Global Health Promotion

Global Health Promotion http://ped.sagepub.com/

Beyond the accolades: a postcolonial critique of the foundations of the Ottawa Charter Karen McPhail-Bell, Bronwyn Fredericks and Mark Brough Global Health Promotion 2013 20: 22 DOI: 10.1177/1757975913490427 The online version of this article can be found at: http://ped.sagepub.com/content/20/2/22 Published by: http://www.sagepublications.com

On behalf of:

International Union for Health Promotion and Education

Additional services and information for Global Health Promotion can be found at: Email Alerts: http://ped.sagepub.com/cgi/alerts Subscriptions: http://ped.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav

>> Version of Record - Jun 24, 2013 What is This?

Downloaded from ped.sagepub.com at Queensland University of Tech on June 24, 2013

490427

2013

PED20210.1177/1757975913490427Global Health PromotionK. McPhail-Bell et al.

Original Article Beyond the accolades: a postcolonial critique of the foundations of the Ottawa Charter Karen McPhail-Bell1, Bronwyn Fredericks1 and Mark Brough1

Abstract: Introduction: The Ottawa Charter is undeniably of pivotal importance in the history of ideas associated with the establishment of health promotion. There is much to applaud in a charter which responds to the need to take action on the social and economic determinants of health and which seeks to empower communities to be at the centre of this. Such accolades tend to position the Ottawa Charter as ‘beyond critique’; a taken-for-granted ‘given’ in the history of health promotion. In contrast, we argue it is imperative to critically reflect on its ‘manufacture’ and assess the possibility that certain voices have been privileged, and others marginalized. Methods: This paper re-examines the 1986 Ottawa Conference including its background papers from a postcolonial standpoint. We use critical discourse analysis as a tool to identify the enactment of power within the production of the Ottawa health promotion discourse. This exercise draws attention to both the power to ensure the dominant presence of privileged voices at the conference as well as the discursive strategies deployed to ‘naturalize’ the social order of inequality. Results: Our analysis shows that the discourse informing the development of the Ottawa Charter strongly reflected Western/colonizer centric worldviews, and actively silenced the possibility of countervailing Indigenous and developing country voices. Conclusion: The Ottawa Charter espouses principles of participation, empowerment and social justice. We question then whether the genesis of the Ottawa Charter lives up to its own principles of practice. We conclude that reflexive practice is crucial to health promotion, which ought to include a preparedness for health promotion to more critically acknowledge its own history. (Global Health Promotion, 2013; 20(2): 22–29) Keywords: health promotion, research, Ottawa Charter

Introduction The Ottawa Charter is undeniably of strategic importance in the history of ideas associated with the establishment of health promotion. There is much to applaud in a charter which responds to the need to take action on the social and economic determinants of health and which seeks to empower communities to be at the centre of this. In amongst the accolades generally attributed to the Ottawa Charter there have however been some occasional rumblings of discontent (1,2). In this paper we seek to avoid further hubris. We take up a postcolonial

stance in which the silences and assumptions apparent in the development of the Charter are examined using critical discourse analysis (CDA). We argue that such an exercise is crucial to a more reflexive health promotion practice able to recognize and challenge its own colonial underpinnings.

The Ottawa Conference and the Ottawa Charter for Health Promotion The first WHO International Conference on Health Promotion was held in Ottawa on 21

1. School of Public Health, Queensland University of Technology, Queensland, Australia. Correspondence to: Karen McPhail-Bell, Queensland University of Technology, Kelvin Grove Campus, Victoria Park Road, Kelvin Grove, 4059, Queensland, Australia. Email: [email protected] (This manuscript was submitted on 14 May 2012. Following blind peer review, it was accepted for publication on 17 December 2012) Global Health Promotion 1757-9759; Vol 20(2): 22–29; 490427 Copyright © The Author(s) 2013, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975913490427 http://ped.sagepub.com Downloaded from ped.sagepub.com at Queensland University of Tech on June 24, 2013

