Health Promotion International, Vol. 14, No. 2, 191-192,
June 1999
© Oxford University Press 1999
Resource Reviews |
People-Centred Health Promotion
John Raeburn and Irving Rootman, John Wiley, Chichester, ISBN 0 471 97137 5 (paper)
Bath Spa University College ‘So how about it, dear reader?' is the rather unconventional final sentence to a book which offers a spirited and ardently written account of People-Centred Health Promotion (PCHP). Raeburn and Rootman are clearly on a crusade, with their final entreaty to the reader acting as a rallying call. Their ultimate goal is to persuade and empower their targeted audience, whom they refer to as ‘doers' of health promotion or ‘wanting to be doers' (students), to go out and engage in PCHP. In order to achieve this goal, they have put together a text which is intellectually stimulating, controversial and compelling. It is easy to be carried along on the wave of enthusiasm which drives their writing. The reader knows where these authors stand from the outset. This is not an objective and anaesthetized discourse on health promotion. There are strong philosophical elements to the work, much of which is value laden. Written by two well-known academics from social science disciplines, who are also seasoned health promoters, their strong views may not endear them to other social scientists or professional health promoters. They talk about social scientists, e.g. as often liking to be ‘lordly and remote' and the professional as a ‘supreme being who observes godlike the doings of a depersonalized and abstract common mob'. The notion of professionalism and professional training comes in for further attack. The authors feel that training reinforces the view that professionals are a ‘special race, to whom due deference should be given by the unwashed masses'. A principal aim of the book, therefore, is to provide a resource for training that puts an alternative view and creates a different type of professional, one who adopts a more facilitatory role. In this capacity, the book may prove effective.
It is coherently written and is presented in three parts. The first part deals with the fundamentals of the Raeburn and Rootman version of PCHP, and places it into the theoretical and political spectrum. The mnemonic PEOPLE is used to highlight the philosophical and practical elements of the key components, e.g. People-centredness, Empowerment, Organizational and community development, Participation, Life quality and Evaluation. There are novel terms and phrases dotted throughout the text, e.g. ‘ill-being' and ‘jpfs' (‘just plain folks' cited from research by Lave, 1988), and a helpful section on the concept of strength building. Part two of the book takes a selection of the basic principles and considers them in depth, to provide a basic conceptual and procedural structure for PCHP. This emphasis on fundamental concepts, issues and approaches contains worthwhile discussion on empowerment, community development, and the cultural and spiritual dimensions of health (the latter two generally being ignored in other health promotion texts). Part three of the book elaborates on the practice of PCHP and the application of key principles, concentrating specifically on what the authors refer to as the people system. The penultimate chapters in this section are case studies which demonstrate how the PCHP approach can be translated into real projects. This final part, therefore, is where the authors attempt to take PCHP outside the realms of rhetoric and make it operational by applying the principles to practice. It is rather surprising that they incorporate within this a concluding chapter which is self-indulgent and borders on the realms of fantasy. Having adopted a pragmatic approach for most of the volume, they close with wishful thinking in exploring and presenting a vision of an ideal society based on PCHP principles. Nonetheless, this does not detract from the true value of the book, which is the appeal to the reader to adopt a more challenging approach to health promotion. It encourages the health promoter to strive for the attainment of positively experienced health and well-being within a quality of life context, and provides clear advice on how to work towards this end. There are lucid explanations of many of the terms and concepts that have been in use by health promoters for some time, but are frequently misunderstood. One such term is empowerment, which is the concept that best describes what the authors are trying to achieve. Although they admit to not liking the word, they nevertheless regard empowerment as the basic philosophical tenet for those that are ‘alive’ in their health promotion work.
That they choose to use the word ‘alive' in this context points to a potential problem. Raeburn and Rootman are keen to persuade the reader that their people-centred approach to health promotion has the moral high ground, and in doing this they border on sounding self-righteous. If you do not agree or are unable to work in a people-centred way you may be left feeling that you lack ‘human values' or your values are ‘hard' rather than ‘soft'. Essentially, the authors present a strongly argued, but singular view of health promotion. They refer to PCHP as the third wave following on from what they label, and by implication reject, the lifestyle and social model eras. Lawrence Green, in his Foreword to the book makes a similar point. He regards the authors as having established a beachhead between the victim blamers on one side and the system blamers on the other. This may well be the case, but in establishing this beachhead they have taken no prisoners.
The numerous strengths of the book, however, far outweigh any such weaknesses. This is an invaluable addition to the growing number of publications informing health promotion practice. As a training resource it will prove useful, not only as a stimulus for debate and discussion, but also as a practical example of how to operationalize empowerment. Ultimately, the success of this book might be measured in the impact it has on the ‘doers' and ‘would be doers' of health promotion,...so how about it, dear reader?
REFERENCE
Lave, J. (1988) Cognition in Practice: Mind, Mathematics and Practice in Everyday Life. Cambridge University Press, New York.
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