Commentary: In Search of a New Ethic for Health Promotion

Abstract

David Buchanan’s (2006 [this issue]) “A New Ethic for Health Promotion: Reflections on a Philosophy of Health Education for the New Millennium” constitutes one of those rare essays that we occasionally need if we are to reinvigorate a familiar debate over the dialectic of health education. What I found remarkable in reading this article is that many of the same issues that Buchanan so eruditely identifies were raised more than 20 years ago by Edward Bartlett and Richard Windsor (1985) when they juxtaposed the philosophy, goals, and processes of health education with those of medicine. Like the conclusions Bartlett and Windsor drew at the dawn of a new era of a more scientifically grounded health education, Buchanan (our new Descartes?) has arrived at some of the same conclusions—albeit by a slightly different, more contemporary analysis—about the fundamental differences between health education based on a medical model that demands behavioral change in response to intervention for the sake of efficiency and health education grounded in a more expansive humanism that respects the essential selfdeterministic nature of man at the expense of efficiency. There is no question that in the last three decades health education has sought increasingly to emulate the medical model. The question is why and, more important, whether this fascination has led us in a direction that promotes population-wide improvements in health status without trampling on individual freedoms, compromising considerations of social equity, or setting up odious, politically motivated moral imperatives that run the risk of blaming the victim as a matter of public policy (Allegrante & Green, 1981). Prior to the 1970s, much of health education practice possessed the characteristics of the education model that Buchanan describes as a model for this new century. Notions of critical judgment, self-understanding, liberation, social justice, and civil society certainly resided at the core of health education efforts throughout most of the early decades of the last century. These purposes of a vibrant, broadly conceived health education continue to be essential elements of what many of us—most notably Freudenberg (1978), Minkler (1989), and Wallerstein (1992)—would argue are still, if not more so, necessary to the work of health education today. The problem is that policy makers accustomed to