Health promotion : ideology, discipline, and specialism

241 Pages·2015·1.937 MB·English

by  Kemm, J. R

Health Promotion
Ideology, discipline,
and specialism

Health Promotion
Ideology, discipline,
and specialism
John Kemm
1
1
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Dedication
This book is dedicated to my dear wife who has lovingly cared
for me and the family for so many years.

Preface
At a time when health promotion and public health are undergoing greater
change in England than at any time since 1949 with responsibility for public
health shifting from the NHS to local authorities it is vital to think clearly about
health promotion.
This book takes the position that health promotion is an important and
worthwhile activity and that it could and should flourish once again. However
this cannot happen unless we understand and correct the weaknesses in health
promotion as it is currently practised in the UK. All too often health promotion
as a discipline has been seen as incoherent and lacking in rigor. The term health
promotion is used to describe an ideology (a collection of beliefs and values), an
academic discipline and a specialism or profession. The term can only be under-
stood when it is clear in what sense it is being used. The phrase ‘health promo-
tion, everybody’s business’ makes good sense when used to describe the
ideology of health promotion but no sense when used to describe the profession
of health promotion. The Ottawa charter on health promotion is an excellent
exposition of the ideology of health promotion but cannot be used as a job
description for health promotion specialists.
The relation between general public health specialists and health promotion
specialists has been the subject of much debate and relationships between the
two groups have not always been easy. This book argues that health promotion
is not the same as public health but is a vital part of it. Health promotion requires
a distinct set of knowledge and skills which are not possessed by most other
public health professionals.
The debate on the relative importance of environmental and lifestyle deter-
minants all too often sets them as alternatives whereas both are important. The
argument about the responsibility of state or individual for health has been
similarly unhelpful, creating a false dichotomy. There is a danger that complex
health promotion arguments are reduced to slogans such as ‘victim blaming’,
‘making healthy choices, easy choices’ and ‘fear messages don’t work’ when the
ideas behind these slogans need to be carefully analysed. Excessive concern for
autonomy has sometimes made health promoters nervous of persuasion and
promoting the value of health. At the same time they have often argued the need
for legislative measures (such as banning smoking in certain places or raising
the price of alcohol) while failing to acknowledge the paternalistic nature of
viii PREFACE
such measures and the conflict with autonomy. Principles of both paternalistic
beneficence and autonomy have a place in health promotion but the need for
giving priority to one principle has to be justified in each case. Health promo-
tion is often criticised as being ineffective but the discipline has made little con-
tribution to development of robust evaluation methods. Health education is an
important element within health promotion but one that is often downplayed
by health promoters. New technologies such as SMS and the internet have
opened up new channels for health education. For much of the public health
workforce engaged in health promotion their main role is health education.
This book will explore these difficulties and attempt to produce a coherent
theory of health promotion. All health promotion is context dependent and
different countries will need different approaches and strategies. Government
talks about the importance of healthy lifestyle but falsely implies that changing
lifestyle is easy. This book examines the strategies and legislation relevant to
health and health promotion produced by successive governments in UK
including the current coalition government and critically considers their effect.
Being based on UK and Ireland experience the book is most relevant to that
context but the problems addressed and the principles considered are relevant
to most countries.
The book is written in the belief that health promotion has a vital contribu-
tion to make to the health of populations. By thinking more clearly about the
theoretical and practical difficulties it has to face the profession of health pro-
motion can once again be useful. Although much of the book is directed at
public health and health promotion specialists it is also relevant to policy mak-
ers, nurses, doctors, teachers and many other professions. Health promotion is
indeed everybody’s business and the many people for whom health promotion
is part of their professional role should find the message of this book relevant to
them.
Contents
1 Introduction: mapping the issues 1
2 A history of health promotion 15
3 Evidence for health promotion 31
4 The determinants of health 41
5 Assessing need and planning 51
6 What governments can do 65
7 Supporting individual behaviour change 79
8 Health education 95
9 Ethics of health promotion 111
10 The wider public health workforce 121
11 Health promotion specialists 131
12 Settings 143
13 Community development 155
14 Social marketing 163
15 Changing lifestyles with health promotion: some examples 177
16 Evaluation 195
17 Partnership and influencing people and organizations 207
18 The way forward 215
Author index 219
Subject index 225