The Social Significance of Health Promotion

The Social Significance of Health Promotion

The Social Significance of Health Promotion

The Social Significance of Health Promotion


This volume sets out the long and fertile history of health promotion and delineates its contemporary role. It goes on explore the potential of health promotion to impact on our social values and sense of community.


A massive change in attitudes to healthcare paradigms began to make itself felt in the West with the coming of age in 1974-1982 of health promotion. Prior to that time, ‘health’ was pretty well seen as being an objectively measurable phenomenon and the right and proper domain of biomedically trained scientists, principally doctors of medicine in its various tightly defined specialties. As I have shown in various analyses, health promotion was by no means an invention of the 1970s—it has been with us for as long as the history of medicine itself—but the appreciation of what its role could be was seriously reconsidered in 1974 (by the signal work of Marc Lalonde) and then this was reinforced and systemised by WHO in 1982.

In order to understand the tone and content of what follows in this book, let me explain what health promotion is and why it now plays the crucial role it does. The very demanding reductionist training required of scientific biomedicine unavoidably created a major ‘participation barrier’ between clinical practice and the capacity for lay people to make effective and informed use of it. Throughout much of the nineteenth and early twentieth centuries the great medical battles for public health were being fought and won. The refinement of microscopy, for instance, heralded immense strides in bacteriology and the control of specific disease states. Public health was put on a rational and programmatic basis with the development in our great cities of sewerage systems and the like, and with the elaboration of legislation about health and safety in the workplace, food distribution, etc.

But obviously, as major advances were made in scientific medicine, the ‘participation barrier’ between the healers and the sick became ever greater. Advanced liberal democracies spent increasing proportions of their GNP on improvements to public health, largely by putting more and more funding into the professional biomedical side of the equation until it became obvious (in the 1970s) that such a use of public health money was becoming less efficient in terms of its returns in the form of an increasingly healthy population.

It was only then that questions were seriously considered relating to how the public’s use of existing biomedical expertise could be rendered more efficient. Participation had to be re-invigorated. Space does not allow me to deal . . .

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