If we were to accept Michel's view that "health promotion"
is limited to promoting health-related behaviours, with the
other "stuff" actually being "the new public health" would
we not be in the position of:

a) arguing that the nursing profession is limited to caring
for patients and clients and urging structural changes to
help nurses better care for them;
b) believing that social work is really only about
counseling and supporting clients with a concern about
structural issues that help social workers better care;
c) seeing occupational therapy as being only about assisting
people to lead productive lives and again, working to
imrpove the structure of caring services?
d) physicans should concern themselves with healing the
sick, etc.

I believe that at least some in all of these domains would
argue that part and parcel of their professions and their
activities is, in addition to working to support the
development of sensitive caring services, advocating for
policies that support their clients in a variety of ways
outside of their limited caring roles.  All of these ongoing
professions have as part of their training and in their
guiding principles, the responsibility to raise issues that
are fundamental to the well-being of all.

So, for example, an instrinsic part of social work training
is concern with social policy and the ramifications of
societal factors upon clients well-being. Indeed, the
principles of social work practice espoused in the US and
Canada state that it is the responsibility of social workers
to constantly raise these issues and understand their impact
upon the populations. This is done in the organization of
services, through involvement in the political sphere, and
through work with allied professions and interests.

If, the actual practice of social work is limited to
clinical intervention then this is a deficiency in the
profession, not something to celebrate. Ditto for medicine,
nutrition, and evryone else in the "service professions."

Now, should the field of health promotion (and health
promoters) voluntarily separate itself from the issues
called by Michel as the "new public health".  Is this not
a retreat into reducing the health of populations to "How do
we get people to act healthy?" There is much data, and a
rich theoretical and philosophical traidtion that suggests
this is a path laden with problems. Yes, people should eat
well, yes, people should not smoke, yes people should
exercise, yes people should cope, yes, yes, yes.  Is this
all there is, and should be to "health promotion". No!!

"To date, most policies in the area of health promotion have
supported healthy lifestyles.  Now we need to give more
emphasis to policies that create healthy living conditions
and work to ensure that the voices of society's least
powerful express their concerns in these policy areas."

Action Statement for Health Promotion in Canada, Canadian
Public Health Association, July 1996.

Available from: [log in to unmask]


Best wishes,

Dennis Raphael




Dennis Raphael, Ph.D., C.Psych.
Associate Professor
University of Toronto
Division of Community Health
Faculty of Medicine
Department of Behavioural Science
McMurrich Building, Room 101
Toronto, Ontario M5S 1A8
Tel: (416) 978-7567
Fax: (416) 978-2087
E-Mail: [log in to unmask]