Controversy Concerning The Scope Of Health Promotion
The complexity and value-laden character of these targets of health promotion policies were shown by the language of the critiques and debates that greeted both the Health Education Planning book and Surgeon General`s Report. The controversy hinged on phrases such as individual versus social responsibility for health, facilitating individual behavior change versus broader, institutional and social change approaches to health promotion, behavioral versus ecological strategies, healthy people versus healthy cities and healthy policies, blaming the victim versus blaming the manufacturers of illness.
The federal office that issued the Surgeon General`s Report published in the same year a quasi-official definition of health promotion as "any combination of health education and related organizational. political and economic interventions designed to facilitate behavioral and environmental changes conducive to health. this did not silence the critics, who continued to worry in subsequent years that the Reagan administration, which took office in 1981, would use a narrower concept of behavior and individual responsibility in its health promotion policy to justify cuts in basic health services and government programs.
At the heart of the health promotion debates and in some of the contentious phrases and ideologies, one can find both positive and pejorative uses of the word lifestyle. As a target for health policy and programs, lifestyle is, for relate to health. To others, lifestyle is a composite expression of the social and cultural circumstances that condition and constrain behavior, in addition to the personal decisions the individual might make in choosing one behavior over another. Both uses of the term acknowledge that lifestyle is a more enduring (some would say habitual) pattern of behavior than is often connoted by the term behavior or action.
The persistence of behavior became an increasingly important dimension of health behavior as the chronic and degenerative diseases displaced acute, communicable diseases in the list of the leading causes of morbidity and mortality. Once, a single act such as getting an immunization could provide a lifetime of protection against an infectious disease, but now, a lifetime of simple, seemingly harmless acts-such as eating high-fat foods, smoking a few cigarettes each day, going to work in heavy traffic without seat belts, and driving home after a few drinks-account for most of society`s disease. injury, disability, and premature death.
Although health education had been successful in public health campaigns to change single health-directed acts, many policy makers and health officials of the 19970s were not confident that health education could bring about changes in the new public health targets-the more complex, lifetime habits and the social circumstances associated with the term lifestyle. With such elusive targets as socially embedded lifestyles, public health education could have an impact on public health only if it joined other sectors and brought multiple social forces to bear, some of which would go beyond the ethical definition of and most policy makers understanding of health education.
There was also the question of equity and social justice. As James Mason, than director of the Centers for Disease Control (CDC), now assistant secretary for health, put it a few years later :
" It is my observation that, up until now, most of the behavior changes we have promoted have involved the better-educated,, upper-and midle-class segments of our society. If health promotion is a good thing, it should be good for the whole society, not just that portion which is favorably predisposed. Unless we are able to reach all segments of the population, we will never meet the goals we have set for a national consciousness for wellness in America"
Health education was drawn into the fray with the opportunity to provide leadership for an expanded public health policy of lifestyle priorities and objectives under the mantle of health promotion. The previously quoted quasi-official definition of health promotion sought to position health education centrally in the new federal policies and programs. A refined and simplified version of that definition is offered here : Health promotion is the combination of educational and environmental support for actions and conditions of living conductive to health. The actions or behavior in question may be those of individuals, groups, or communities, of policy makers, employers, teachers, or others whose actions control or influence the determinants of health. The purpose of health promotion is to enable people to gain greater control over the determinants of their own health. This control ideally resides with the individual when the determinants are ones over which he or she can exert personal control, but with some aspects of the complex lifestyle issues, especially those that affect the health of others such as drunk driving, the control that people exercise must be through community decisions and actions.
Source :Lawrence w. Green and Marshall W. Kreuter, 1991, Health Promotion Planning An Educational and Environmental Approach, Mayfield Publishing Company, Mountain View, California.
