Health Promotion: revitalizing or reinforcing ideas of disease causation
During the first few weeks of class we spent a fair amount of time discussing theories of health behaviour, techniques for health promotion and strategies for behaviour change, most notably social marketing. We also touched on the eco-social model of health (or at least ideas that resonate from it). I like revisiting this model at different points throughout my degree. Personally, it serves as a good reminder that, while most health interventions tend to narrow in on particular “levels” (be it micro, messo, or macro) we need to remain conscientious of the entire system and how our efforts fit into the “big picture”.
It would seem that the eco-social model is a fairly dominant theory in the current field of public health and by extension health promotion. For me this brings up an interesting question about the translation of health promotion theory into practice. Specifically what mechanisms are in place to ensure that health promotion interventions are reflective of the (eco-social) theory upon which the discipline is currently centred? Furthermore, I can’t help but see (in the absence of such mechanisms) the potential for health promotion to perpetuate dated and counter productive conceptualizations of health and disease.
As an example, on practicum this summer, I worked with a housing organization to redesign/expand their community garden program. Food insecurity had been identified as a major problem among tenants; the decision was made to increase access to and participation in the community garden program. Prior to starting my practicum I couldn’t help but have (many) reservations about the methods used. Relevant to the discussion at hand, I wondered what “message” this sent to the participants. How did focusing the solution at the individual/lifestyle level shape how the participants perceived their role in creating the challenges they face? In the larger context I wondered how, if this approach were repeated across communities and time, it would reinforce wide held social beliefs about the origins of poverty.
When interventions that target individual health behaviours lack, at the very least a discussion of the broader socio-structural conditions that contribute to the problem, I think it is very easy to perpetuate bio-medical and lifestyle theories of disease causation that are so dominant in modern day (western) society. From this perspective, I wonder to what extent health promotion contributes to the creation of a social environment that is unreceptive to upstream ideas about health and disease.
The way health promotion practitioners frame an issue undoubtedly has an effect on shaping the way participants, and in the long run society in general, understands that issue. It is important to consider the negative (albeit unintended) consequences public health interventions can have, not necessarily on the individuals that they serve (though there is a significant amount of discourse in the literature about that – and an interesting blog article about social marketing, individual health behaviour theory and victim blaming here), but rather on the cultural attitudes and values that society holds towards the origins of health and disease. While not all interventions are capable of addressing every social “layer” that contributes to a problem they are at the very least, an opportunity to expand the dialogue on disease causation and thus expand society’s opionion about appropriate mechanisms for improving health.