Dear Everyone,
Hi! Thanks to those who responded to the previous posting about the possibilities
of identifying standards, criteria, or "best practice" norms (including specific
values, principles, and strategies) in health promotion practice. (Responses are
still welcome!) Here are a few more questions.

1. Are health promotion guidelines/criteria etc. a good or bad idea? What are the
dangers of having them? What are the dangers of not having them? (What are the
benefits of having them/not having them?) Is consensus around guidelines
something to aim for/is it possible? Is there intrinsic value to having health
promotion guidelines beyond that of satisfying funders that standards etc. are
being followed - will health promotion guidelines/criteria/best practice norms help
facilitate the increased control of individuals and communities over the
determinants of health?

2. One of the major questions I am struggling with is this - what ways of people
working together are consistent with health promotion philosophy? This of course
assumes there is an accepted health promotion philosophy. (I must say I find this
all very complicated!) When I think of people working together in ways that are
consistent with my idea of health promotion philosophy (which I realize is probably
not everyone's), I think of cooperation-based non-authoritarian non-hierarchical
structures and processes. But when I look at many health promotion organizations
I see stratified management/employee set-ups with some people by virtue of their
position having more power and authority than others, as well as getting more
money than others. I see discussion of worker empowerment but it is still in a
context where there are managers and those being managed, and while I suppose
there are degrees of empowerment, I wonder if there can be full empowerment
when others have the final say about something (even if they choose not to
exercise that authority in a particular situation). Should people working in health
promotion be working towards different kinds of formal and informal relationships
in their workplace - what about self-management and rotating coordination and
concerted efforts towards skill and knowledge sharing? I realize there are all sorts
of logistical questions that would have to be worked out, and I should say that I am
not advocating that everyone in a workplace have an equal say about every single
issue. What I am wondering is if maybe the power and authority to make decisions
should be not according to hierarchical position but according to other factors, for
example, (a) how affected a person will be by the consequences of a particular
decision, (b) how involved a person will be in implementing a decision, or (c) the
level of a person’s expertise and knowledge specific to the particular issue being
decided (giving recognition to all the different kinds of knowledge there are, not just
professional or academic but experiential as well). I realize I have gone on for
some length so maybe I should summarize - what I am wondering is: How would a
vision of working together in a health promotion kind of way be articulated? Would
it be non-authoritarian and non-hierarchical (and non-paternalistic) in structure and
process, or is a management/employee division consistent with health promotion
philosophy and principles, or are there other possibilities? And so on!

I would really appreciate any comments, opinions, ideas, thoughts, insights,
anyone has on these questions. (I have another burning question but have run out
of steam so will wait a bit before I ask it, watch for it!). I really would like to
understand the issues more, not just for the project I am working on but in a very
personal way as someone who might be out there doing health promotion work one
of these days (months, years).

Hope everyone is having a great weekend,
Barbara Kahan
graduate student in health promotion at the University of Toronto
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