Articles/1997/2
RHP&EO is the electronic journal of the International Union for Health Promotion and Education

Editorial: Health promotion settings

Maurice B. Mittelmark
Department of Psychosocial Sciences and Research Center for Health Promotion
School of Psychology, University of Bergen
Bergen, Norway

Phone: +47 55 58 32 51; Fax: +47 55 58 98 87
E-mail:maurice.mittelmark@psych.uib.no

Mittelmark, M.B. Health Promotion Settings. Internet Journal of Health Promotion, 1997. URL: ijhp-articles/1997/2/index.htm

The paper by Eberhard Wenzel addresses a very important issue: are settings merely places where one finds people whose behaviour needs changing (the cynical view), or are settings important forces on behaviour such that research and intervention on settings (not just on the people in them) are worthy objectives? Or both?

Having acknowledged the significance of the paper's topic, I must also say that I am more than a little troubled by the way in which Wenzel has chosen to set the topic up. The critique of Baric's `mechanistic' view of settings sets up, unnecessarily, a straw man that detracts from Wenzel's main point. This straw man depicts Baric, and WHO-Europe, as supporting a very simplistic, mechanistic, and paternalistic approach to settings, one in which the objective is to change the behaviour of people, who just happen to be found conveniently in settings such as schools, work places, and so forth.

No one I know of in WHO or in academic health promotion thinks about settings in this way. For a fairer description of current thinking, readers may turn to the Sundsvall Statement on Supportive Environments for Health, that summarizes the Sundsvall (Sweden) Conference, held 9-15 June, 1991, which Wenzel refers to only in passing, as a contrast to Baric.

For those who don't have a copy handy, let me abstract a few key points: The concept of supportive environments refers to the physical and social aspects of our surroundings including where people live, their local community, their home, and where they work and play. Supportive environments provide access to resources for living and opportunities for empowerment. Thus, action to create supportive environments has many dimensions including physical, social, spiritual, economic, and political.

I contend that this is much more typical of current thinking about settings that any mechanistic view. So why the focus on the Baric citation, except to be provocative?

This provocative stance detracts from Wenzel's main point as I understand it -- the properties of settings themselves are too rarely objects of regard with reference to their health promoting and health damaging properties. Wenzel describes convincingly how the perspectives and traditions of behavioural ecology and the ecology of human development could be drawn on to develop health promotion research and action that would focus on settings as forces on peoples' behaviour, health and functioning.

Wenzel concludes: "Despite the lip-service paid to settings, we have not yet been able to come up with realistic descriptions of settings, which we believe to be crucial to the development of living conditions and lifestyles conducive to health." The tone of this concluding remark is that "we" have made half-hearted attempts, if any, to deal with an issue that "we" are far more comfortable giving mere lip service to. Who are "we"? If academic health promotion does not take the lead, who else can? I challenge Wenzel to follow the present paper with a second offering, one which describes in detail the opportunities for, and challenges of, developing ecologically-oriented programs of health promotion research. The health promotion arena needs to be educated regarding the potential of such an approach. Enough provocation.

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