratic values).
• Health promotion is underpinned by values.