What are the goals of health promotion and the most apropriate means of achieving them? The prevailing view is that these goals are to prolong life and reduce mortality rates. Since the leading causes of morbidity and mortality are now largely attributable to lifestyle behaviorssmoking, diet, exercise, etc.the means of achieving reductions in heart disease, cancer, strokes, diabetes and other chronic conditins are to identify more effective techniques for changing people's behavior. Virtually all health promotion research is currently directed towards accomplishing this objective. But at what cost? As researchers strive for more effective ways to change people's behavior, what are the implications for individual autonomy, integrity, and responsibility? Buchanan sets out to explain why a science of health promotion is neither imminent or estimable. He argues that health promotin is inescapably a moral and political endeavor and that goals more befitting the realization of human well-being are to promote self-knowledge, individual autonomy, integrity, and responsibility through putting into practice more democratic processes of self-direction and mutual support in civil society.
Reviewer:Linda C. Baumann, PhD, RN, CS, FAAN(University of Wisconsin-Madison)
Description:The author of this book presents an alternative to the excessive reliance on the scientific method to analyze modern health problems and to design health promotion programs, which tend to be focused on more effective ways of changing people's behavior. In this instance, the author advocates a practical reasoning approach to improving human well-being to promote autonomy and responsibility that is mutually supported by society.
Purpose:The purpose is to advocate for a new way of thinking about promoting individual and community well-being. Because major health problems typically arise from social and behavioral factors, the author explains why health promotion is inescapably a moral and political endeavor. Human well-being is best achieved by promoting autonomy and responsibility through putting into practice the use of practical reason to gain self-knowledge, self-control, self-direction, and mutual support in civil society. These are worthy objectives in that the author's argument that health promotion goals are intricately tied to well-being and social well-being is convincing. He meets his objectives.
Audience:The book is written for practitioners in public health and behavioral medicine and is an excellent resource for graduate students in health science programs such as nursing, health education, and psychology. The author has a doctorate in public health and is an Associate Professor of Community Health Education in the School of Public Health and Health Sciences at the University of Massachusetts, Amherst. He is the founding director of the Office of Public Health Practice and Outreach, the principal investigator on the W.K. Kellogg Community-Based Public Health Initiative, and co-author of a book published in 1999 entitled Preventing AIDS Dogma, Dissent, and Innovation.
Features:The book is divided into two parts. In Chapters 1-4 the author describes the shortcomings of the scientific framework currently used in health promotion practice. In Chapters 5-9 he presents an alternative direction. In part one, the author argues that because of social and behavioral etiology, leading causes of morbidity and mortality are political and ethical issues. He provides a history of health promotion and discusses the pressure from a growing managed care system to most effectively change patient behavior as a means of controlling costs. In Chapter 3 the shortcomings of a positivist approach are presented, and Chapter 4 is a critique of pitfalls of the leading behavioral theories: social learning theory, social marketing, and empowerment. In part two, the practical reason approach is proposed as an alternative to the instrumental reason approach to health promotion. With his alternative framework, the author argues that human well-being is achieved through cultivating certain values. The value of mindfulness is essential for gaining self-knowledge, and the goal of health promotion is to encourage social practices that foster mindfulness about values that matter. In Chapter 7 he discusses the modern American erosion of trust and social solidarity that is usurped by a preoccupation with individual rights. Social practices need to be revived. In Chapter 8 he presents recommendations for health promotion practice, research, training, and program development; and in the final chapter he proposes that the sources of human well-being lie in promoting social practices that enable people to live more closely in tune with the values of justice, caring, and responsibility. This approach requires an ethical human relationship of caring as the central value of health promotion. A particularly interesting chapter is a critique of leading theories of behavioral change and the pitfalls and limitations of the predominant positivist approach to studying behavior change. I found no obvious weaknesses in the book and am not aware of similar publications.
Assessment:Personally, I enjoyed reading an eloquently presented discussion of the limitations of current behavioral theories that are used to guide health promotion practice. These theories were developed using very specific targeted outcomes for change, and may not be appropriate for changing behavior of populations of people without addressing critical human values that, in turn, impact society. This is a thoughtful and provocative book.