RHP&EO is the electronic journal of the International Union for Health Promotion and Education

Can The Health Services Become More Holistic?

Elisabeth Fosse

University of Bergen, Norway

One of the headlines of the Ottawa-charter is to reorient the professions of the health services in a health promotion direction. In practice, this would implicate a more holistic approach to the issues of health, and it would implicate a certain degree of deprofessionalisation. I think this object could be contradictory to the rationale behind professionalisation. In this paper I will use the results from my Ph.d.-project to show how this can be the case.

I have been studying the implementation of a national programme that was initiated to stimulate local health services to give a higher priority to health promotion. My project is a qualitative study of local projects in five municipalities. I studied the projects for a period of five years.

The purpose of the programme was that health promotion should be given higher priority, both within the health services and across sectors. This meant i.a., that health should be a premise in the forming of public policy. The aim of the programme was, however, quite vague, and the municipalities themselves could decide what to do after the programme was over.

The programme had, however, little impact on health promotion activities in the municipalities.

One of the key questions is if the programme really could be expected to change the health services in a health promotion direction. Or more specifically: Was it realistic to expect that health professions should change the way they think and act?

Literature on professions and professionalisation has been one of the approaches I have used to interpret the process and the results of the programme. According to Abbott professions will try to achieve jurisdiction of a field or a task. So far, doctors have showed little interest in health promotion. Prevention has been the term that has been used, it has its basis in a bio-medical paradigm. In recent years, however, it has been suggested that the capacity of medical specialisation of public health should be increased.

Public health nurses is the most important professional group within the health services. However, other professions are trying to get jurisdiction over the field of health promotion.

My conclusion is that there are signs that health promotion could become a new field for professionalisation. Professionalisation seems to bee a strong force in the development of occupational groups. If this is so, it could be a difficult task to reorient the health services in a more holistic direction.

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