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Health promotion

“Health promotion” – understood as the specific concept of actions in favour of health, not as a category of marketing operations – was born at the end of the 70s of the last century. To simplify this, one may point to its double origin. On one hand it was an attempted answer of modern medicine to the changing health problems of developed societies and an idea to improve the effectiveness of traditional health care activities (mainly disease prevention and health education). On the other it was meant to counter the phenomena of “medicalization” of the society and the incapacitation of “ordinary people” in relation to medical activities and recommendations. This was to be achieved by (1) redefining the concept of health (mainly exhibiting its “positive” and “negative” aspects and its environmental, social and cultural conditions) and (2) making individuals and social communities active subjects in health-related issues and providing comprehensive support to their pro-health activities (that is why the “Ottawa” definition of health promotion mentions allowing ordinary people to take more control over their own health). Subsequent international conferences on health promotion expanded its rhetoric by indicating desired pathways for the improvement of concepts, structures and actions.

In practice, the idea of health promotion has been differentiated into four major aspects. Firstly, with respect to the specificity of groups that it has been addressed to (e.g promotion of the health of women, children, youth, the sick and disabled, medical personnel, the unemployed). Secondly, with respect to the specificity of communities where it was found applicable (e.g. promotion of health in the media, health care centres, local communities, schools and other educational centres, military units, workplaces). Thirdly, with respect to the specificity of health problems that it was meant to tackle (e.g. promotion of mental health, oral cavity health, healthy nutrition, health relating to the circulatory system, occupational safety). Fourthly, with respect to what is emphasized most often in the literature, namely the distinctness of the subject (and the primary objective) of interventions and interactions (e.g. shaping individual behaviours, complex lifestyles, material and social infrastructures, social and organizational mechanisms). Regardless of the above, it has been changing as a result of developments in the methodology of exerting influence on the behaviour of individuals (e.g. new education techniques, lobbying, social marketing) and the methodology of transforming social structures (organizations, communities).

One can risk to pose a thesis that in its principles health promotion is essentially a philosophy of change – a change of the position of health in the systems of social values (as opposed to considering this value absolute), a change of the way medics, social politicians and other professionals perceive health that allows them to see its complexity, humanistic aspect, numerous circumstances and interdependencies among phenomena, a change of the identity of individuals and societies towards subjective thinking about their own lives and health, a change of social and environmental conditions that would make them facilitate and support these subjective aspirations and favour equal access to health, a change of lifestyles chosen by people to more health-friendly ones, a change of the methods of interaction in favour of turning away from the “technical” attitude towards man, and the mutual isolation of actions taken in individual sectors that have an influence on health circumstances. This types of changes postulated in health promotion may of course be multiplied by presenting them at subsequently lowered levels of generality.

Although in scientific papers we may come across attempts to present this general idea in a comprehensive and cohesive manner, the same idea is interpreted rather freely in practice. It is most often understood as carrying one of the four following meanings: (1) the process of exerting influence on people in order to make them act in a way recognized as the most friendly to their health, (2) all efforts aimed at preventing a disease perceived from a biomedical point of view, (3) the process towards strengthening and improving health, life quality, comfort or wellness, extending beyond actions aimed at disease prevention, (4) all social efforts that protect and improve health, including actions for counteracting poverty and educational lacks (Breslow 2001).

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