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Book Review
Theory in a nutshell: A guide to health promotion theory
Don Nutbeam and Elizabeth Harris (eds)
ISBN: 007 470821 1999 80 pp pages Sydney, Australia: McGraw-Hill Book Company
Deirdre Davis
School of Social Inquiry, Murdoch University, WA
Jennifer Dodd
School of Social Inquiry, Murdoch University, WA
Theory in a nutshell offers a brief overview of some of the central theoretical approaches informing health promotion strategies and practice. The authors start from the premise that theoretically informed health promotion leads to more effective programs. However, they suggest the role of theory in building promotion programs and projects is often more implicit than explicit. The aim of the book then is to provide students and practitioners with a rudimentary knowledge of the most influential theories in order to demonstrate how a 'prudent' use of theories can improve the 'effectiveness and sustainability of health promotion programs'.
The book is broken into six chapters, staring with a chapter on what theory is and how it assists at the level of application. The subsequent five chapters are then divided according to different aspects of health promotion beginning with a chapter on theories explaining individual behaviour followed by a chapter on theories of community change and communal action. The next chapter deals with communication and outlines two different models of mass communication. This is followed by a chapter on organisational change and then one on the development of healthy public policy. Each chapter includes an outline of the basic theories followed by a short commentary on the strengths and shortcomings of each theoretical model and is finished with a useful one or half page summation of the main points and suggestion for further reading. The book also provides tables in many chapters which assist the reader to understand and make comparisons at a glance by graphically mapping out different aspects of a theory and the differences between theories.
The authors explain in the epilogue that the book is 'only an introduction' to the different theories and models guiding health promotion practice and that for more detailed information the reader will need to go to the suggested reading lists or elsewhere (although the reading lists, as mentioned below, suggest a narrow selection of texts). With this in mind we still believe there are some important omissions in this book which limit its usefulness to both students and practitioners. Whilst it does capture in a 'sound bite' the basic theories and aspects of health promotion it gives no mention of some of the more sociologically informed theories such as the structuralist-collectivist approach (SCHP) (Richmond 2002:206) which emphasizes the importance of including structural, social and economic determinants in the theory and practice of health promotion. Further, the authors fail to engage with some of the most recent critiques and discussions on the problems of current models of health promotion. We acknowledge that a full outline and discussion on the more complex questions surrounding health promotion are beyond the remit of the book; nevertheless we believe the introduction could have usefully outlined the broader context of health promotion and given some indication of the deeper debates within health promotion - for example, those surrounding individualist and structural perspectives and social capital theories as applied to health promotion (see for instance Gleeson 199; or Labonte 1999). Reference to the political and economic context within which health promotion is practiced in relation to local versus global processes, models of funding and the relationship between health promotion and public health could have usefully informed the reader in relation to notions of community mobilisation and change.
The 'commentary' in each chapter provides only a surface analysis of the relative weaknesses and strengths of different theoretical approaches and at times do not cover all the theoretical approaches; for example, the 'health belief model' was not discussed in the commentary. Indeed, in relation to the critique of theories we believe the book would have benefited from giving some attention to sociological insights into social action especially with regard to the health belief model and theories of reasoned action and planned behaviour. Questions surrounding the perceived passivity of the subjects of health promotion information and the uncritical acceptance of the role of rationality in personal decision-making are by now well recognised criticisms of health promotion theory with both health promotion and sociology of health literature. Similarly, the discussion on the social influence on health behaviour makes no comment on the possible ill effects of social pressure such as guilt and anxiety. These and other issues have also been the subject of extensive and sustained critique within sociology and by people working in the area of health promotion and some acknowledgement of them would have strengthened the discussion and alerted the reader to areas requiring further exploration.
On its jacket, the book is described as an invaluable and essential introduction to health promotion theory for practitioners and students. This perhaps overstates its impact and is best qualified. As a brief introduction to theories guiding health promotion it is adequate for first year undergraduate students from various health related areas including health promotion, nursing, medicine, community health, social work, sport sciences and so on. However, we believe the value of this text for sociology and the sociology of health, and indeed health promotion practitioners, is at best limited. The book was published in 1999 and is now in its third reprint. There are now many other sources that provide better overviews of the area, for example, O'Connor-Fleming and Parker (2001), Egger et al (2002); and others that include better critical discussions on the issues and problems within health promotion, for example, Bunton et al (1995), Gleeson (1999), Daly (200) and Richmond (2000).
Theory in a nutshell is clearly set out and the inclusion of tables to illustrate the essential theoretical elements is a very good tool for students trying to come to grips with the differences between approaches. However, to better serve the interests of students the book could have provided a broader range of readings and included information about useful journals such as Health promotion journal of Australia and The Australian and New Zealand journal of public health. The merit of the book perhaps lies in the way it does make explicit links between theory and health promotion practices and strategies which could make it useful if basic undergraduate reference.
References
Bunton R, Nettleton S and Burrows R (1995) The sociology of health promotion: critical analyses of consumption, lifestyle and risk. London: Routledge.
Daly J (2000) Challenges in public health and health promotion: a way forward, Health Promotion Journal of Australia 10(1): 4-8.
Egger G, Spark R, Lawson J and Donovan R (2002) Health promotion strategies and methods, Roseville, Australia: McGraw-Hill.
Gleeson D (1999) Social capital theory: implications for public health, Health Promotion Journal of Australia 9(3): 183-187.
Labonte R (1999) Social capital and community development: practitioner emptor, Australian and New Zealand Journal of Public Health 23(4): 430-433.
O'Connor-Fleming ML and Parker E (2001) Health promotion: principles and practice in the Australian context 2nd edn, Sydney: Allen and Unwin.
Richmond K (2002) Health promotion dilemmas' in John Germov (ed) Second opionion: an introduction to health sociology, South Melbourne: Oxford University Press: 195-214.
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