The following message is from Michel O'Neill, currently  at University of
British Columbia.  A similar message was also posted on the international
HEALTH-PROMOTION list-serv managed by Bo Haglund. Apologies for the
cross-posting!

Hi lists !

A couple of months ago, I posted an international call for information about
whether or not the debate currently going on in Canada on differences
between health promotion (HP) and population health (POPH) was going on
elsewhere.  I got 9 replies, 6 from Canada and 3 from Australia (just the
numbers and where the replies come from are interesting); thanks to those
who took the time to react ! The bottom line is that although there seems to
be a current debate going on in many quarters and countries about
evidence-based health promotion (this debate has been echoed recently by
many postings following up a request from New-Zealand in the
Health-promotion research list managed by Bo Haglund), it seems to have
taken the form of HPR vs POPH mainly in Canada. You will find below, in
bullet form (this is the English version of the overheads I intend to
present on June 10 in Montreal), the gist of my thoughts at this point in
time. I hope it is useful and contributes to the debate. Comments,
critiques,etc. more than welcome.

Merci beaucoup.

(Overheads begin here,each separated by a sting of asterixes)

********************
Health promotion vs. Population health: a difference of visions or
visionaries ?

by
Michel O'Neill, Ph.D.

Groupe de recherche et d'intervention en promotion de la sante (GRIPSUL),
Ecole des Sciences infirmieres, Universite Laval .
Visiting Scholar, Institute of Health Promotion Research (IHPR), UBC,
Vancouver.

4e conference pan-canadienne sur la recherche en promotion de la sante,
Montreal, 9-12 juin 1996

********
Structure of the argument:

Health promotion (HPR) vs. Population health (POPH): a difference of
 visions or visionaries ?

1) A critical perspective: why ? how ?
2) Context: HPR vs. POPH: a local debate ?
3) Theoretical et ideological assumptions
4) Contradictions: Why opposing the two ?
5) Power: the social position of the protagonist
6) Dialectics: toward a synthesis ?
7) Conclusion: Beyond turf wars

**************
A critical perspective: why ? how ?

A) Defending or analysing health promotion ?
*The organiser's demand
*The difference between green books

B) Why use the CSSPH (Eakin et als.,1996)?
* Sound epistemological formulation (reflexivity)
* Disseminate a "perspective in progress"
* Provides a useful structure for the paper

C) How I will use it here
* To present and defend a thesis
* Utilising the five CSSPH categories

Eakin, Joan; Robertson, Ann; Poland, Blake; Coburn, David; Edwards, Richard
"Toward a Critical Social Science Perspective on Health Promotion Research"
Health Promotion International , 11(2): 1996 (forthcoming issue)

************

Thesis:  between HPR and POPH is:

 - More a difference of visionnaries than one of vision.
 - A difference which has had and still has consequences.
 - The health of Quebecquers and Canadians calls for an alliance rather than
a turf war.

*****************

2) Context:Health promotion vs. Population health, a local debate

A) Global context: the constant rise of neo-conservatism since the mid-70's

B) Health promotion vs. Population health: mainly a canadian debate
(australian echoes: the Labonte effect ?)

****************

3)  Theoretical/ideological assumptions

A) Similar theoretical assumptions
*POPH discourse carried by one group (CIAR)
*HPR discourse carried by many groups  (HPR in Canada, CPHA)
*POPH discourse: the most recent reformulation of the public health
perspective
* Public Health: the basic context for HPR

B) Different ideological assumptions ?
*HPR social democrat,  POPH neo-conservative ?

*********************

4)  Contradictions: Why opposing the two ?

* Oppositions put forward by HPR
* POPH has ignored HPR movement
* POPH:replaced HPR at Health Canada and in several provinces
* POPH: classical vision of science, + politically acceptable
* HPR: more encompassing vision of science, =B1 politically acceptable

************

5-A) Power: the social position of the the actors in Health promotion (the
barefoot doctors)

* mostly women; low level local, provincial or federal civil servants,
professional or community practitionners, consultants and academics, usually
marginals  with little or no access to real political and economical powers

* a discourse coming from many quarters, often perceived as idealistic and
unclear, based on a marginal conception of science

5-B) Power: the social position of the actors in Population health (the
over-specialists)

 * mostly men; CIAR: the academic elite of major canadian universities; high
level civil servants and politicians; significant access to political and
economic elites

* an economicist and positivist discourse carried by one voice, perceived as
clear

*************************

6) Dialectics: toward a synthesis ?

* If historically HPR = thesis and POPH = antithesis, is a synthesis
 possible ?
* Yes because:
1) no distance on the content
2) little distance on the ideology
3) benefits  inconveniencs of alliance between the over-specialists and the
barefoot doctors of public health, notably to confront bio-medicine

**************

7) Conclusion: Beyond turf wars ?

* Difference between HPR and POPH: more a difference of visionnaries than
one of vision; a non-issue for most but the HPR establishment
* A difference which has had and still has consequences, replacement of HPR
 by POPH, with yet ambiguous (- and +) results
* Need for an alliance rather than a turf war; enough time spent on this
debate
* Three examples where both visions are integrated
* The usefulness of a CSSPH
*******************

Bonne journee !

*************************************************************************
Michel O'Neill, Ph.D.

Professeur titulaire, Ecole des Sciences infirmieres;
co-directeur, GRIPSUL;
4108-J, Pavillon Paul-Comtois
Universite Laval, Quebec, Qc
Canada, G1K 7P4
Telephone: +(1)-418-656-7431 Telecopieur (fax): +(1)-418-656-7747
Internet: [log in to unmask]

Co-directeur, Centre collaborateur quebecois de l'OMS pour le
developpememen=
t
de villes et villages en sante;
2400 D'Estimauville
Beauport, Qc
Canada, J3G 4M4
Telephone: +(1)-418-666-7000 #461 Telecopieur (fax): +(1)-418-666-2776
Internet: [log in to unmask]
****************************************************************************