Evidence: the holy grail of integrated health promotion and health education

Abstract

There is no doubt that health promotion and health education (HP/HE) in the UK are in a crisis, in view of the limited amount of financial resources available, the reduction in services and the lack of available new specialist jobs. The Government seems to have made a political decision about the reduction (if not abolition) of HP/HE services, with the danger of throwing the baby out with the bathwater' by neglecting the support for research into methodologies that are still needed for preventing disease and improving health. The idea of creating 'health promoting settings', sponsored by WHO, is gradually losing its supporters. The other alternative, that of integrating HP/HE into the core activity of a setting, is resulting in HP/HE losing its identity and being absorbed into that core activity. This could be considered by some as an advantage, since all the members of a setting become involved in the activity. There are, however, disadvantages in that this integrated form of HP/HE cannot be separately evaluated since it is a part of the core activity. Thus it remains fossilised at the stage of its integration, and does not produce any specific institutions with structured research and development facilities, or create new approaches based on new scientific discoveries, such as the new insights into the contribution of genetics to the prevention and treatment of disease. In this article, it is argued that there is a way of saving HP/HE as a method for the improvement of people's health, based on the differentiation of activities, the 'value-added' aspect and differential diagnosis, given the problems of the settings and integrative approaches drawing on new evidential methods.