Health Education Research Vol.20 no.3, © Oxford University Press 2004; All rights reserved
Health Promotion: Planning and Strategies
Keith Tones and Jackie GreenSage, London, 2004
376 pp, ISBN 0-7619-7449-0
Keith Tones and Jackie Green's book provides an essential and timely contribution to the evolving literature on health promotion theory and practice. The book is important as it seeks to provide a ‘distinctive voice for health promotion’ at a time when conceptual, policy and organizational changes in some countries are resulting in numerous interpretations and often misconceptions regarding its definition and practice.
The strengths of the book lie in its comprehensive and logical coverage of the core issues in health promotion theory and practice, supported by careful and consistent referencing. The latter establishes it as an important and up-to-date resource tool for students and experienced professionals. It sets out by highlighting the need to understand health ideologies and discourses, and focuses on the key process of empowerment. It covers approaches to assess health status and its determinants. Tones' Health Action Model is revisited, and his long-standing interpretation of health promotion as the synergistic interaction between health education and healthy public policy is described and discussed in depth. These two phenomena lie at the heart of the book and Tones and Green's interpretation of health promotion. They clearly see power and politics as centrally important. Following this route they argue consistently throughout the book that the process of empowerment underpins their understanding of health promotion.
The challenge they see health promotion facing is how to operationalize health promotion at a practical level. They provide an excellent discussion of empowerment in relation to determinants of health actions, health promotion planning and healthy public policy. They also provide an excellent chapter on the latter.
Parts of the book cover well-trodden paths in rehearsing the health promotion discourse.
The authors provide an impressive analysis of the role of systematic programme planning as the key to effective health promotion practice.
Some of the other chapters of the book, although comprehensive in content, could have been strengthened by improving presentation, layout and style. For example, I am not sure why the chapter on Mass Communication is twinned with Community Action/Development. Beyond them being important tools for health promotion, their linkage is not clear and no rationale sufficiently provided. The same applies to the chapter on Settings and Methods, which again lacks a sufficient rationale, with various setting areas discussed together without any clear establishment of commonalities. This chapter then goes on to cover methods for facilitating learning with no links to the previous discussion of settings. The authors themselves though highlight the limitations of attempting to discuss all methods and strategies in health promotion interventions (‘a task of encyclopaedic proportions’) and they therefore attempt to draw out the key principles.
The Evaluation chapter covers many of the essential key issues, but I would have liked to have seen a stronger conclusion.
Although the authors provide a rather brief paragraph at the end of each chapter, they could have provided more substantive linkage sections between chapters, which would have strengthened the overall context and framework of the book by pulling together many of its essential arguments.
In many ways, in terms of ideology and values, research and practice, Tones and Green have succeeded in capturing the ‘distinctive voice’ of health promotion. They have also highlighted its weaknesses and limitations; in particular, are intervention programmes related specifically to health promotion or could they be seen as health improvement or public health programmes? Many limitations they argue are due to the lack of appropriate theoretical bases underpinning many health promotion programmes.
There are several contemporary issues in relation to the distinctive voice of health promotion which I would have liked to have seen included in the book. The effects of current policy and organizational changes in the British NHS and the omission of health promotion and health education as terms, with preference given to multidisciplinary public health and terms such as ‘health improvement’; the growth of interest in population health and its relationship to health promotion in Canada; discussion of health promotion as a discipline and as a profession; implications of the work in many countries on health promotion competencies in relation to workforce development and capacity building; and finally the role of academic health promotion in relation to these and related issues.
The major innovation in the book, which is in itself a reawakening, is that Tones and Green reappraise and reflect on a new role for health education as the central feature and distinctive voice of health promotion. They argue strongly for education having a key role in healthy public policy; influencing the conditions of learning; influencing policy makers, politicians and professionals, and by being overtly political, achieving social and political change. They leave specific mention and discussion of the ‘New Health Education’ until the final pages of the book and, in particular, its 2-page Epilogue. I would have liked to have seen a discussion of the future role of the new health education form a more substantive part of the book; in particular, to clarify its relationship to the future role and direction of health promotion.
This book forms a substantive and comprehensive resource, and I would strongly recommend it to policy makers, researchers and practitioners who are interested in the promotion of health. I would also recommend it as a seminal text for students specializing in health promotion and related areas. I will certainly be including it as required reading for my post-graduate students.
International Health Development, Research Centre Faculty of Health, University of Brighton, UK
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