Promotion Discourse Research Articles

Persecutory health

A critical approach from the standpoint of social philosophy is taken aiming at analyzing aspects of current production of knowledge and technologies in health promotion. Its capacity of generating perplexities, dilemmas and dissatisfactions is also evaluated, despite its strength and effectiveness in many levels. The analysis is based on Ivan Illich's "social iatrogenesis," Peter Skrabanek's "coercive healthism," and Giorgio Agamben's theoretical approach of "homo sacer"--a man whose life is worthless. The limits and dilemmas of the idea of personal responsibility are discussed as a persuasion strategy in health promotion discourses and practices. All these proposals produce "persecutory health" as a side effect.

The end of death in late modernity: An emerging public health challenge

Health promotion discourses often assume that death and loss are someone else's business—usually palliative care or bereavement care. Palliative care and bereavement care, in their turn, provide direct service, acute care approaches to death and loss. Between these two approaches, little health promotion is evidenced. This paper critiques the assumptions both make about death in late modernity arguing that death and loss are increasingly social experiences for people that require active support and community development from the ‘new’ public health. The past therapeutic emphasis and the secularized view of death are receding. A new approach to death and loss is needed and the new public health may have an important major role to play in addressing these changes.

Ottawa to Bangkok: changing health promotion discourse

The discourse of the 2005 Bangkok Charter for Health Promotion in a Globalized World represents a radical departure from that of the Ottawa Charter that, in 1986, staked a place for the health promotion field in mainstream public health. Via a critical analysis of the discourse in these two Charters, this paper illustrates a shift from a 'new social movements' discourse of ecosocial justice in Ottawa to a 'new capitalist' discourse of law and economics in Bangkok. The Bangkok Charter's content may identify 'actions, commitments and pledges required to address the determinants of health in a globalized world through health promotion', but this paper shows how its discourse works to naturalize and perpetuate many of detrimental determinants associated with 'globalization'.

Three Challenges to the Ottawa Spirit of Health Promotion, Trends in Global Health, and Disabled People

Health promotion according to the 1986 Ottawa Charter of the first global health promotion conference "is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment". In this commentary, I explore three powerful challenges to the spirit of the Ottawa Charter and to global health. The first challenge is the departure from the WHO definition of health; the second challenge relates to the appearance of the transhumanist/enhancement model of health which includes human performance enhancement beyond species-typical boundaries as part of the concept of health. The third challenge consists of the limited involvement and understanding of disabled people with their different models of 'disability/impairment' (medical, social, transhumanist/enhancement) in the discourse of global health and health promotion. Not dealing with these challenges impairs the ability of health promotion to deal with global health problems, the 'health' needs of marginalized groups--in particular, disabled people--and the Millennium Development Goals.

Studying the striving and opposing forces in newspaper journalism: the actantial model of health promotion

The cultural aspects of health promotion are important in policy development as well as in assessing effectiveness of health promotion activities. The discourses on promoting health and well-being in journalism reflect the health promotion culture in society. This article illustrates how health promotion is portrayed by 147 newspaper items from the two Finnish quality dailies during the period 2002-2004 and introduces a semiotic Actantial Model of Health Promotion (AMHP) for studying health promotion cultures. The most popular news themes on health promotion were physical and social environment, welfare services, nutrition and obesity, and mental well-being. The actants (actors, actions and abstract factor) of health promotion were identified and the AMHP with seven key actants (generator, health-object, public, tool, executor, threat and obstacle) was constructed. The model sheds light on two sides of health promotion discourses in journalism. The dominant culture of health promotion was represented by policy actions, information, education and scientific research, which were defined by health experts, decision-makers and researchers. Representations of the opposite culture--'the otherness' of health promotion included external harmful factors and unhealthy behaviours, mentalities opposed to being health-oriented, rationally uncontrolled living, disorder, disharmony and insecurity. The opposing factors were presented by people and institutions lacking the will, ability or motivation for a health-oriented life. To understand better the values of health promotion, it is necessary to assess the characteristics of the opposite side of health promotion culture, because the current dominant values can be described more clearly by the boundaries--by 'otherness'. The study argues that the AMHP can be used as a semiotic method to identify the value dimensions and the boundaries between the dominant and the opposite discourses of health promotion in various communications such as advertising and health education. Also, it provides a tool for the analysis of the media's role in 'victimization' or 'heroization' of various population groups.