K. McPhail-Bell et al.

November 1986, as a concrete step toward Health For All 2000 and beyond (3). This conference saw the endorsement of the Ottawa Charter becoming the key establishing document of health promotion as a field of public health practice (4). Since then, the Ottawa Charter has taken on a ‘Holy Grail’ status. Religious metaphor has become common in emphasizing the significance of the Ottawa Charter, with references to it as a ‘mantra for health promotion workers’ (5) and ‘the new public health bible’ (6). Such reverence, though, can also serve to deflect the possibility for critique. Positioned as the first international conference on health promotion in the service of ‘Health For All’ are grand claims of universality and inclusivity. We question here the foundations of these claims. While the Charter itself commends strong principles of collaboration, advocacy and empowerment, it is not entirely clear that these ideals were reflected in the context of its production. We argue that the Ottawa Charter cannot be fully interpreted outside of the context of its production; hence, it is imperative that we question its assumptions and critically reflect on that moment in history.

Postcolonial standpoint We take up an explicitly postcolonial standpoint in this paper. Postcolonialism provides a framework that endeavours to destabilize dominant Western discourse and power (7). One of the central features of postcolonial theory is an examination of the impact and continuing legacy of European conquest, colonization and domination of non-European lands, peoples and cultures. It recognizes that colonial assumptions have widespread consequences for inequality and, as a form of anti-racist research, understands ‘colonial’ as being imposed and dominating, not simply foreign and alien (8). As such, central to postcolonialism is an analysis of ideas of and belief in Western superiority over nonWestern peoples and cultures (9,10). It also draws attention to the assumptions held by Westerners about the colonized and marginalized, including developing nations and Indigenous peoples. This involves critically analysing the assumptions of colonizers regarding the colonized, and the damaging effects of such ideas on the colonized. Using CDA as a tool we seek to critically (re)consider the discourse associated with the initial

23

development of the Ottawa Charter. This makes it possible to examine the hegemonic viewpoints (11) – a particularly useful aspect given the language used in health has meaning and significance beyond its literal content (12–14), and that the ‘new health promotion movement’ generated an associated new critical domain of knowledge and discourse (15). Thus, a postcolonial standpoint is critical for considering the way in which a particular neocolonial vision of global health was mobilized by the Ottawa Conference. Furthermore, a postcolonial standpoint enables attention to the possibility of colonization as part of health promotion practice, with an emphasis upon creating a decolonized way forward into the future (7,16,17).

Critical discourse methodology Methodologically this paper draws from CDA to emphasize ‘the role of discourse in the (re)production and challenge of dominance’ (18). A crucial element of this approach is to identify the enactment of power within the production of discourse. Here, the power to exclude or limit certain voices in order to privilege others is central to discourse as a segregating structure. Following Van Dijk (18) we understand this exercise of power to involve both the power to control the context of discourse production (such as through the exclusion of some participants from communication events) as well as the discursive strategies themselves which ‘naturalize’ the social order of inequality (19). Thus we take up the task of CDA here as involving both commentary on the control of the production of the Ottawa Charter discourse as well as discursive structures evident within the background papers of the Ottawa Charter. We argue that our concern with placing the Ottawa Charter within a broader context of its own production puts into practice a generalized principle of CDA to recursively move between text and context (20). Without this acknowledgement of context we fear that much of what has been said about the Ottawa Charter ‘discourse’ takes the Charter as an isolated piece of text. In this vein it is not surprising that the Charter is regularly idealized even within CDA literature, thus exemplifying ‘participatory democracy’, emphasizing people as ‘diverse and complex’ (see 21). Therefore, rather than focus on the text of the Charter itself we have focused on the context of its IUHPE – Global Health Promotion Vol. 20, No. 2 2013


24

Original Article

production. This was achieved firstly through a critical examination of the organization of the Ottawa Conference, including an official list of participants (22) apparently designed by the Conference organizing committee, and secondly via an analysis of the background papers prepared to inform the Ottawa Charter. In terms of providing an analysis of the discursive strategies evident in the development of the Ottawa Charter, we examined the background papers for the five sub-themes of the Ottawa Conference, dated October 1986 (23), comprising six papers: Strengthening Communities by Margaret Stacey (England) Creating Environments for Health by Trevor Hancock (Canada) Learning and Coping by Jean-Martin CohenSolal (France) Reorienting Health Services by Franca Ongaro Basaglia (Italy) Reorienting Health Services by Helmut Milz (Denmark) Building Healthy Public Policies: Focus for a New Public Health by Nancy Milio (U.S.A.) A reflexive approach throughout analysis was maintained by means of a reflective diary (24) and communication between the authors, in an attempt to document and share our evolving consideration of the relationship between text and context from a postcolonial standpoint. With an interest in how a Western-centric worldview operated within the background papers to inform the ‘new health promotion movement’, a coding scheme (25) was then developed comprising two major features: i) normalization of a Western view of health; and ii) exclusionary tactics regarding non-Western views. This schema was refined and adjusted in an initial testing process with particular attention to power structures (26).

