> Thank-you David and Rhonda for a stimulating exchange. If I might enter the
> fray, I'd like to offer a few comments/observations:
>

Dear Blake,

I'm delighted you could join us!

> * I think that David makes very valuable points about the need for
> reflexivity in theory and practice of health promotion, and about the
> potential for 'false consensus' when people choose not to be explicit about
> their values, ethical stance, and world view (or these remain hidden behind
> 'motherhood' statements that are perhaps too open to being coopted by those
> with radically opposed ideological stances because they are not
> sufficiently explicit about their ethical base).
>
> * however, implicit in your line of argumentation, David, is an essentially
> modernist call for consensus on what health promotion is in the context of
> a postmodern panopoly of perspectives and voices.

You are wrong about this Blake.  I am not calling for consensus.
Quite the opposite in fact - at the moment we have a false consensus
made possible by ambiguity.  Here's what I say on page 5 of _Health
Promotion: Philosophy, Prejudice and Practice_.


"Mature human enterprises are shaped by theories of purpose.
Professions worthy of the name take the trouble to think out
substantial theories about why they do what they do.  Science,
education, technology and law each have carefully crafted and
well-established philosophies.  Of course each profession has
several theories about its nature and purpose, and there are
disagreements between advocates of the different philosophies.  But
this is all to the good since it is necessary for each competing
philosophical school to develop the very best justification for its
account of the profession's purpose, and for its description of best
practice.  A plurality of rationales is a sign of a reflective
profession (or at least of a profession where serious reflection is
a constant possibility).  Moreover, where theoretical pluralism
exists any researcher or policy-maker worth her salt should feel
duty-bound to explain what basic kind of advance or change she is
seeking.  That is, she should feel obliged to indicate which
theoretical tradition her practical proposal is built on.

But at the moment this is not possible in health promotion.
Fundamental theoretical reflection cannot take place.  Although
health promotion has many theories of process (theories about how
best to perform X, theories about why method A is more effective in
achieving goal C than method B, and so on) it possesses not one
sustained account of its purpose.  Theories of health promotion of
equivalent substance to theories of science or jurisprudence are
strikingly absent.  There is much rhetoric, countless gestures to a
healthier world for everyone, but scant attention to the bed-rock
question 'what is the point of promoting health?'  And unless this
situation changes health promotion is surely heading for a mighty
fall.

        The Purpose of This Book

This book is an attempt to show the source
and full nature of the difficulties facing health promotion
theorists and practitioners, and to offer a theoretically sound way
forward - to indicate one route by which a serious discipline might
come into being.  The book argues that health promotion does not
just happen, nor is health promotion always unquestionably a good
thing.  Rather all health promotion is prejudiced - it is all based
ultimately on human values of some kind and is, therefore,
ultimately inspired by political philosophy - even if health
promoters are unaware of it.  The theory offered in Part III of this
book is no exception, but makes a virtue of its prejudice by
acknowledging it and using it to set limits on those health
promotion interventions carried out under its aegis.

If health promotion is to mature, other thinkers must offer other
theoretically justified (not just rhetorical) ways forward.  There
must be deep and continuing dialogue between the different
theorists, and there must then either be unity in the profession or
- as is much more likely - markedly different types of health
promotion must emerge.  And as this happens health promotion must
remain (or become) of practical use.  This is certainly a tall
order, but it is not out of the question.  Perhaps this book will
mark the beginning of the end of health promotion's adolescence."


I hope that shows that we agree on this point.


>I think many people in
> this field feel torn between desiring a more coherent consensus on the
> goals, world view, and methods of health promotion (and the legitimacy it
> is hoped this might portend in the eyes of those who may currently dismiss
> health promotion as 'wooley', inconsistent, overambitious, etc), and on the
> other hand, a profound unease about the prospect of an
> artificial/imposed/engineered consensus or 'grand narrative' that
> constructs health promotion in much narrower terms and in the processes
> silences many voices and perspectives that reflect the full diversity of
> the world we live in. I seriously doubt that consensus on the nature of
> health promotion will make it an more palatable to those who oppose it; the
> nature of their objections will simply change to allow for their continued
> opposition, because in many cases their objections re scope, vagueness etc
> mask a deeper-seated but rarely articulated discomfort with the ideological
> stance embodied in the type of health promotion Rhonda is talking about
> (more explicitly oriented towards social justice).

