Settings for Health Promotion: Linking Theory and Practice

Settings for Health Promotion: Linking Theory and Practice. Poland BD, Green LW, Rootman I (Editors). Thousand Oaks, CA: Sage Publications, 2000; viii + 373 pp. Paperback $24.95 U.S.

The authors use a social ecological model for health promotion that is based on the foundations of the Ottawa Charter to argue for the use of settings as the focus for health promotion interventions. They contend that people cannot and ought not to be treated in isolation from the larger social units in which they live, work, play, worship and go to school. To be successful, health promotion practitioners must take a sociological approach to promoting health, rather than continue to rely on psychological interventions such as behaviour modification, health education, and social marketing, which have not proven to be effective at aggregate, population or community levels of action. Rather, by focusing on the settings where people congregate, health promotion practitioners can create environments that positively affect the behaviour that occurs in it, and intervene to create change in those settings that foster behaviours with negative consequences. Settings are conceptualized as more than containers of target audiences for interventions - passive recipients of service. The interaction of people within a particular setting and also among other settings in which they "live" is explicitly acknowledged. Acknowledged also is the lack of power held by professionals to intervene and change settings; rather, the authors underscore the importance of history, economics, political and cultural contexts, processes, and imperatives in shaping environments.

That being said, this collection of essays from leading authors in health promotion from Canada, United States, New Zealand, Netherlands, and the United Kingdom, offers examples of practice in many formal settings - homes, schools, workplaces, health care institutions, clinical practice, and the community. Each chapter provides context, discussion of barriers and facilitators within the settings, the status of knowledge about the setting, and descriptions of practice in the setting. Every chapter has at least one commentary from another author, allowing the reader to participate vicariously in conversations about the ideas presented and their applications in different cultures, nations, or political systems.

Soubhi and Potvin discuss homes and families as health promotion settings. Fisher provides challenges to the narrow definition of the "family" as a social unit in traditional conceptualizations, and Kalnins suggests the home itself and the neighbourhood in which it is situated are powerful determinants of health and ought to be considered as targets of interventions.

Parcel, Kelder and Basen-Engquist examine school health promotion, discuss specific interventions, and make suggestions for practitioners. Perry and MacLaren, Leonardo and Perez provide alternative perspectives in their commentaries.

Polanyi, Frank, Shannon, Sullivan and Lavis examine the strengths and limitations of the three common approaches to workplace health promotion, and identify and discuss the challenges faced in implementing a workplace determinants approach to health promotion. Bertera, in his commentary, provides a case example to illustrate his points, while Eakin makes suggestions for the practitioner to overcome barriers inherent in the workplace approach to health promotion.

The history and development of health promotion in health care institutions is examined by Johnson, while Lethbridge anticipates future trends that will impact health care delivery in the next decade. Mullen and Bartholomew offer an alternative position to both Johnson and Lethbridge, suggesting that there is room for improvements in health outcomes when there are targeted health education programs (e.g., for diabetes, and asthmatics and their families).

Factors relating to the physician, the patient, and the practice setting are examined by Goel and MacIsaac in the chapter on health promotion in clinical practice. Zapka outlines the difficulties in assessing current health promotion practice in clinical settings and makes a persuasive argument for incremental incorporation of health promotion (at the primary, secondary and tertiary levels) into physician practice.

The next two chapters focus on community and policy. Boutilier, Cleverly, and Labonte discuss empowering community development practice. The commentary is particularly lively, with Raeburn, de Leeuw, and Poland weighing in on the issue with their disparate points of view. Lavis and Sullivan suggest that policy is important as it represents a key mechanism for (or against) change and introduces the reader to the concept of "policy legacies". Kreuter follows with his argument that we must communicate a coherent vision of population health to policy-makers in order to integrate the analysis of health consequences into public policy decision-- making. The book ends with a review of themes raised by the contributors and commentators and offers suggestions for future research.

This comprehensive publication balances theory with practical examples and suggestions for the student, the professional and the policy-maker who are interested in promoting the health of populations. I found this publication on the reading lists for several courses at Canadian universities at both graduate and undergraduate levels in several faculties when I did an electronic search for this review. Further, it is being promoted and recommended internationally, no doubt because of its provocative yet pragmatic approach to the issues. The inclusion of commentary with the essays is a brilliant innovation that encourages the reader to think critically about the topic.

[Author Affiliation]

Ardene Robinson Vollman, RN, PhD

Adjunct Associate Professor, Faculties of Nursing and Kinesiology

Adjunct Assistant Professor, Faculty of Medicine, Department of Community Health Sciences

University of Calgary