BTA's Cool Britannia: British national identity in the new Millennium

This work provides an insight into the image of Britain resulting from the discourse of British tourist promotion as reflected in materials published by the British Tourist Authority, now officially renamed VisitBritain. Our analysis will lead us to state that a new image of the country –Cool Britannia- has been increasingly featured in BTA materials since the late 1990s, coinciding with the New Labour period in office. It will be argued that this truly postmodern image, currently fighting to become hegemonic, can be analysed in terms of national identity, thus leaving behind the traditional concept of heritage at least because Britannia can no longer recognise herself in a deceased body which is being artificially preserved.

Public health nurses’ supervision of clients in Norway

The aim of this study was to explore and describe what public health nurses (PHNs) understand by client supervision and how they perform it. The main principles of the health promotion discourse initiated by the World Health Organization (WHO) over the last 20-30 years are client participation and the view of the client as expert. Supervision is one relevant intervention strategy in the empowerment process, in which these principles play a central role. There is a lack of research pertaining to the intervention models employed by PHNs. Twenty-three transcribed audiotaped dialogues between PHNs and their clients were analysed by means of qualitative content analysis. What the PHNs understand by supervision and how they perform it can be described by three themes: continuity in relationships and reflexivity in the supervision approach, communicating with the client about his/her needs, problems and worries; and the organization of client supervision. The PHNs in this study understand client supervision as communication and relationships with clients on the subject of a healthy lifestyle, child development and coping with everyday life. The PHNs' approach to client supervision seemed to include aspects of empowerment by means of client participation and the view of the client as expert. However, the PHNs themselves had an expert role.

Working Out

This article examines workplace health promotion (WHP) from a critical perspective. Based on a 2-year ethnographic case study of the development of the Associate Recreation Center (ARC) at an automobile manufacturing plant, the study investigates the interrelationships between health promotion discourse and managerial ideology, and the corresponding implications for employees perceptions of health, the healthy body, and personal identity. Analysis suggests that the field of WHP draws on dominant social discourses of health that embody managerialist values. This initiative encouraged employees to adopt managerial-values of self-denial and self-control as the central components of health, producing self-disciplining bodies and hegemonic judgments of self and other.

THE CANADIAN 'WORLD CITY' AND SUSTAINABLE DOWNTOWN REVITALISATION: MESSAGES FROM MONTREAL 1962–2002

THE CITY GOVERNMENTS OF CANADA's largest metropolitan centres have, in recent years, experienced some dramatic changes of civic leadership and policy agenda, as well as reductions in financial support, and reorganisations that include the controversial 'megacity' mergers in Toronto and Montreal. Nevertheless, city governments are permanent and relatively stable institutions in a 'world of flows', characterised by 'floating populations, transnational politics within national borders, and mobile configurations of technology and expertise' (Appadurai 2001: 5). In Canada, they are creations of Provincial statute with specified powers and duties to perform. Their democratic raison d'etre is to serve local electors and promote their well-being: a role that has somehow to be reconciled with the ebbs and flows of globalisation. In North America, there is a long history of 'civic boosterism'. For a century or more, Canadian city governments have fought hard to position themselves in global markets that are expected to deliver economic benefits and further enhance their competitive advantage. Over the past ten years or so, more sophisticated and subtle techniques of 'place marketing' have been developed and the goals have widened, so that the desired benefits now embrace improvements to the physical environment and amenities for disadvantaged communities, as well as well as local income and employment. In this context, a favourable international profile is considered critical to the success of strategies to revitalise downtown areas and adjacent inner city neighbourhoods as vibrant cosmopolitan centres. In the early 1990s, Metropolitan Toronto (1992) and the City of Vancouver (1992) both adopted development plans for their Central Business Districts (CBDS) expressing their intention to nurture sustainable growth, and foster the ideal of the 'liveable city' (Shaw 1995; Marshall 2001). Likewise, Ville de Montreal wanted to be a 'modern city on a human scale': Montreal must make a change in direction towards sustainable urban development. The decisions made today affect future generations and must take into account the environmental, economic and social impacts, both in the short and long term. (1992: iii-iv) The benefits would be distributed to improve 'quality of life' for all urban communities, including those in the most disadvantaged areas. With reference to the case of Montreal's central Ville-Marie District, this article discusses the changing discourse of promotion to international audiences and the emerging framework of public policy that espouses the principles of sustainable development and social equity. Raising the international profile For the past forty years, successive civic leaders of Montreal - like their counterparts in Toronto and Vancouver - have placed a very high priority, not only on competing successfully with other metropolitan centres in North America, but on attracting inward movement of capital, people and knowledge spanning all continents. Until comparatively recent times, most Canadian city governments focused their promotional efforts on luring investors with promises of hard infrastructure, tax concessions and development sites (Ward 1998). Economic growth through modernisation over-rode all other considerations. Grand civic projects that signified 'progress' were key indicators of success. Under the leadership of Mayor Jean Drapeau from the late 1950s, Ville de Montreal adopted a pragmatic approach and saw little need to consult local communities on the desirability of large-scale reconstruction in the CBD and surrounding inner-city areas to accommodate flagship commercial and public buildings. Mayor Drapeau's vision was expressed very powerfully in the 'superblock' Place Ville-Marie (1962): symbolic centrepiece of downtown modernisation and prototype for subsequent complexes. Designed by signature architect I.M. Pei, circulation was separated on three levels - pedestrian, motor traffic and rail - with shopping and offices integrated in a monolithic structure that defied the traditional street. …

