Health promotion: the next generations

By Michel O’Neill, Vice-President of Communication, IUHPE and Editor in Chief, RHPEO and Sophie Dupéré, Managing Editor, RHPEO

Future generations and leadership in health promotion

All « trekkies », those enthusiastic fans of the worldwide popular American science fiction series Star Trek, know that the original characters who played Captain Kirk, Scott and Spock had to hand over their roles to new characters who followed them in the series The Next Generation, and finally once again over to the following generation in the series Deep Space Nine.  In the most recent series, the main protagonist is in fact a heroine: a woman was finally the captain of spaceship Enterprise. As editors of RHPEO, we encountered numerous events throughout the year 2004 which triggered our reflections on the renewing of leadership within our field, on the global as well as on the local or national levels.

The first instance was at the European health promotion summer school course in which one of us participated (Dupéré, 2004); this proved to be an exceptional inter-generational academic experience for thirty students who came from a wide spectrum of countries to participate under the supervision of about fifteen professors and tutors.  The second was a highly interesting debate held on the Reviews of Health Promotion and Education Online (RHPEO), IUHPE’s electronic journal that we manage on a daily basis; it highlighted inter-generational issues around the very definition of health promotion (Sharrock et Idema, 2004 ; Green, 2004 ; Rootman, 2004 ; Ritchie, 2004). Thirdly, a number of members of IUHPE’s Board of Trustees and IUHPE leadership attended the Second International Conference on Local and Regional Health Systems (Conférence, 2004) in Quebec City; there, a great deal of informal debate took place around the composition of the next generation of health promotion professionals who, according to some, are mostly ‘ young, brilliant women’ who see their access to leadership positions blocked by ‘ old men ’ clinging on to their positions and power.  Finally, the central importance of people, human capital, and the humanistic values of our field should make us reflect on how these values are transmitted. It was one of the main lessons we brought from the 18^th IUHPE World Conference held in Melbourne in April 2004 and is one which has also appeared in a number of recent papers published on RHPEO (Kasmel, 2004, Restrepro, 2004 ; Sparks, 2004).

The combination of these elements and events struck us as being sufficiently significant for IUHPE to launch a debate and a more systematic reflection on these issues.  This paper is simultaneously published in the series of Notes from the Editors of RHPEO, where IUHPE members are invited to participate and react, and as an editorial in Promotion & Education. Who will be the Captain Kirks of tomorrow’s health promotion field and what is the current generation in power doing to nurture their emergence and their access to decision-making positions ? 

The notion of generations

In many northern countries, the operational definition of a generation was for a long time about 25 years, i.e on average the time for a person to give birth to a first child.  Today in these countries, given the drastic reduction in the number of children born and the fact that women are giving birth to their first child much later, we are probably much closer to 30 years. The exact numbers are not that important; what we would like to highlight is the fact that the very notion of generation evolves according to the time and period in which it emerges, and even more so according to the cultural contexts.  In several southern countries for example, there are many social and cultural parameters which frame a very different debate when one discusses generational issues such as: respect for the elders; strictly delineated hierarchies between sexes, groups, families and individuals; the ritualised access which marks the status of adulthood at a much younger age than most northern societies. And these are but a few of the distinguishing characteristics.  Above all, irrespective of geography or culture, the differences in values between generations are usually a critical element.

We have used the word generations in its plural form in the title and throughout this paper in order to clearly signal the diversity contained within it.  How many years does it take for the emergence of a new generation, which naturally aspires to take its place whether in health promotion or in society in general?  What are the differences in terms of work ethic and approaches, which risk creating misunderstandings and potential conflicts between the generations?  Is it important to better understand these differences and to deal with them?

Gender and generations

The differential place of women and men (in health promotion as in the rest of society) is an additional element to add to the reflection on generations.  Indeed, in all societies, the gendered distribution of paid work outside the home is influencing the way in which the new generations can access to work and power, including in our field.  In many societies today, formal paid work is done mostly by men, while women assure the domestic work and most of informal work.

However, since the middle of the 20th century and in particular in northern countries, the greater presence of women in the paid workforce has considerably modified the landscape. One can observe though that in the majority of countries, that does not guarantee an equal access to power.  The fact that women interrupt their professional career paths in a more systematic way than men, due to pregnancy, has also an impact on the generational question: due to these periods of interrupted professional activity, they often tend to be less advanced than their male colleagues of the same age.  An in-depth analysis of these issues goes way beyond the aim of this paper, but it is clear that the gender question interacts with the one of age in complex ways and impacts on the issue of generations in health promotion.

Renewing leadership in health promotion

The issue of leadership renewal is not solely faced by the health promotion field: the average age of politicians in many countries exemplifies it quite dramatically, as is the current situation of Pope John Paul the second. The question is not simplified due to the fact that our field is quite young and that its development has not progressed equally across the regions of the world the northern, primarily Anglo-Saxon cultures occupying a dominant position and role.  It is only towards the middle of the 20^th century that more systematic professional and scientific practices in health promotion and education began to emerge, as very well described in the book published to celebrate the 50^th anniversary of the IUHPE (Modolo and Mamon, 2001).  For many people from the southern hemisphere, since its beginning (Banerji, 1986) and even today, health promotion seems to be a northern preoccupation which has been poorly adapted to the epidemiological contexts of the problems they face. Do the preoccupations of health promotion’s pioneers from northern and southern countries converge? Are they equally disseminated?  Does the fact that the younger generations from the South are often trained in the North complicates matters, because of the brain drain phenomenon as much as of the acculturation to other values and practices ? In our opinion, we should nurture a more culturally sensitive development of the international leadership in health promotion, more inclusive of the southern countries and aiming towards a better representation of its main figures. 

Another issue: many of our pioneers are still alive or have just passed away, and in countries where the field has begun to professionalize more recently, they may still be holding their positions. How then can these individuals, who have dedicated their lives to developing a field which is often associated with their own person, hand over the torch?  Is it utopic to think that we can ensure smooth transitions in order to avoid ‘throwing the baby out with the bath water’ ?  What is at stake for the inter-generational transfer of knowledge seems very crucial to us; in many places, we run the risk of putting aside unique skills and knowledge because of poorly planned transition processes.  Indeed, are we fully aware of the numerous skills and vast knowledge of the « dinosaurs » (O’Neill, 1993) of our profession? Are they themselves ready to share them with others, knowing that it is often the foundation upon which their power is based?  Do they think that they can also learn from these exchanges?  Should we be investing in mentoring more systematically, as it is a mechanism to transfer knowledge which has proven to be effective in many instances?  Can we learn from other domains, such as the “learning organisations” which are very fashionable in the world of management today (Réseau Cefrio, 2004)?

Many of these questions are still unanswered. We thus would like to invite IUHPE members of all ages to contribute to this debate, and in particular perhaps the youngest either in age or career. Go to <www.rhpeo.org>, in the section of 2005 articles, where the way to do so is explained if you click on the link at the end of the electronic version of the paper that you will find there.

Looking forward to hearing from you !