Again we are in agreement.  I am urging a much more explicit and
well-argued advocacy of health promotion as a practical movement for
social justice.  There are certain other 'voices' in health promotion
(named and criticised rather robustly in the book!) that seem to be
wanting this too - but close inspection of what they say and
recommend shows them to be deeply conservative and for the status
quo. It is only by forcing the issue - by getting the different
theories out in the open - that we will be able to move on.

I envisage a time where health promoters will be able to say "I am a
an 'egalitarian health promoter'", or "I am a 'conservative health
promoter'") (or catchier labels than this!) etc.  These labels will
then mean something substantial - the differences will be clear - and
people -both providers and receivers - will be able to decide what
sort of health promotion they want.

>
> * while I agree with you David that "clear thinking" (critical thinking) is
> vital (not just in health promotion, but in all aspects of life), I am less
> convinced that it need be in service of definitively arbitrating the nature
> of health promotion. Precisely because values and politics infuse virtually
> all aspects of human endeavor (not just health promotion), critical
> thinking about implicit values, assumptions, perspectives, agendas and
> so-forth is vital on an ongoing basis as part of being clear for oneself
> and to others about our own ethical stance in our practice, even as we
> disagree about what we construe health and health promotion to be
>

Agreed - in fact your last sentence is exactly what I'm trying to
say.  We are not yet clear enough about our moral commitments -
either to ourselves or others - and we must try to improve this
situation.  As we do, disputes and controversies will become clearer
and health promotion will move on - much for the better in my
opinion.

> * I think that some of what people are reacting to in what David writes is
> not so much the contention that theory and practice are value-bound and
> political, but rather his sweeping portrayal of health promotion
> practitioners as naive, uncritical and misguided... which may be perceived
> as dismissive, pejorative, and patronizing.  I for one would be much
> relieved if David you could share your excellent ideas and profound
> challenges to the profession in a gentler, more supportive and encouraging
> manner...

I don't think health promotion practitioners are naive and
uncritical, but I do think that we are misguided - by which I mean
that we are guided not by theories (plural) of our own making but by
forces and traditions that are often very happy to have us either
work ineffectively or carry out projects of their choosing not ours.
Powerful interests want and promote ambiguity in the less powerful -
they prosper to the extent that they can manipulate us, and it is
easier to manipulate people who are unclear about their basic
purposes.

I receive many letters from people who are grateful for my quest for
clarity.  For example, here is a note I received today:

BEGINS:

Best Mr. Seedhouse,

I write to You in regards to the book "Health Promotion, Philosophy,
Prejudice and Practice". I want to thank You for writing the book that
is the best book that I have read within the area of health promotion.
I read it when I was totally confused about the health promotion
issue, and it helped me to structure my thoughts and to complete my
paper in Public Health/Health Promotion at XXXX Instiutet this
spring.

ENDS

I've removed identifiers for the usual reasons.

This is a typical response to my stuff, and is the reason I wrote
it.  (There is another sort of typical response - a less favourable
one - but we'll let that pass at the moment!!)

I am deeply committed to improving health promotion and so I think it
is a little unfair to say that I'm dismissive.  It is true that I
have little time for confused thinking, and even less for the
preening and posturing that one finds everywhere in academia, but I
spend endless months on these issues because they are so important.

I hope my work doesn't sound patronising either.  It isn't meant to
be.  It is simply honest - or at least that's what I intend.  I tell
it as I see it and hope something good will come of it.

It sounds to me that this is what you do too Blake, and indeed is
what most health promoters do.  And because of this I am certain that
we will move on and in the end mount increasingly successful
challenges to the debilitating iniquities a handful of shamelessly
selfish, small-minded people are imposing on us these days.
>
>
> Thanks for the opportunity to share. I look forward to people's feedback
> and ongoing debate.
>

Thank you.  I hope we can continue this debate.  I hope others will
join in too.

With best wishes



David Seedhouse