Measuring community empowerment: a fresh look at organizational domains.

In 1986, the Ottawa Charter identified community empowerment as being a central theme of health promotion discourse. Community empowerment became a topical issue in the health promotion literature soon afterwards, though its roots also come from earlier literature in community psychology, community organizing and liberation education. Subsequent international conferences to address health promotion in Sundsvall, Adelaide and Jakarta have acted to reinforce this concept. It is as relevant today as it was more than a decade ago. The literature surrounding health promotion has since moved onto other overlapping theoretical perspectives, such as community capacity and social capital. And yet the critical issue of making community empowerment operational in a programme context remains thorny and elusive. Community empowerment is still difficult to measure and implement as a part of health promotion. This article offers a fresh look at key theoretical and practical questions in regard to the measurement of community empowerment. The theoretical questions help to unpack community empowerment in an attempt to clarify how the application of this concept can be best approached. The practical questions address the basic design characteristics for methodologies to measure community empowerment within the context of international health promotion programming. The purpose of this article is to allow researchers and practitioners to address again the important issue of making community empowerment operational.

Public health policies and advocacy in Latin America: chances and environments to support these initiatives.

This paper attempts to bring the theoretical/romantic discourse of health promotion to the concrete/circumstantial reality of Latin American countries. It analyzes living conditions the fulfillment of the universal needs of citizens and the role that leaders and advocate health professionals play in the region. Focus is placed on the problems diagnosed by the data of the Panorama Social de America Latina for the Latin American situation during the 1990s including high mortality and morbidity rates societal and domestic violence drug consumption child abuse and prostitution. A verification of the correlation between the existence of basic resources for the population to have health and the most frequent problems on the continent in the last decade is also conducted. Overall data point out the vulnerability of the Latin American economy when facing crises in which the situation of health deteriorates concomitantly with socioeconomic decline. Further analysis demonstrates that the struggle against poverty and the efforts to improve the levels of health and quality of life cannot be based solely in a monetary and economic-oriented policy of development. An alternative program is advocating domestic international and intersectional redistribution public policies for Latin American states to become healthy and reduce poverty.

Collective Lifestyles as the Target for Health Promotion

The last five years have witnessed intense debate among health researchers in Canada regarding the overlap of the health promotion and population health discourses. Meanwhile, strong currents within health promotion have attempted to move the field beyond a focus on individual behaviour towards the influence of social environments on health, although the tendency is often to fall back on individual behaviour modification as the primary lever for change. The Population Health research agenda bypasses behavioural determinants of health and explores instead social determinants. This body of knowledge provides useful insight for addressing some of the tensions in the health promotion discourse. This paper explores two of these tensions: whether individuals at risk or general populations should be targeted for change; and whether lifestyle is an individual or a collective attribute. We propose the notion of collective lifestyles as a heuristic for understanding the interaction between social conditions and behaviour in shaping health.

