Good work. Thanks SS
-----Original Message-----
From: Dennis Raphael [SMTP:[log in to unmask]]
Sent: Wednesday, March 08, 2000 5:38 AM
To: [log in to unmask]
Subject: Re: Request for health measurement instrument
At 08:33 PM 3/7/2000 -0500, you wrote:
>Dennis: Could you give us a hint why it is problematic to use
>self-esteem as an outcome? Does this also apply to confidence
>ratings? SS
From the conclusions of the previously mentioned monograph on
self-esteem.
Conclusions and Implications for Public Health and Health Promotion
To conclude, my analysis suggests that the relevance of
self-esteem for
health has been overrated. Self-esteem does not appear to be, by
itself, a
promising target for health promotion or health-enhancing efforts.
The
determinants of health status and health-enhancing behaviors are
multidimensional and usually environmentally or contextually based.
Efforts should first be focused upon promoting health-enhancing
environments. The efforts in the "New Public Health" (Milio, 1987)
and
the "Healthy Cities Movement" (Hancock, 1993) illustrate the healthy
public
policy approach to health promotion. Community-based health
promotion
programs are attempts to enhance the more immediate psychosocial
environments of individuals (Bracht, 1990).
Some health promotion activities are concerned with
influencing
individuals' means of coping with adversity and are consistent with
research indicating that psychological factors may influence health
status
and health-enhancing behaviour. The processes to be targeted should
probably be self-attributions, self-efficacy, control, or learned
helplessness since these more comfortably explain the psychological
disposition and health stats and behaviour linkages. One component of
community-based health promotion activities, for example, is
enhancing a
community's control over the determinants of health (Bracht, 1990).
Many health providers continue to work one-on-one with
clients. In these
situations, individuals may present with personal deficits, including
low
self-esteem. These clients manifest problems functioning within the
current environment, and the causes of these difficulties may lie
either in
their present life situation, or for those with more serious
difficulties,
in experiences which occurred in the past. In either case the
evidence
would suggest a focus upon enhancing personal self-efficacy,
self-attributions, or perceptions of control through currently
available
therapies rather than simple self-esteem enhancements.
In summary, whatever the level or type of health promotion
intervention or
activity implemented, the emphasis should not be upon improving
individuals' self-esteem, but rather on enhancing health and
health-related
behaviours. In some cases, this will involve enhancing environmental
opporunities, in other cases, developing individuals' means of coping
with
diversity.
Self-esteem is important. Should it be our focus? No.
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********************************************************************
Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 101
Toronto, Ontario, CANADA M5S 1A8
voice: (416) 978-7567
fax: (416) 978-2087
e-mail: [log in to unmask]
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