Health Education Research Advance Access originally published online on July 7, 2006
Health Education Research 2006 21(4):598-599; doi:10.1093/her/cyl011
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Health Promotion: Evidence and Experience
Health Promotion: Evidence and ExperienceKevin Lucas and Barbara Lloyd
Sage Publications, London (2005)
168 pp. ISBN 0-7619-4006-5
Professor of Health Promotion, Department of Education & Health Promotion, University of Bergen
This is a quite personal account of health promotion. It begins with four pages giving personal perspectives of the authors, a book feature that is rare. The personal view offered by Lloyd manages not to mention health promotion (!), while Lucas' reveals the book's theme better than the title does: He and Lloyd worked for years in different parts of the health and higher education establishments in England, yet they came to the same conclusion about the state of health promotion in England. The exposition of that point of view is the subject of the book.
So, what is the particular point of view of these authors? Summarising their eight chapters in my own words, their starting point is the assertion that the trend to increase emphasis on prevention in the English National Health Service (NHS) is good, but this trend should be extended by funding NHS programmes whose primary focus is improving people's lives in areas the people themselves identify. They point out that UK public health is dominated by medicine and non-medically trained public health practitioners are treated as inferiors to those with medical training. As long as this is the case, they state, the improvement mentioned above is unlikely to happen. The public health root of health promotion practice in the UK has resulted in meaningless and ineffective efforts to target whole risk groups for behaviour change, such as smokers. What is needed are approaches and programmes that respect how culture imbues behaviours such as smoking with meaning, programmes that focus on improving subjective health (well-being) and programmes that treat individuals as the unique beings they are. There is also a most interesting chapter that calls attention to the fact that the natural world around us and animals can have important salutary effects on health and it is time health promotion paid attention to the therapeutic potential in the environment.
Lucas and Lloyd use another chapter to posit and defend their position that the social cognition models used to develop interventions offer incomplete explanations of people's behaviour. We need to see people as wholes, they point out, not just in terms of their attitudes, beliefs and intentions. Programmes can be more successful if they view people as complex, affected by cognition, but also by emotions, life experience and culture. However public health is preoccupied with the idea of risk and uses epidemiological findings to pummel the public with behaviour change messages that do little good and quite a bit of harm. This preoccupation needs changing, the authors maintain. Health promotion agencies should provide social support to people in need and help foster social networks in communities. This arena is underdeveloped compared to intervention aimed at changing people's health related behaviours. Health promotion should not be guided by medical practitioners. Doctors should treat disease. What is needed, according to Lucas and Lloyd, is a change in leadership of public health that would permit, even encourage, the addition to public health of a new perspective, additive to disease prevention work. This new perspective will respect lay concepts of health and aim "to improve the quality of people's lives without necessarily adopting disease prevention as a primary aim." (pp. 136).
On many pages, the authors criticise the meaningfulness, effectiveness and ethicality of health promotion practice as it is the UK today. They call for a change in leadership that will remove medicine as the controlling actor. They urge that the people themselves should replace doctors as the setters of public health priorities. They conclude that "much health promotion, as practiced currently, simply doesn't work." (pp. 141).
The most valuable contribution this book makes to the literature is, in my view, the chapter on the natural environment's potential to promote health. I wish the chapter gave more detail, going into the topic of environmental psychology much more deeply, but even in its brief form in this book, Lucas and Lloyd fill a gap in the existing book offerings in our field.
Missing from the book, in my view, is a critical final chapter, which would suggest mechanisms whereby their call for change might be turned into action. Through what processes would they have public health priority setting happen? Who would replace the doctors in managing health promotion in the NHS? How would the good in the present system be preserved while routing out the bad? How would the success or failure of the regime of change be judged, and by whom?
On many subjects, the authors' strongly held points of view are expressed in critiques that totally dominate the subject at hand; too often, there is little to no balance in points of view. As but one example, the Transtheoretical Model (Stages of Change) is the subject of about five book pages, of which one short paragraph is introductory and the rest is criticism. The criticism is welcome, but should have been balanced with other points of view. The naïve student who might happen to read this treatment of stages of change, and not go on immediately to read other treatments, would have a rather twisted view of the model.
Perhaps the most serious weakness is that the authors' contention that health promotion doesn't work is not backed up by a serious review of literature. It may not work as they wish it to, in England, and in the spheres in which the authors have moved, but in other places and in other people's experience, many elements of health promotion do work well.
Summarising, I agree with Keith Tones, who wrote in his foreword that the book presents a new perspective on health promotion that complements other texts. He recommends it to readers, and so do I, but not as a primary text for students being introduced to health promotion. It is valuable as a supplementary text, however, and should be on lists of recommended reading.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||