Health promotion through the lens of population health: Toward a salutogenic setting

While strong currents within health promotion have attempted to move the field beyond a focus on individual behaviour towards one that examines the contribution of social environments on health, the tendency is often to fall back on individual behaviour modification as the primary lever for change. The Population Health research agenda bypasses behavioural determinants of health and explores instead the role of social determinants. This body of knowledge provides useful insight for addressing some of the tensions in the health promotion discourse. This paper explores two of these tensions: whether individuals at risk or general populations should be targeted for change; and whether lifestyle is an individual or a collective attribute. Merging the resolution of these tensions with Aaron Antonovsky's salutogenic model, this paper develops the concepts of collective lifestyles and salutogenic settings for future theoretical development in health promotion and public health.

Reducing coronary heart disease in the Australian Coalfields: evaluation of a 10-year community intervention

Coronary heart disease is a leading cause of death in Australia with the Coalfields district of New South Wales having one of the country's highest rates. Identification of the Coalfields epidemic in the 1970's led to the formation of a community awareness program in the late 1980's (the healthy heart support group) followed by a more intense community action program in 1990, the Coalfields Healthy Heartbeat (CHHB). CHHB is a coalition of community members, local government officers, health workers and University researchers. We evaluate the CHHB program, examining both the nature and sustainability of heart health activities undertaken, as well as trends in risk factor levels and rates of coronary events in the Coalfields in comparison with nearby local government areas. Process data reveal difficulties mobilising the community as a whole; activities had to be selected for interested subgroups such as families of heart disease patients, school children, retired people and women concerned with family nutrition and body maintenance. Outcome data show a significantly larger reduction in case fatality for Coalfields men (although nonfatal heart attacks did not decline) while changes in risk factors levels were comparable with surrounding areas. We explain positive responses to the CHHB by schools, heart attack survivors and women interested in body maintenance in terms of the meaning these subgroups find in health promotion discourses based on their embodied experiences. When faced with a threat to one's identity, health discourse suddenly becomes meaningful along with the regimens for health improvement. General public disinterest in heart health promotion is examined in the context of historical patterns of outsiders criticising the lifestyle of miners, an orientation toward communal rather than individual responsibility for health (i.e. community `owned' emergency services and hospitals) and anger about risks from environmental hazards imposed by industrialists.

An Exploration of the Discursive Constructions used in Young Adults' Memories and Accounts of Contraception

The study reported in this article uses discourse analysis to examine the meaning and significance of contraception for young adults and emphasizes the social construction of meaning to better explain what can limit and what can facilitate use of contraception. The study used memory work (Crawford et al., Emotion and Gender: Constructing Meaning from Memories. Sage, 1992) and group discussions to collect accounts of contraception. Analysis of the accounts revealed that constructions of contraception used in the memories all signified sex, which invoked wider gendered discourses surrounding sexuality. Such discourses gave rise to contradictory positionings for the actors within the memories. In contrast, the accounts of contraception from the group discussions were predominantly produced with reference to a health promotion discourse. However, further analysis revealed that the constitution of this discourse was always highly precarious. These findings are discussed in terms of the implications for health promotion efforts.

Risk and the regulated self: the discourse of health promotion as politics of uncertainty

Employing the concepts of risk and governance, this paper develops a specific theoretical and critical perspective on the discourse of health promotion. The paper begins by examining some problems with the influential formulations of risk offered by Ulrich Beck and Anthony Giddens. It then discusses some recent Foucaultian contributions on the topics of risk and governance, and particularly the work of Robert Castel, which draw attention to the role of risk discourse and self-regulatory techniques of governance in those societies exhibiting a form of rule known as 'neo-liberalism'. The paper examines health promotion in the light of the new preventive strategies of social administration that have emerged in these societies and that target the 'at risk' individual and utilise the agency of subjects in processes of self-regulation. It explores some implications of the new risk discourse for the self, and raises some questions about the politics of the enterprise of health promotion as a whole.

The Marketing of Empowerment and the Construction of the Health Consumer: A Critique of Health Promotion

Health promotion claims to be empowering. However, this claim is not without major problematic contradictions and inconsistencies. The way in which health promotion is also controlling is identified in this article. To understand why the discourse of health promotion is traversed by this empowering/controlling contradiction, the discourse is critically analyzed, revealing a parallel with the structure of the discourse of marketing. Health promotion, rather than fulfilling its promise of empowerment, effectively constructs the individual subject as a "health consumer" in accordance with the model of consumer capitalism.