Community As The Center Of Gravity For Health Promotion
If the first Surgeon General`s Report on Health Promotion and Disease Prevention seemed to put too much responsibility on the individual, some of the wishful thinking of some health promotion advocates has expected too much of national policy and centralized planning. If the victim-blaming implicit in policies that focused on individual behavior was unfair, the system-blaming implicit in some of the more sweeping social reform proposals offered as alternatives was unproductive. A unified middle ground must be found if health promotion is to be viable policy. The value-laden, culturally and ethically defined nature of many of the lifestyle issues such as diet make it impossible to dictate behavior uniformly from a distant central government, especially in pluralistic, democratic societies.
The private nature of many of these practices, such as sexual and sedentary behavior, make them inaccessible to effective surveillance and regulation. The constitutional and civil right of citizens protect most of the behaviors, including even the right to bear arms in the United States, or the right to sexual practices among consenting adults, or freedom of speech protecting pornography and advertising of unhealthful products. The state or provincial dominion of large federation or commonwealth governments, such as those of Australia, Canada, and the United States, limit the powers of central goverment in favor of state or provincial rights to police power in matters of health,, and most of these powers are ceded to local governments.
The private nature of many of these practices, such as sexual and sedentary behavior, make them inaccessible to effective surveillance and regulation. The constitutional and civil right of citizens protect most of the behaviors, including even the right to bear arms in the United States, or the right to sexual practices among consenting adults, or freedom of speech protecting pornography and advertising of unhealthful products. The state or provincial dominion of large federation or commonwealth governments, such as those of Australia, Canada, and the United States, limit the powers of central goverment in favor of state or provincial rights to police power in matters of health,, and most of these powers are ceded to local governments.
In the final analysis, the most effective and proper center of gravity for health promotion is the community. State and national governments can formulate policies, provide leadership, allocate funding, and generate data for health promotion. At the other extreme, individuals can govern their own behavior and control the determinants of their own health up to a ponit, and should be allowed to do so. But the decisions on priorities and strategies for social change affecting the more complicated lifestyle issues can best be made collectively as close as possible to the homes and workplaces of those affected.
This principle assures that programs are relevant and appropriate to the people affected, and it offers greater opportunity for the people affected to be actively engaged in the planning process. The overwhelming weight of evidence from research and experience on the value of participation in learning and behavior indicates that people are more committed to initiating and upholding those changes that they helped design or adapt to their own purposes and circumstances.
This principle assures that programs are relevant and appropriate to the people affected, and it offers greater opportunity for the people affected to be actively engaged in the planning process. The overwhelming weight of evidence from research and experience on the value of participation in learning and behavior indicates that people are more committed to initiating and upholding those changes that they helped design or adapt to their own purposes and circumstances.Community may be the town. or country in sparsely populated areas or the school, worksite, or neighborhood in more populous metropolitan areas. It is, ideally, a level of collective decision making appropriate to the urgency and magnitude of the problem,, the cost and technical complexity of the solutions required, the culture and traditions of shared decision making, and the sensitivity and consequences of the actions required of people after the decision is made. Once national policy settled on objectives for health promotion in countries such as Australia, Canada, Finland, Netherland, Sweden, and the United States, the necessity of adapting those policies to the state or provincial and community levels became inescapable.
Source :
Lawrence w. Green and Marshall W. Kreuter, 1991, Health Promotion Planning An Educational and Environmental Approach, Mayfield Publishing Company, Mountain View, California.
