Can I add the following from a paper forthcoming in
Health Promotion International,
"The Question of Evidence in Health Promotion"

"It is becoming increasingly apparent that progress in health
promotion requires agreement on basic definitions and values.
Seedhouse (1997) argues that failure to be explicit about
definitions and values leads to conceptual confusion and
sloppy practice. While pluralism is certainly a worthy goal,
the development of health promotion as a discipline requires
closure on some key issues.  Macdonald and Davies (1998)
provide a compelling argument for accepting the Ottawa Charter
definition of  health promotion -- Health promotion is the
process of enabling people to increase control over, and
improve their health (WHO, 1986). For them, there are clear
advantages in classification of activities for doing so:

        The key concepts in this definition are ‘process' and
‘control'; and therefore effectiveness and quality assurance
in health promotion must focus on enabling and empowerment. If
the activity under consideration is not enabling and
empowering it is not health promotion (Macdonald and Davies,
1998,  p. 6).

        This definition suggests that some useful and health
protective activities may not necessarily be enabling or
empowering. Examples that come to mind are standard medical
treatments for illness, public health efforts of mandating
polio vaccinations or restricting tobacco use, and government
establishment of breakfast programs for children or shelters
for the homeless. MacDonald and Davies (1998) further argue
that:

        These concepts [of enabling and empowerment] are
reflected in the action areas of the Ottawa Charter for Health
Promotion [building healthy public policy, creating supportive
environments, strengthening community action, developing
personal skills, and reorienting health services] which
fundamentally advocates a basic change in the way society is
organized and resources distributed (Macdonald and Davies,
1998,  p. 6).

The implications of this view are noteworthy. First, health
promotion is about enabling people to improve their health,
and secondly, evidence relevant to health promotion should
bear directly on factors that support or prevent enablement
and empowerment (determinants of health), activities that
support enablement and empowerment (health promotion), and
assessing whether these activities have been successful
(evaluation of health promotion). It also makes explicit the
strong values statement that underlies health promotion work."

Dennis


Our Web Sites have information and reports from all of our
Quality of Life Projects!
http://www.utoronto.ca/qol     http://www.utoronto.ca/seniors

*************************************************************
In the early hours I read in the paper of epoch-making
projects
On the part of pope and sovereigns, bankers and oil barons.
With my other eye I watch
The pot with the water for my tea
The way it clouds and starts to bubble and clears again
And overflowing the pot quenches the fire.

 -- Bertolt Brecht
**************************************************************

Dennis Raphael, Ph.D.
Associate Professor
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 308
Toronto, Ontario, CANADA M5S 1A8
voice: (416) 978-7567
fax: (416) 978-2087
e-mail:   [log in to unmask]