Findings and discussion The colonial context of the Ottawa Conference As has already been noted, the Ottawa Charter is regularly referred to as a key global contribution to health promotion. Yet its own self-positioning is

somewhat ambiguous. Consider the Charter’s following statement: The conference was primarily a response to growing expectations for a new public health movement around the world. Discussions focused on the needs of industrialized countries, but took into account similar concerns in all other regions. (3) It is very difficult not to see a colonial imagination at work in a charter which is concerned with a global agenda, but based on the needs of (wealthy/Western) ‘industrialized’ countries. Moreover, the invisibility of Indigenous people within ‘industrialized’ countries within the background papers ignores history and belies the health inequality now faced by Indigenous people. The Ottawa Charter was positioned as building on an agenda established at Alma Ata by a much broader cross-section of both rich and poor countries (27,28), which emerged in a new political context including the presence of a decolonizing Africa and the influence of a global anti-imperialist and leftist movement (29,30). Thus, establishing the Ottawa Conference as taking forward this agenda in the interests of the global health but based on unmet needs in the West is an unlikely way to begin a shared global dialogue. The Charter has been critiqued for its top-down and WHO-dominated process of development, and for almost entirely focusing on industrialized countries (2). This sort of privileging was in part facilitated by the hierarchical processes of the Conference. For example, the Charter was withheld from Conference participants until the last day. Delegates were given time over lunch on the last day to provide feedback on the draft – with some participants apparently expressing ‘intense dissatisfaction’ with this very limited process of collaboration (1,2). Moreover, participation at the Ottawa Conference was by invitation only (1,22). It is alarming that in the development phase of an international movement led by the WHO and in the wake of the Alma Ata Declaration, a primarily privileged ‘club’ of 38 predominantly wealthy nations was fashioned to create a movement for addressing health inequality. A colonizer’s imagination was clearly at work here, though this has remained unacknowledged in the history of health promotion. In terms of Indigenous representation, there were but two: an Indigenous consultant from the First Nations Confederacy, in her

IUHPE – Global Health Promotion Vol. 20, No. 2 2013



capacity as an educator; and a participant from Research and Development in Health and Welfare Canada who referenced Indigeneity in their professional backgroundi (22). In this way, the process did not reflect the ideals of the Charter itself, reflecting instead the established global order of inequality. Although each conference participant no doubt brought with them their own ideas regarding health promotion, ‘…those ideas and the subsequent discussions in Ottawa would also be shaped by the reading material that greeted them’ (31). This is particularly significant given the power of language about health to position and create relationships among individuals, environments and institutions (21). Indeed, there was reportedly a feeling amongst conference participants that they were ‘…being managed by WHO to some extent, to produce the kinds of statements which WHO had already decided on’ (1). Indeed the background papers clearly established such a strong premise for the Charter that it is somewhat unclear the extent to which the conference itself functioned as a forum for further dialogue which might influence the Charterii. Personal histories, educational experiences, and scholarly training can shape interpretations, and it is recognized that Eurocentric academies have a history of failing to inform learners of the complete history of ideas and events that have shaped and continue to shape human growth and development (8).

Normalization of a Western view of health When examining the discursive strategies within the background papers, initially key categories, themes and terms were located, including recurrent or significant themes, to organize the data and bring a systematic order to the analysis (32). Immediately evident throughout the papers was a striking use of language claiming a collective view of humanity and health. Frequently, terminology such as ‘our ultimate health hazard’ (paper 1), ‘our health establishments’ (paper 1), ‘…we have moved… to feeling superior and dominating nature’ (paper 2), ‘…we rejoin humankind in past epochs and other cultures’ (paper 5), and ‘us all, especially the disadvantaged’ (paper 6) (italics authors) was utilized. Paper 2 provided a salient example of how the entire history of humanity is connected as one to the Homo habilis, ‘the oldest known member of the genus Homo’.

