Health promotion, health promotion, where fore art though health promotion?
The rise of the oxymoronic preventive health and the invisibilisation of health promotion
Lily O’Hara Emirates College for Advanced Education Abu Dhabi, United Arab Emirates
[email protected]
Jane Taylor University of the Sunshine Coast, Australia
Margaret Barnes University of the Sunshine Coast, Australia
Overview 1. Background 2. Research design 3. Results
4. Conclusion
1
Background
Naming things • Both shapes and reflects our feelings, judgements, choices and actions • Dietitian – Nutritionist • Health Promotion – Health Improvement – Health Advancement • Not just semantics 6
Changing discourse in health promotion • Major shift since 1986
• Then: socially proactive health promotion in the Ottawa Charter for Health Promotion • Now: biomedically defensive form of health promotion
7
Knowledge gap
LILY O’HARA
2
Research design
Research design Epistemology • Constructivist
Theoretical Perspective • Critical theory
LILY O’HARA
Theoretical Framework • Critical systems heuristics
Methodology • Multimedia critical discourse analysis
Critical discourse analysis • Critique text for evidence of power and ideology
• Used to reveal ideas, absences and assumptions • Identify power interests buried within texts • Purpose: social change
Critical discourse analysis Role of power and ideology in supporting or disturbing the discourse Rhetorical, lexical and visual strategies particularly wrt claims-making Actual words and images LILY O’HARA
Multimedia critical discourse analysis • Broad definition of text • Includes words, pictures, symbols, ideas • Vocabulary, grammar, sentence structure, visuals and overall structure of the text • Enriches our understanding of the way words and imagery are used to prosecute an ideological agenda
Data • 10 weight-focused public health initiatives
• Implemented by Australian Government between 2006 and 2013 • Policy, policy development documents, social marketing campaigns, parliamentary inquiry report and government response
Documents analysed • Policy: Healthy Weight 2008 • Development of National Preventative Health Strategy • Social marketing campaigns
• Parliamentary inquiry
Documents analysed • Development of National Preventative Health Strategy o Australia the Healthiest Country by 2020 Discussion Paper
o Technical Report on Obesity o National Preventative Health Strategy Overview o National Preventative Health Strategy Roadmap
o Government response: Taking Preventative Action
Documents analysed • Social marketing campaigns o Measure Up o Swap It, Don’t Stop It
• Parliamentary inquiry o Inquiry report: Weighing it up: Obesity in Australia o Government response
3
Results
Use of terms • Health promotion • Illness prevention or disease prevention
• Preventive health or preventative health • 437 total uses (excluding use in titles) • Each term most likely to be used alone
Use of terms • Disease prevention:
10 uses
• Preventive health:
360 uses 82.4%
• Health promotion:
51 uses
11.7%
• Health promotion coupled with prevention-oriented:
16 uses
3.7%
2.3%
400
350 300 250 200 150 100 50 0 Disease prevention
Preventive health
Health promotion
Prevention and health promotion
Weighing it up Govt Response
Weighing it up Taking Preventative Action Roadmap Overview
Obesity Technical Report Discussion paper Healthy Weight 0
Health promotion
20
40
60
Prevention and health promotion
80
100
120
Preventive health
140
160
Disease prevention
180
200
180
160
140
120
100
Health promotion 80
Preventive health
60
40
20
0
Discussion paper
Obesity Technical Report
Overview
Roadmap
Taking Preventative Action
Health promotion • • • • • •
51 uses of health promotion alone 37 of 51 referred to programs, strategies and activities 20 of 37 refer to workplace health promotion 39% of the total uses Settings for preventive health discussed frequently Health promotion terms for other settings based programs not used
4
Conclusion
Preventive health • Dominant term • Draws on biomedically reductionist concept of prevention • Attempts to remove negative disease connotation by coupling it with positive term ‘health’ • Oxymoronic or just moronic???
Evolving terminology or changing ideology? • Depoliticised ‘preventive health’ discourse
• Consistent with retreat of the welfare state • Why workplace health promotion? • Liberal, capitalist / corporatist ideology
Evolving terminology or changing ideology? • For profit companies providing individualist health risk assessments
• Weight loss companies targeting workplaces • Powerful economic incentives for companies to advocate for workplace health promotion • Limited opportunity for companies in non profit sectors such as schools, hospitals and cities
Consequences • Invisibilise or remove recognition from health promotion as a discipline and practice • Personally and professionally confronting • Serves to devalue the principles of modern health promotion
Thank you
