Health Education Research, Vol. 17, No. 6, 775-776,
December 2002
© 2002 Oxford University Press
BOOK REVIEW |
Evaluation in Health Promotion: Principles and Perspectives
Irving Rootman, Michael Goodstadt, Brian Hyndman, David V. McQueen, Louise Potvin, Jane Springett and Erio Ziglio (eds) WHO Regional Office for Europe, Copenhagen (2001) 533 pp. ISBN 92-890-1359-1
HER UK Editor
This compendious work on evaluation consists of 23 chapters incorporating contributions from 52 internationally recognized authors in the field of evaluation and health promotion. Reading it is a not insubstantial task—but certainly worth the effort.
The book, like Gaul, is divided into three main parts. One of these, labelled ‘Perspectives’, consists of eight chapters that offer a variety of valuable insights into key issues that are at the heart of contemporary debate about evaluating health promotion initiatives. The authors clearly demonstrate one of the main reasons why the ‘gold standard’, randomized controlled trial is entirely inappropriate to evaluating typical health promotion programmes, i.e. the fact that they are ‘...complex packages of multilevel, multistrategy population-based approaches that focus on a broad range of environmental changes’ and are frequently concerned with ‘horizontal programmes’ that seek to achieve macro level social and economic change rather than specific ‘health’ outcomes. The nature of evidence is debated and, not surprisingly, epistemological issues are extensively explored. Again, unsurprisingly, interpretive paradigms are given pride of place along with qualitative methodology. Holistic and ‘positive’ dimensions of health, together with reviews of assessing ‘quality of life’, are also well represented in the perspectives. A chapter on health economics almost seems out of place but QALYs and DALYs are discussed together with some of the important issues associated with economic analysis and such problematic notions as the costs and benefits of health promotion programmes (a matter of considerable current interest considering the angst associated with the prospect of financing people’s increasing longevity!). An analysis of quality assurance is included in this section which ends with a consideration of the links between research and policy development—and which reminds us that policy contributing to health originates largely outside the formal health sector.
A second major section of the book concentrates on ‘Settings’. Apart from a detailed review of evaluating the now well-established ‘settings approach’ to hospital, workplace and school, community-wide initiatives are thoroughly explored. In addition to presenting ‘logic frame’ models of systematic planning, matters of a philosophical and ideological nature are discussed together with practical and political issues, and recommendations for practitioners. These include, for example, guidelines for participatory evaluation—a sine qua non for health promotion’s emancipatory mission!
Eight chapters address evaluation issues in the third major section of the book: ‘Policies and Systems’. Apart from providing an authoritative statement about WHO’s new service to its European member states (appraisal of investment for health), remaining chapters discuss principles and practice of evaluating ‘healthy public policy’ both generally and specifically. Regional and community levels are analysed; policy aspects of a Heart Health Initiative are considered; issues in evaluating mass media campaigns are examined.
Chapters are also included on such matters currently in vogue as ‘social capital’ and the important evaluation strategy of ‘health impact assessment’. One author makes the telling point that (as with most other aspects of assembling evidence for the effectiveness and efficiency of health promotion) evaluating policy is essentially concerned with tracking moving targets!
It is, of course, not possible to provide a comprehensive and detailed review of a book of this substance. Suffice it to say, it offers a thoughtful, and, above all, expert and authoritative account of key issues—including epistemological and methodological; political; technical matters. Its raison d’être is to provide a thorough account of these various ‘philosophical’ and practical domains. Its ‘guiding principles’ explicitly state the ideological orientation of health promotion, and, in this way, they provide a blueprint for the kinds of evaluation that are appropriate and ethical. As will be apparent, the principles reflect WHO’s various pronunciamentos over recent years from the Ottawa Charter onwards. They are:
- Fundamental concern with equity and social justice.
- Empowerment—programmes should enable people to gain control over the various individual, socioeconomic, cultural and environmental determinants of their lives and their health.
- Participation—at all levels.
- Holistic—mental, physical and social dimensions of health and living.
- Intersectoral—collaborative working.
- Sustainable.
- Multistrategy—policy development, organizational change, community development, legislation, advocacy, education and communication.
Accordingly, following the dictates of ‘authenticity’ and ‘catalytic validity’, the process and goals of evaluation should not only be appropriate to the complexity of the task, they should actively contribute wherever possible to the values underpinning them and their ideological purpose.
What are the book’s limitations? The limitations are few. However, although three separate sections have been identified, there are areas of overlap, and a certain lack of coherence and logical progression. What else might be expected with 52 authors and 23 chapters! Accordingly, this is a book that is best used as a reader. My regret, therefore, is the lack of an index, which would have enabled readers to create their own coherence by pursuing topic references in different chapters.
The only other limitation—identified by the editors—has to do with what the book is not about. First of all, it does not purport to be a text on research methodology: those requiring such a cookbook will need to look elsewhere. Secondly, in the editors’ words, the book ‘...does not consider...issues in the evaluation of individual behaviour change. [Neither does it] emphasize the evaluation of traditional work for disease prevention’.
Quite rightly, the book adopts a broad-based approach to the definition of evidence and deviates from what Parlett and Hamilton described as the ‘agricultural–botanical paradigm’. Indeed, the Working Group’s advice to policy makers famously declared that ‘...the use of randomized controlled trials to evaluate health promotion initiatives is inappropriate, misleading and unnecessarily expensive in most cases’.
I am happy to commend this book to readers: I shall certainly use it!
Notes
If you wish to review any books on behalf of the journal and/or to become an HER reviewer, suggest or send potential books for review please contact: John Kenneth Davies, Book Reviews Editor, Health Education Research, c/o Faculty of Health, University of Brighton, Falmer, Brighton BN1 9PH, UK. Tel: (+44) 1273 643476; Fax: (+44) (0) 1273 643324; E-mail: J.K.Davies{at}brighton.ac.uk
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