25

Such an all-encompassing reference depicts a global, homogenous population and implies underlying inclusion, respect, empathy, commonality and goodwill in its audience. By further sifting, comparing and contrasting the ways themes emerged, ‘interpretive repertoires’ (32) operating in the background papers could also be considered. This process revealed an inherent centrality of individualism, a key characteristic of Western culture in its tendency to separate human nature (e.g. body and mind) (33). For instance, the first paper assumed the dominance of individuality when claiming that WHO’s journey towards positive health would be ‘no simple matter… given the individualistic starting point’ based around ‘individual pathologies’. The second paper by Hancock also demonstrated an individualist world view in its placement of the individual in the influential Mandala of Health (34) as ‘…the central focus of our efforts’. This is in contrast to other models of health and wellbeing not referenced, such as Aboriginal models (for example from the National Aboriginal Health Strategy [NAHS] Working Party [35]), or other Indigenous models (for example, the Kwaio concept of wellbeing [36]). Thus, by way of excluding other health models and world views, the background papers worked to normalize Western individualistic neo-liberal assumptions and in so doing created a conceptualization of health promotion implicitly Western and neo-liberal in nature. Emotion and social identity categories also play an important role for constructing social actors, such as political authorities and, in this case, those who would contribute to the ‘evidence-based’ conceptualization of health promotion (26,37). The use of membership categories that united Western nations in the health promotion movement created a homogenous identity of the future, moving carefully between all-inclusive categories such as ‘global’, to categories distinguishing between developing and industrialized countries. These patterns of variation opened up moments of a multicultural possibility – albeit situated within a Western framework. For example, when arguing for equity in health, paper 6 drew emotionally laden contrasts between society members: ‘…an infant of an immigrant… a family of nationals…a black male pensioner… a white woman retiree… an unemployed single mother… a securely employed father’. Notably, even this example of IUHPE – Global Health Promotion Vol. 20, No. 2 2013


26

Original Article

diversity in social actors was situated within an assumption of a wealthy welfare state economy (38). Regardless, such a focus on difference can work to reconcile conflicting ideas, manage contradiction or uncertainty, and offer counter alternatives (32,39) – a useful tool for maintaining the positive frame of health promotion. Compared with the invoking of injustice, inequality and victim blaming, health promotion was thus positioned as a way to address inequalities and differing experiences of ill health, while still vested within a Western neo-liberal framework. The ‘representations of otherness’ evident in the papers worked to create a hybrid space that transformed particular peoples into a ‘subject’ upon which surveillance could be exercised, where the marginalized became a necessity for ‘worthy’ health promotion practice, while at the same time excluded as possible sources of wisdom (40). For example, Western knowledge was prioritized in paper 1 by predominantly utilizing Western examples to demonstrate proactive responses to health issues: UK’s Community Health Councils; a support group in Edinburgh; protesting housewives in South Wales; the Stuttgart community study and Heartbeat Wales; and the British National Health Service. Bhabha has discussed the valorization of spaces of mixing – spaces where truth and authenticity move aside for ambiguity. Such ‘hybridity’ is significant for knowledge production (41). Thus, just as the background papers implied there to be the homogenous Western ‘we’ and non-Western ‘other’, dominant and marginalized knowledge sets were inherently poised as binary opposites – and in doing so, their existence as homogenous entities perpetuated. Consequently, through the hybrid embrace and exclusion, health promotion became embedded with Western assumptions about what ‘we’ do for the ‘other’, who does not do for themselves.

