RHP&EO is the electronic journal of the International
Union for Health Promotion and Education
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From medical model to a critical social science perspectiveby Louise Rowling, University of Sydney Rowling L., From medical model to a critical social science perspective, Reviews of Health Promotion and Education Online, 2002. URL: reviews/2002/6/index.htm. Shifts and twists in theory and practice in health education and promotion over two decades of my career in the field, emerged as I set about the long overdue task of selecting my five favourite resources. I first thought I would look at the resources on my shelf that looked the most worn, the resources that despite their age I keep returning to as I carry out research, write, teach and work with graduate students. In making that selection I decided to also include resources that set new pathways for me. A long and winding path opened up before me, a path I continue to tread when I read Ian Young and Trefor William's (1989) seminal work The Healthy School. Prepared over a decade ago it set the stage for a shift in practice that has occurred in Europe, Canada, Australia and New Zealand from school health education, to health promotion in schools, to health promoting schools. A comprehensive triadic framework of: health education curriculum; school ethos; and family and community involvement was proposed. Whilst the labels for these areas can vary, the framework remains pertinent today and has shaped many projects globally. Firmly grounded in both educational and health education/promotion research, it offered a new way of improving the conditions that create a healthy school community. It put the needs of staff and parents firmly on the agenda along with the necessity for involvement of other stakeholders. It set the stage for a reorientation in school health from sole focus on risk factors and health problems to focussing on the impact of the setting on health. Travelling the health promoting school path I encountered one of the modules of Leo Baric's trilogy of books Health Promotion and Health Education in Practice, Module 2, The Organisational Model (Baric, 1994). This text contains a historical overview of the field, as well as the theoretical underpinnings that contributed to understanding the shifts in conceptualisations and practice in the early 1990s. The two sections that were of enormous value were on the Organisational Model and Health Promoting Settings, particularly in setting direction for my health promoting schools work. Here organisational theory was used as the theoretical basis to inform the change from a medical model to a 'settings approach'. The critical perspective evident through the writing as well as the careful analysis of underlying values and language have been invaluable to me in penetrating the multi-disciplinary perspectives that are encountered in research and practice in health promotion. This acceptance of a multi-layered understanding represented a change from the 'black and white' of a medical model to the 'grey' of the critical social sciences. The community level focus of this changed practice was well elaborated in Neil Bracht's edited book, Health Promotion at the Community Level (Bracht,1990). The text is firmly grounded in an ecological view of health and focuses on enabling communities and social and political action. The structure of the book moves from theory and concepts to an analysis of communities and partnership formation; community interventions, evaluation and case studies. The book offered a breadth and depth that was needed in community health promotion at this time. Critics labelled this concern with community participation and action as 'soft', a label still applied to some forms of health promotion, but this text and its more recent edition (Bracht,1999), provided a validation for those committed to valuing the active involvement of community participants in creating the conditions for health and in the shift in power base. The latest edition articulates the challenges of social action for health with international examples of practice, and reinforces the earlier emphasis on community participation. An amusing and insightful illustration of the importance of the community in health planning is demonstrated in the companion video 'The Best Laid Plans' in an Australian resource kit 'Planning Healthy Communities' (SACHRU, 1991). The video demonstrates two health promotion professionals conducting a needs assessment in 'Anytown'. We follow the workers as they 'consult' the community about their needs using the same questionnaire from another project because "you have got to do a needs assessment before you spend millions of the taxpayer's money". They have to collect 'evidence' that the community wants 'the multi-function human resources center' that the government has planned. The younger worker is sceptical of a 'one size fits all' process and questions whether this center is what the community needs. Members of the community find out about the process and carry out their own assessment following guidelines in a manual from the local library the 'Planning Healthy Communities' kit. The video ends with the health promotion staff finalising their report and being informed that community members have sent their report to the Minister as well giving the results to the newspapers. The question of 'evidence' brings me to my final resource The Handbook of Qualitative Research (Denzin and Lincoln, 1994). Written from a multi-disciplinary perspective, as a handbook, it contains in one volume what you need to know about qualitative research, if you were stranded on a desert island. Having made the shift in my own research to privileging the 'voices' of participants in the early 1990s this book has been an invaluable resource for maintaining rigor in my work and for dispelling the doubts that positivists try to engender with their criticisms of 'soft' research and evaluation. Within its covers are endless important issues for health promotion research and evaluation, especially understanding different ontological positions and maintaining a reflexive stance to our work. This handbook has also been invaluable for graduate students setting off on their doctoral research journey. References
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