Rejoinder to Sharrock and Iedema

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Like Larry Green, I am very pleased to have the opportunity to reveal my reaction to the Sharrock and Iedema critique of the first eight papers of our ‘Five Favourite Resources’ series.  I found this piece fascinating in critiquing my personal view of health promotion.  However, I was brought suddenly to a stop.  Was this really the way I saw the world?  Was this actually the way I wanted to convey the development of my understanding of the field to which I had committed myself over more than two decades?  Why was this interpretation of my paper causing me to frown, and to feel as though I wanted to tell Sharrock and Iedema that they had it all wrong?  But before I comment further, I need to reveal a bit of background as to my relationship with the paper and its authors.

Some short time back, Sharrock had enrolled with my institution to undertake her MPH degree and having completed the coursework component, she approached me for advice on her preferred topic for her dissertation. Once she had made clear her desire to carry out a discourse analysis on some recent health promotion material, I suggested to the Editorial Board of the RHPEO that it could be an interesting exercise for us all if she analysed some of the initial reviews already posted online. With agreement all round, I invited Iedema to bring his linguistic and semantic expertise to the exercise and take a co-supervisory role with me, since what Sharrock was attempting was beyond my area of proficiency.  At that stage of the activity, I was both ‘subject’ and ‘object’ of the investigation since as co-supervisor I was influencing the treatment of the topic, yet I had also authored one of the eight papers to be analysed.  Rather than continuing to straddle both sides, I encouraged Sharrock and Iedema to complete a short paper arising from Sharrock’s longer dissertation, without my collaboration, and I was very pleased that it was reviewed as acceptable for online publication at the RHPEO site.

Thus from the beginning I was ambivalent – on the one hand feeling quite proud, from a professional point of view, that one of my students was contributing to the underdeveloped debate on the philosophy and ideology underpinning health promotion, while on the other from a more personal point of view, being continually surprised that my perspective could be interpreted so differently from the way I thought I was conveying it.  So what did I hope I was conveying and why did I feel a bit indignant?

After days of contemplation, I guess it is on the issues of power and control that I feel I have been misinterpreted.  Twenty five years ago when I was undertaking health education in a clinical role, I can definitely accept that I was working on the basis that as the provider of the education, I could maintain a more powerful and controlling position, whereas in recent years working with populations, I see empowerment of communities as central to my philosophical stance.  From this chronological perspective I accept Sharrock and Iedema’s perception of my work that there is an “oppositional, evolutionary and binary relationship” between these phases.  However, in endeavouring to empower others, I believe in the maxim ‘knowledge is power’ – or one small part of gaining power anyway – so that my current health promoting activities would be lacking if they did not include health education within my toolbox of strategies.  But whereas in my original clinical work, my educational contributions were standardised offerings, determined from a provider perspective and thus in my eyes emanating from a Modernist approach, now I believe I work in a post-Modernist framework.  By this I mean that I see no standardised way to work except to proceed in acknowledging and building on the widely varied values of each community I seek to empower, and to include attention to the social, cultural, economic and political context within which these communities exist.  So, maybe the oppositional and binary relationship is not between my definitions of health education and health promotion but between health education as I defined it early in my health promotion work and health education as I perceive it in the latter years of my working life.  Like Larry Green, I believe that evolving forms of health education should continue to form the foundation of effective health promotion practice.

Overall, I really appreciate the innovative efforts of the authors in raising these issues and hope others will join me in further debating the issues raised. Thank you.

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