Exclusionary tactics regarding non-Western views Despite the tone of collectivity mentioned above, the implicit assumption was clearly that the stories that mattered most were those from wealthy nations. Indeed, all six authors were from wealthy industrialized nations, drawing their examples from this privileged context in framing positive

health-promoting action. A case in point is paper 6, which included references to: Sweden’s Intersectoral Health Council; Australia’s National Health Forum; Germany’s National Committee for Health Education; Japan’s compulsory health insurance; and Ireland’s pre-planning for a multi-sectoral health policy. The exclusion of developing country and Indigenous voices may be associated with the way the privileged often ignore the role that they play in perpetuating inequality in health promotion practice (42). Further, through the essentialist power of this homogenous collectivity, normalized assumptions of the identity of ‘we’ were deployed strategically to discursively superimpose aspirations of an inclusive shared project, while at the same time camouflaging the hierarchical global order of power at work. The ‘positive’ positioning of health promotion also seemed to normalize professional intervention onto the weak or powerless ‘other’: the ‘wavering population… refusing to choose and change a number of everyday behaviours’ (paper 3), communities of developing nations requiring outside help to be ‘…awaken[ed]… against the oppression from which they suffered and its causes’ (paper 1), ‘the lower classes’ (paper 3) and so on. Such language was couched within a discourse of ‘enablement and empowerment’, global awareness and community involvement. In doing so, health promotion was established as a movement that ‘transcends traditional boundaries’, siding with the powerless by calling on ‘the need to revise the fundamental assumptions, concepts and attitudes of the health services’ (paper 5). However, it was also this very language that perpetuated an ambivalent marginalization of non-Western views. Such ambivalence implies colonial ‘mimicry’; that is, the partial recognition/representation of the colonial object, acting as a camouflage of difference by only partly resembling the other (43). Through this ambivalence, the ‘other’ is both desired – as a symbolic space required for a ‘worthy’ health promotion project – and yet excluded as a source of knowledge. For example, paper 1 included only one Indigenous reference regarding the struggle of ‘Amerindians’ to improve their health after dispossession, but did not elaborate on this. Further, the paper’s sole developing country example framed the Khonds at Gram Vikas in India as powerless and in need of an outside health team. This positioning




of health promotion as a form of external intervention and a noble enterprise, was woven throughout the background papers. Health promotion professionals were seen to be ‘…in the business of “doing good”’ (paper 1), working hard to address problems of the day as they ‘…wonder[ed] what devices should be used to meet these challenges’ (paper 3). Parallels can be drawn to the way missionaries, general practitioners, teachers and government workers wrote in the early colonial periods in, for example, India, Australia, America, Africa and so on (44,45). The process of implementing the background papers marginalized non-Western voices and created a space that gave strength and identity to health promotion as the ‘solution’. Perhaps so engrained was this ambivalence that the attitude remained evident even 20 years on, in the reflections of Ottawa Conference participants, who claimed ‘…if you did not [join the health promotion movement] yet, for your own health you better join…’ (46). Silences are of particular importance from a postcolonial standpoint (32). In reference to this, the papers were analysed with a ‘split’ approach by reading along with the meaning authors were creating, while simultaneously reading against the text’s intended flow to search out gaps and silences. As already alluded to, the silencing of the voices of developing nations and Indigenous peoples was manifest and their exclusion foreshadowed the continuance of a public health practice that narratively positioned marginalized recipient communities as needy and without agency or intellectual contributions. Indeed, the effect of this is evident where health promotion is at times practised as a neo-colonial enterprise that reframes Indigenous health in accordance with a Western, linear epistemology that excludes and conflicts with Indigenous knowledge systems and practice (47).

Conclusion In order to work collaboratively and respectfully, health promotion practitioners must turn their gaze from the ‘other’ onto themselves, to reflect critically on their own positions of privilege (48). By taking a postcolonial stance, this paper has used CDA to question the grand narrative of the first International Conference on Health Promotion, by way of

27

examination of its own production. A range of strategies were identified, revealing that the discourse informing the development of the Ottawa Charter masked underpinning power imbalances and Western-centric worldviews, while also silencing non-Western voices. We do not conclude that health promotion cannot be used for addressing health inequality, and indeed we are aware of the many emancipatory examples of community-based health promotion around the globe. However, we argue that a reflexive practice is crucial to this enterprise, including a preparedness for health promotion to more critically acknowledge its own history. Without this, health promotion becomes yet another form of neo-colonial practice. Thus, this paper calls for further consideration and action as to how the principles and values of health promotion may be practised upon itself, in an effort to realize the original vision of health promotion for all people. Acknowledgements The authors wish to acknowledge the intellectual contributions by Dr Chelsea Bond to this work.

Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Notes i.

ii.

This participant identified his expertise as being in the ‘…development, management and provision of primary health care programs for… Indian and Inuit peoples in Canada… as well as the Third World’. Other conference materials such as the agenda and conference report were unavailable from the World Health Organization. As such the authors cannot comment on the extent to which the background papers are from the imaginings and workings of the conference curators.

References 1. Raeburn J, Peters L. The first international conference on health promotion: A New Zealand perspective. Health Review. 1987; 6(4): 24–27. 2. Raeburn J. Ottawa Charter: Reflections from down under. Promot Educ. 2007; 14(suppl 2): 10. 3. World Health Organization. Ottawa Charter for Health Promotion. Ottawa, Canada: WHO; 1986. 4. WHO Secretariat. Global health promotion scaling up for 2015 - A brief review of major impacts and developments over the past 20 years and challenges for 2015. Background Document for the 6th Global IUHPE – Global Health Promotion Vol. 20, No. 2 2013


28

5.

6.

7. 8.

9. 10. 11.

12. 13.

14.

15. 16. 17.

18. 19. 20. 21.

Original Article

Conference on Health Promotion in Bangkok, Thailand. Unedited Working Paper. Bangkok, Thailand; 14 July 2005. Baum F, Sanders D. Can health promotion and primary health care achieve Health for All without a return to their more radical agenda? Health Promot Int. 1995; 10(2): 149–160. Baum F. The new public health evolves. In: Baum F (Ed). The New Public Health (3rd ed). South Melbourne, Australia: Oxford University Press; 2008: 31–67. Gandhi L. Postcolonial Theory: A Critical Introduction. Sydney, Australia: Allen & Unwin; 1998. Sefa Dei GJ. Critical issues in anti-racist research methodologies: An introduction. In: Sefa Dei GJ, Johal GS (Eds). Critical Issues in Anti-racist Research Methodologies. New York, USA: Peter Lang; 2005: 1–27. Ashcroft B, Griffiths G, Tiffin H. Post Colonial Studies: The Key Concepts (2nd ed). Milton Park, UK: Routledge; 2007. Hall S. The west and the rest. 1996. Edley N. Analysing masculinity: Interpretive repertoires, ideological dilemmas and subject positions. In: Wetherell M, Taylor S, Yates SJ (Eds). Discourse as Data: A Guide for Analysis. London, UK: The Open University; 2001: 189–228. Foucault M. The Birth of the Clinic: An Archaeology of Medical Perception (Translated from French first published 1963). New York, USA: Vintage Books; 1975. Aldrich R. Flesh-coloured Bandaids: Politics, Discourse, Policy and the Health of Aboriginal and Torres Strait Islander Peoples 1972–2001 Faculty of Medicine. Sydney, Australia: University of New South Wales; 2006. Aldrich R, Zwi AB, Short S. Advance Australia Fair: Social democratic and conservative politicians’ discourses concerning Aboriginal and Torres Strait Islander Peoples and their health 1972-2001. Soc Sci Med. 2007; 64125–137. Robertson A, Minkler M. New health promotion movement: A critical examination. Health Educ Behav. 1994; 21(3): 295–312. Moses AD. Time, indigeneity, and peoplehood: The postcolony in Australia. Postcolonial Studies. 2010; 13(1): 9–32. Moreton-Robinson A. Epistemic violence: The hidden injures of whiteness in Australian post-colonising borderlands. In: Petrilli S (Ed). White Matters: Il bianco in questione. Rome, Italy: Meltemi editore; 2007: 299–312. van Dijk TA. Principles of critical discourse analysis. Discourse & Society. 1993; 4(2): 249–283. Fairclough NL. Critical and descriptive goals in discourse analysis. J Pragma. 1985; 9739–9763. Luke A. Beyond science and ideology critique: Developments in critical discourse analysis. Annual Review of Applied Linguistics. 2002; 2296–110. Porter C. Ottawa to Bangkok: Changing health promotion discourse. Health Promot Int. 2006; 22(1): 72–79.

