An Exploration of the Ideology of Health Promotion and Critical Implications for Public health

摘要

This dissertation analyzes the ideological, conceptual, and moral foundations of health promotion discourse. It highlights their implications for the field of public health and for broader socio-cultural contexts.udUsing a critical interpretive qualitative approach, the study employs semi-structured interviews to understand how conceptions of health promotion are articulated by a group of professional health coaches. Additionally, written and visual health communication and social marketing materials from the Centers for Disease Control and Prevention are examined through qualitative discourse analysis.udFindings from both sets of data are convergent and support the claim that, currently, the pursuit of health is mainly justified with reference to an individualistic, rationalistic and moralizing doctrine that continues to be pervasive. This translates into professional recommendations which stress individual responsibility for achieving health through discrete behavioral and lifestyle changes.udivudIt is argued that the dominant approach in health promotion discourse fails to integrate a coherent understanding of the structural determinants of health and does not take into account the complexity of the production of health, nor the rich phenomenology of health in daily life. The present dominant status of individualistic conceptions of health contributes to the spread of a reductive understanding of health among the citizenry.udThe study points to critical public health implications, including the urgent need for integrating social determinants in the pervasive professional ideology of health. As the health promotion workforce - such as health coaches - is expected to grow at a fast pace in the near future, it is imperative that a more comprehensive conception of health production be incorporated into the training of health promotion and of health professionals, generally. Additionally, efforts should be made so that the social determinants of health become integrated into public debate, public policy agendas, and health communication.udThis analysis favored depth over scope. The main limitation of the study is the small number of interviews with health coaches from a single organization. Additional empirical studies are needed to include other health promotion and health care groups as well as lay participants, and to integrate a comparative perspective into the analysis.