Health Promotion International Advance Access originally published online on August 23, 2005
Health Promotion International 2005 20(3):211-212; doi:10.1093/heapro/dai020
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Who gets what: politics, evidence, and health promotion
Science journal, starting with its July 2005 issue, presents its readers with 125 questions and problems yet to be resolved by the scientific community. These range from the deceptively simple (‘what is the structure of water?’), the obvious (‘what triggers puberty?’ or ‘what are the roots of human culture?’), to the amazingly esoteric (‘do mathematically interesting zero-value solutions of the Riemann zeta function all have the form of a+bi?’).
More than half of these issues have to do with human and ecosystems health. Some of these, indirectly, point to new directions in public health and health promotion research. From the moment that the human genome had been unravelled, the scientific community has been speculating (and some frankly have been engaging in wishful thinking) about the impact of genomics on public health and health promotion.
With the realisation that it is not the genes and our genome that regulate human development but rather the proteins that they code for, the Science essay addresses the question ‘how many proteins are there in humans?’ (The answer is: It has been hard enough counting genes. Proteins can be spliced in different ways and decorated with numerous groups, all of which makes counting their numbers impossible for now.) This question is simply a put-off, and an invitation to move into areas where no health promotion researcher has gone before: proteomics.
Inspirational as these 125 questions may be, does any of them touch upon the ‘Great Unknowns’ in our field? Science journal is generally not seen as the number one reference work for the theory and practice of health promotion. It would be worthwhile, though, to make an inventory of the boundaries of our current knowledge, the challenges for further scientific development of health promotion, and the mysteries that we have touched upon but never consciously addressed.
There can be little doubt that our peers could easily come up with 125 questions and issues in health promotion and health development that complement the Science list. In some ways this has already been done. For example the knowledge gap facing health promotion has already been articulated by the International Union for Health Promotion and Education (IUHPE, 2000a
, 2000b) and the US Institute of Medicine (Smedley & Syme, 2000). The evidence challenges have also been the focus of recent conferences this year, for example the European IUHPE Health Promotion Effectiveness Conference in Stockholm and WHO's 6th Global Conference on Health Promotion in Bangkok. Nevertheless the key questions for the development of health promotion have not as yet been formulated as unequivocally as Science has done.
In the last issue of Health Promotion International, Bambra, Fox & Scott-Samuel (2005) have again demonstrated that health is a quintessentially political issue. As a consequence health promotion research and practice should engage more consciously and conscientiously in political action and inquiry. One of the fathers of modern political science, Harold Lasswell, as early as the 1930s, described politics and policy development as fundamentally asking the questions who gets what, where and how (1930, 1936). Incidentally, he also regarded the act of ‘politicking’ as a psychopathology. Although political science has evolved considerably over the decades, it might be helpful for health promotion developers and analysts to be aware of potential psychopathologies among those who decide on the fate of our proposals and findings (Eulau & Zlomke, 1999).
The next stage in the evidence debate will have to address far more explicitly and astutely the political nature of health promotion and of science itself. In this issue, Lahtinen and colleagues (2005) start that debate with making the Finnish political parameters for health promotion research explicit. This is in line with propositions formulated by Rychetnik & Wise (2004) and Raphael (2000).
In an earlier editorial, Nutbeam (2004) presented a UK case-study and started to ask the ‘right’ political questions: How to improve the quality of evidence that overtly is directed towards influencing policy? How to redirect research funding towards that goal? How to include implementation research form the very start of intervention development into research designs? What are the parameters of successful networking between politicians, academia, and health promotion practitioners?
The utility-driven evidence (UDE) framework has been suggested as one way forward to respond to such questions (De Leeuw & Skovgaard, 2005). From a perspective of knowledge utilization modelling it is proposed that evidence can serve seven different types of political utilities. One type of evidence would serve one type of utility best. A different format of evidence generation and application is needed for each purpose, be it academic curiosity, intervention implementation, tactical usage, or other knowledge utilities in the political arena.
Louise Potvin and her colleagues (2005) have suggested that a further integration of social science into public health practice would yield better and more practicable answers to such questions. Most if not all of the articles in this issue do just that; but the most critical question still stands: who gets what, when and how in health promotion research and practice?
REFERENCES
Bambra, C., D. Fox & A. Scott-Samuel (2005) Towards a politics of health. Health Promotion International, 20(2), 187–194.
de Leeuw, E. & T. Skovgaard (2005) Utility-driven evidence for healthy cities: Problems with evidence generation and application. Social Science & Medicine 61, 1331–1341.
Eulau, H. & S. Zlomke (1999) Harold D. Lasswell's legacy to mainstream political science: a neglected agenda. Annual Review of Political Science, 2, 75–89.[CrossRef]
IUHPE, International Union for Health Promotion and Education (2000a). The Evidence of Health Promotion Effectiveness. Shaping Public Health in a New Europe. Part One: Core Document. Brussels: ECSC-EC-EAEC.
IUHPE, International Union for Health Promotion and Education (2000b) The Evidence of Health Promotion Effectiveness. Shaping Public Health in a New Europe. Part Two: Evidence Book. Brussels: ECSC-EC-EAEC.
Lahtinen, E., P. Koskinen-Ollonqvist, P. Rouvinen-Wilenius, P. Tuominen & M.B. Mittelmark (2005) The development of quality criteria for research: a Finnish approach. Health Promotion International, 20(3), 306–315.
Lasswell, H.D. (1930) Psychopathology and politics. University Chicago Press, Chicago.
Lasswell, H. (1936) Politics: Who gets what, when, how. McGraw-Hill, New York.
Nutbeam, D. (2004) Editorial: Getting evidence into policy and practice to address health inequalities. Health Promotion International, 19(2), 137–140.
Potvin, L., S. Gendron, A. Bilodeau & P. Chabot (2005) Integrating social theory into public health practice. American Journal of Public Health, 95(4), 591–595.
Raphael, D. (2000) The question of evidence in health promotion. Health Promotion International, 15(4), 355–367.
Rychetnik, L. & M. Wise (2004) Advocating evidence-based health promotion: reflections and a way forward. Health Promotion International, 19(2), 247–257.
Smedley, B.D. & Syme, S.L. (2000). Promoting Health. Intervention Strategies from Social and Behavioural Research. Committee on Capitalizing on Social Science and Behavioural Research to Improve the Public's Health. Washington DC: Division of Health Promotion and Disease Prevention, Institute of Medicine.
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