Re the criticism of Eberhard Wenzel's comments by DeAnne Hobbs
.
What disturbs me first is why someone would be so pompous as to insist that
a person with a PhD should be referred to as Mr rather than Dr.  Especially
when that person is calling for a professional debate.  I can find nothing
but professional comments in his original email, whether you agree with
them or not.  And to suggest that his comments are not to do with improving
the health of people seems quite petulant.

On a more serious note, Dr Wenzel's point is a good one. While we find
theories of behaviour change to be useful and productive in working to
promote the health of the community, we do need to remember that they are
simplistic representations of complex situations.  We have learned from any
number of expensive behaviour change projects that behaviour change is hard
to bring off and sustain, and is most likely to occur only when other
conditions in people's lives are favorable. At the population level,
significant shifts in behaviour occur over extended periods of time and
when behaviour change interventions are accompanied by a range of
complementary health promotion initiatives, particularly community
building, environmental change and policy and regulatory development.

There is also an element of what is 'culturally' relevant in this
discussion - in terms of the culture of the society and of the health
professionals in that society. It is clear that the US, with its more
individualistic perspectives on society, is more concerned with changing
the individual and my guess is behaviour change theories are more prominent
there. This may also explain the very different use of the term 'health
promotion' in the US to the rest of the world and what, for many of us, is
their inexplicable need to keep talking about health education. The
Canadian, European and Australian approaches tend to focus more on broader
approaches.  And this may well relate to our greater willingness to accept
social interventions such as in the regulatory area where we have
significant success with  random breath testing of car drivers to deter
drink driving, mandatory bicycle helmets, mandatory seat belts etc.  The
relationship between the individual and the society is a complex and
variable one, and the differing perspectives and ideologies that encompass
this area are a powerful determinant of approaches to health improvement
and to what aspects of health promotion are likely to be acceptable and
successful in different countries.

Bernie Marshall
School of Health Sciences
Deakin University
221 Burwood Hwy
Burwood 3125, Australia

Tel: (61+3) 9244 6822
Fax: (61+3) 9244 6017

http://www.hbs.deakin.edu.au/healthsci/