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Book Review

Promoting Health: Politics and Practice

Lee Adams, Mary Amos and James Munro (eds)

ISBN: 0-761983-4-2 2002 224 pages Sage Publications, London

N Ernest Khalema
Alberta Heart Health Project, Centre for Health Promotion Studies, University of Alberta, Edmonton, Canada

Promoting Health: Politics and Practice provides a fresh and accessible presentation of current health promotion and public health issues in the United Kingdom. This engaging book presents a broad perspective on how health promotion is linked to its social, political, and transformative foundation. The authors of this edited volume outline health promotion theory and draw on the experiences of practitioners to demonstrate health promotion practice, providing students, policymakers, and healthcare providers with practical and theoretical inspiration.

The book is well researched and clearly laid out in six sections. Each section addresses a theme: the history of public health and health promotion movements in the UK; sustainable development and health; community development and health provision; social exclusion and health inequities; improving and regenerating health through promotion and prevention; and the role of social institutions and public services in health promotion practice. The book opens with historical and contemporary discussions on the sources, causes, and consequences of health promotion practice, policy reforms, and health promotion initiatives since the 1930's.

Section two highlights the link between sustainable development and health by focusing on three areas in health promotion practice: food security; environmental justice; and capacity building in local communities.

Greig and Perry's chapter 'Local Communities and Sustainable Regeneration in the East End of Sheffield' discusses a case study that problematises the concept of community regeneration, and argues that in order for a true community 'revival' to be sustained, poverty, social exclusion, and environmental degradation must be addressed at all levels of policy development. Such an approach tackles head-on the mainstream economic agenda and the institutional framework (infrastructure) that supports it. A common theme in this section is that global capitalism, at both the national and global level, has crippled the capacity for communities to promote their own health. The solution proposed lies in social action for health and the resources and creativity of individuals and their communities. Thus, a supportive environment (whether political, community-based, or otherwise) is of paramount importance for health to be promoted.

Section three focuses on the complex issue of community-based development. Amos' introduction offers a case study of a community development initiative in Sheffield within a socio-historical context of the central debates about health.

Sutherland's chapter 'Community Development and Health Work in Northern Ireland: Context, History and Development' discusses the changing dynamics of healthcare work in Northern Ireland and how the socio-political context has made health promotion very difficult. The author also points to the importance of institutionalising key pillars of health promotion praxis: engagement in building healthy public policies, strengthening community action, reorienting health services, and creating supportive healthy environments as stipulated in the Ottawa Charter for Health Promotion (World Health Organisation 1986).

I found the fourth section by far the most interesting and informative. This identifies key challenges practitioners face in articulating the link between anti-poverty, feminist, disability and health policy issues within a 'hostile' neo-liberal political context, especially the policies of the new centrist Blair Labour Party. Duggan's 'Social Exclusion, Discrimination and the Promotion of Health' discusses the social determinants of health and sociologically unpacks the concepts of social exclusion, social cohesion, health inequities, and social capital.

Theoretically, this book offers a fresh look at the tension of intersecting liberal-humanist principles of 'social justice' and 'equity' with the challenging practice of promoting health. Implicit in this tension is the belief that the essence of health promotion practice entails challenging oppressive and health threatening political and economic structures. Thus, due to its ideological/theoretical foundations, means that the practice of promoting health is a political endeavour.

While admiring and supporting the book's call to health promotion action at all levels, I believe it fails to build capacity for those who are sceptical about health promotion practice and its connection to social justice. At times, I felt that I was expected to accept information without being given a chance to critically assess its contents. In fact, this is the main weakness in this book. The book's argument stresses the necessity for community building, partnerships and the oppressive nature of institutional practice. This approach does not encourage a comprehensive understanding of the effects of not promoting health.

Secondly, because the book is a compilation of chapters written over time, the several themes are not coherently organised. The issue of the influence of globalisation and its neo-liberal orientation, for instance, is not handled in a sustained manner. A thorough discussion of neo-liberal economic policy and its impact on health promotion practice would have brought a valuable dimension to the arguments.

Overall, however, Promoting Health: Politics and Practice struck me as an informative and passionate book. It raises a number of relevant and important questions about health promotion praxis, social policy, and equity issues. The editors provide a menu to evaluate concepts, practices and the theoretical underpinning of health promotion. An important feature is that the book links public health explicitly to sociological theory, to demonstrate the relationship between health care and the social structures that underpin the provision of health services. It does a good job of reviewing major health promotion developments in the UK using a critical, historical, ecological and comparative analytical framework, and includes topical areas such as community development, health inequalities, social diversity, social exclusion, care in the community and media constructions of health. It also contains practical examples combined with current, research-based social science studies explaining some of the key social issues affecting the utilisation of health care.

In conclusion, Promoting Health: Politics and Practice provides an valuable sourcebook for professionals, students and campaigners involved in health promotion. It addresses the fundamental principles of health promotion as well as exploring new horizons and raising controversial issues. Several chapters could easily be used for teaching both undergraduate and graduate courses in public health nursing, social policy, social epidemiology, the political economy of health care, health promotion and practice, and the sociology of health and illness. The links between health promotion theory and practice are clear and the British focus complicates and complements recent international debates in health promotion discourse.

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