22. World Health Organization. An International Conference on Health Promotion: The Move towards a New Public Health - List of Participants. Ottawa, Canada: World Health Organization, Health and Welfare Canada, Canadian Public Health Association; 1986. 23. World Health Organization. An International Conference on Health Promotion: Background papers. Ottawa, Canada: WHO; 1986. 24. Cardano M. Ethnography and reflexivity: Notes on the construction of objectivity in ethnographic research. NetPaper: Dipartimento di Scienze Sociali. 2009; 1. 25. Seale C. Coding and analysing data. In: Seale C (Ed). Researching Society and Culture (2nd ed). London, UK: SAGE Publications; 2004: 305–321. 26. Reisigl M. Analyzing political rhetoric. In: Wodak R and Krzyzanowski M (Eds). Qualitative Discourse Analysis in the Social Sciences. London, UK: Palgrave Macmillan; 2008: 96–120. 27. Catford J. Health promotion’s record card: How principled are we 20 years on? Health Promot Int. 2004; 19(1): 1–4. 28. World Health Organization. Declaration of Alma-Ata. The International Conference on Primary Health Care. Alma-Ata, USSR: WHO; 1978. 29. Cueto M. The origins of primary health care and selective primary health care. Am J Public Health. 2004; 94(11): 1864–1874. 30. Venediktov D. Primary health care: Alma Ata and after. World Health Forum. 1998; 19(1): 79–86. 31. Hills M, McQueen DV. At issue: Two decades of the Ottawa Charter. Promot Educ. 2007; 14(5). 32. Tonkiss F. Analysing text and speech: Content and discourse analysis. In: Seale C (Ed). Researching Society and Culture (2nd ed). London, UK: SAGE Publications; 2004: 367–382. 33. Smith LT. Decolonizing methodologies: Research & indigenous peoples. Dunedin, New Zealand: University of Otago Press; 1999. 34. Hancock T. The mandala of health: A model of the human ecosystem. Fam Community Health: 1985; 8(3): 1–10. 35. NAHS Working Party. National Aboriginal Health Strategy. In: National Aboriginal Health Strategy Working Party (Ed). Canberra, Australia: Commonwealth of Australia; 1989. 36. MacLaren D. Culturally appropriate health care in Kwaio, Solomon Islands: An action research approach. School of Public Health, Health Group. Brisbane, Australia: Griffith University 2006: 367. 37. Fairclough N. Discourse Analysis: Textual Analysis for Social Research. New York, USA: Routledge; 2003. 38. Raphael D. The political economy of health promotion: Part 1, national commitments to provision of the prerequisites of health. Health Promot Int. 2011. 39. Wooffitt R. Conversation Analysis and Discourse Analysis: A Comparative and Critical Introduction. London, UK: SAGE Publications; 2005. 40. Bhabha HK. The other question. Screen. 1983; 24(8): 18–36. 41. Young RJC. Colonial Desire: Hybridity in Theory, Culture and Race. London, UK: Routledge; 1995.




42. Stephens C. Privilege and status in an unequal society: Shifting the focus of health promotion research to include the maintenance of advantage. J Health Psychol. 2010; 20(10): 1–8. 43. Bhabha HK. The Location of Culture. London, UK: Routledge; 1994. 44. Said EW. Orientalism. New York, USA: Vintage Books Edition; 1979. 45. Sefa Dei GJ. Indigenous knowledge studies and the next generation: Pedagogical possibilites for anticolonial education. The Australian Journal of Indigenous Education. 2008; 37(Suppl): 5–13.

29

46. Saan H. Ottawa 1986 revisited. Glob Health Promot. 2007; (17579759): 11–13, 59–60. 47. Sherwood J, Edwards T. Decolonisation, a critical step for improving Aboriginal health [Paper in special issue: Advances in Indigenous Health Care: Building Capacity Through Cultural Safety in Australia, New Zealand and North America]. Contemporary Nurse. 2006; 22(2): 178–190. 48. Max K. Anti-colonial research: Working as an ally with Aboriginal peoples. In: Sefa Dei GJ, Johal GS (Eds). Critical Issues in Anti-racist Research Methodologies. New York, USA: Peter Lang; 2005: 79–94.

