Health Promotion International, Vol. 16, No. 1, 7-8,
March 2001
© Oxford University Press 2001
EDITORIAL |
Health promotion is fantastic, fascinating and fun—personal reflections
Editorial Board The Dutch press announced recently that the Prince of Orange would be the chair of a national committee on water management. I concluded at once that he would be the ideal national health promotion champion, as health promotion is keeping flowing water in a straw-basket!
Holding water in a straw basket: teaching and coaching health promotion often brings me to organic or artistic metaphors. Looking back, I still savour the moment in 1982 when I became part of the critical mass that put health promotion on the map. I realize now how this membership suited my personal biography. It offered me a constructive answer to the disillusions about the establishment and to the fear of the ‘one-dimensional man’ we voiced as students in the revolts at the universities in 1968. To celebrate about 15 years of health promotion (an everyday feast) I want to reflect on the fantastic, the fascinating and the future, and thank everyone for the fun.
As an innovation, health promotion has a fantastic record. The innovative potential of health promotion as a true catalyst of social alchemy has been proven by its successful dissemination and implementation in many areas. It can be found in government policy, in academic circles, in the repertoire of institutions, in professional profiles and most importantly as the source of inspiration for millions of pioneers who acted as local champions for health, inspiring others to join the movement. Few ideas have survived so well in these turbulent days. It helped that the original source (WHO) was both respectable and dissident: a social sound completely different from the medical voices heard so far.
Health promotion as a new vision unfolded the potential in Alma Ata and Health for All—it offered the World Health Organization (WHO) a new cutting edge. It was spread by a clever use of new technology and of formal and informal communication strategies to a wide audience that seemed to be ready to act upon this idea. A charismatic person, one who combined political, professional and public creativity, promoted it. So what was it in her message that made it so attractive to so many? Good PR is part of the answer: international conferences built on national pride and the phrase ‘Healthy Cities’ invited local pride to be mobilized for health.
I estimate that the core ideas of health promotion captured a number of the shifting values of the epoch. The first shift was in the perspective on health—the focus became the positive dimensions and the potential inherent in health. This world is craving for good news; although some may be reminded of the optimism of the enlightenment, others might fear the sugary message of advertising and Disneyworld. Secondly, health was repositioned as a thread in the social fabric—to be studied not in the laboratory, but in real life. So it became a people event, confronting the public, professionals and politicians in new ways. All became actors in an ongoing improvized drama in a public arena. By bringing health out in the open, all people turned out to have a role both in enhancing or in threatening it. It became everybody's business. Thirdly, the notion of equity in the roots of health promotion reinforced the ethical and moral nature of the enterprise—health is about social justice as well. In combination these ideas created a paradigm shift for health. If these ideas sound leftist to you, you are right.
Health promotion is by nature a fuzzy concept and some complain about its lack of specificity. Some keep asking for the ultimate definition. The concept was codified in the Ottawa Charter and to clarify it a Glossary was written. Both offer a better understanding of the quality of its fuzziness. In the five conferences, instead of defining health promotion and making it vulnerable through rigidity, we worked on refining health promotion by learning and experience. So far this has proven to be a more inspiring, profitable approach. Fuzziness made concepts like health promotion, empowerment or community development attractive to many people as a building block of their own Utopia. The exploratory and explanatory processes around these concepts—to develop a common language—are as such an integral part of the team-building effort for health. That richness in implicit values has created its potential as an attractor of people with ideas, enthusiasm and money.
The concept of attractor is derived from complexity theory that helps to develop a second set of thoughts about health promotion. This is what makes this field so fascinating. First it is the people, pioneers who do not accept the world as given, but take an active role in its development without losing their sense of relativity and reflexivity. Secondly, it is the process-orientation; health promotion changed the perspective on change. Both in the public's, the professional's and the politician's mind the mechanical models of change have been predominant. If you have a problem, find the cause, fix it and it's over—‘next problem please’. Many have pointed out the limitations of this approach and our inability to use it to generalize with respect to social processes. The Ottawa Charter already made obvious that single simple solutions were obsolete; to blame only the body-machine or the individual was no longer the answer. Health is a multi-conditioned phenomenon. It is a link to and indicator of other social processes, therefore it requires a systemic approach, a perspective based on complexity.
The change processes are themselves conditional to, but also a result of health-focused actions. Linear models, especially with square boxes should not be trusted. Circular models, spirals in context, preferably animated, are more appropriate. Any inventory of causes and conditions will show that everything linked to health links to everything else. Lalonde or Green are only summaries of relevant factors. Maps on such a large scale are not fit for walking a local path. The good thing about the Ottawa image and its later adaptations by conferences that followed is its illustration as a dynamic force field.
With this image in mind, the question about the magic bullet, the single best solution, becomes spurious. Solutions have to fit the complexity of causes in the social context available. Cases show some generalizations are possible—what helps is mobilizing people, creating capacity-supporting structures and handling processes both by going with the flow and by challenging it. Health promotion also requires respect for what cannot be changed, but not too much.
Health promotion is also a learning community that has shown an ability to expand its capacity to create its own future. My agenda to continue the expansion of health promotion comprises three topics. First, I would like to refocus on the salutogenetic idea. Too often traditional topics and body-related prevention continues to be promoted under the heading of health promotion. I would like to explore dimensions of mental health, of values, of the sense of coherence and of belonging, and of spiritual perspectives, including healthy dying, and much more. Secondly, I would like to reconsider the role of harmony and disharmony in strategies. Partnership and empowerment often promise peace, but can also hide conflicts of interest. In advocacy these power-conflicts are more obvious and we should consider being more assertive in the face of social power. You need disharmonies for harmony to stand out. Third is a challenge of health promotion to science. Instead of mechanical analysing and prioritizing, more respect for interdependency and multi-actor perspectives is required. We need creative thinking. Conclusions from research based on old paradigms will not help us to develop the new; rarely do innovations come from archives.
Health promotion invites us to learn to play a new social game: ‘to manage within the unmanageable, to organize within the unorganizable, to know of the unknowable’. So far health promotion has shown to have great survival value and learning capacity. It is great virtual community to be part of. I am sure health promotion in many forms has eternal life, and in its present shape it is fascinating, useful and necessary; to sum it up, FUN.
REFERENCES
Flood, R. L. (1999) Rethinking the Fifth Discipline, Learning Within the Unknowable. Routledge, UK.
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