Health promotion versus health protection? Employees' perceptions and concerns

The "second public health revolution" targets factors in the environment, together with lifestyle, to prevent illness and untimely death. Yet the growth of the "wellness movement" has driven a wedge between public health advocates who argue for environmental solutions and those whose major focus is individual behavior. This tension is nowhere more evident than in the workplace, where the new wellness professionals are at odds with specialists in occupational health and industrial hygiene. This paper reports findings from a cross-sectional survey of a sizeable sample of workers at six New England facilities of a very large American manufacturing firm, assessing their perceptions of risk in the two domains: environmental exposures and lifestyle risks. Multiple regression analyses reveal that both job risks and life risks are associated with a variety of potentially costly and disruptive health problems, even after controlling for demographic and occupational factors. This analysis suggests that wellness programs in the workplace will be more effective if they integrate environmental protection with efforts to reduce lifestyle risk.     

Smoking health professional student: an attitudinal challenge for health promotion?

Tobacco is a major preventable cause of premature morbidity and mortality. Health professionals are uniquely positioned to provide targeted interventions and should be empowered to provide cessation counselling that influence patient smoking. A cross-sectional national survey was administered to all third year students in four disciplines at the University of Malta. The Global Health Professional Student Survey (GHPSS) questionnaire was distributed to collect standardised demographic, smoking prevalence, behavioural, and attitudinal data. 81.9% completed the questionnaire (n = 173/211). A positive significant association between tobacco smoke exposure at home and current smoking status was identified. Non-smokers regarded anti-tobacco policies more favourably than smokers, being more likely to agree with banning of tobacco sales to adolescents (OR 3.6; 95% CI: 2.5-5.3; p ≤ 0.001); and with a smoking ban in all public places (OR 8.9; 95% CI: 6.1-13.1; p ≤ 0.001). Non-smokers favoured a role for health professionals in promoting smoking cessation (OR 5.1; 95% CI: 3.1-8.5; p ≤ 0.001). Knowledge of antidepressants as tools for smoking cessation was also associated with a perceived role for skilled health professionals in cessation counselling (OR 4.9; 95% CI: 1.8-13.3; p = 0.002). Smoking negatively influences beliefs and attitudes of students toward tobacco control. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.     

Occupational safety and health promotion: competition or cooperation?

Between 1988-1998 in Germany Occupational Safety and Health (OSH) rivalled with Workplace Health Promotion (WHP). Now that European legislation has influenced modernisation of the German OSH, both can embark on useful cooperation. Safety Services and personnel are required to evaluate risk assessment accurately; the results can be helpful for WHP. Safety communication and workers' participation will explore and ensure new avenues in WHP and--in consequence--scientific knowledge concerning work. This knowledge, in turn, can now support modern OSH.     

Health by association? Social capital, social theory, and the political economy of public health

Three perspectives on the efficacy of social capital have been explored in the public health literature. A "social support" perspective argues that informal networks are central to objective and subjective welfare; an "inequality" thesis posits that widening economic disparities have eroded citizens' sense of social justice and inclusion, which in turn has led to heightened anxiety and compromised rising life expectancies; a "political economy" approach sees the primary determinant of poor health outcomes as the socially and politically mediated exclusion from material resources. A more comprehensive but grounded theory of social capital is presented that develops a distinction between bonding, bridging, and linking social capital. It is argued that this framework helps to reconcile these three perspectives, incorporating a broader reading of history, politics, and the empirical evidence regarding the mechanisms connecting types of network structure and state-society relations to public health outcomes.     

Empowerment: A goal or a means for health promotion?

Empowerment is a concept that has been much used and discussed for a number of years. However, it is not always explicitly clarified what its central meaning is. The present paper intends to clarify what empowerment means, and relate it to the goals of health promotion. The paper starts with the claim that health-related quality of life is the ultimate general goal for health promotion, and continues by briefly presenting definitions of some central concepts: “welfare”, “health” and “quality of life”. Several suggestions as to what empowerment is are then discussed: autonomy, freedom, knowledge, self-esteem, self-confidence, and control over health or life. One conclusion of this discussion is that empowerment can be seen as a complex goal which includes aspects of the three central concepts welfare, health and quality of life. To the extent that the empowerment goals aimed at are health-related, it is concluded that empowerment is a legitimate goal for health promotion. But empowerment is not only a goal, it can also be described as a process or as an approach. This process, or approach, in a fundamental way involves the participants in problem formulation, decision making and action, which means that the experts have to relinquish some of their control and power.     

Involving students in learning and health promotion processes--clarifying why? what? and how?

The concept of student participation is currently a popular notion in health promoting schools as well as in general education. However, phrases such as 'involvement', 'participation', 'co-determination' and 'influence' are frequently used without careful definition. In this article two models, developed in the context of health promoting schools in two different cultures, are presented and discussed. The first model makes a fundamental distinction between token and genuine participation. Token participation in health promotion is characterised by focusing on prescribed knowledge, closed and convergent outcomes and targeting individuals isolated from the surrounding environment. In contrast, genuine participation stresses students' own construction of knowledge, open and divergent outcomes and targeting individuals in their context. Genuine participation is in accordance with a democratic health promoting school aiming at students' empowerment and action competence. The second model clarifies a number of different categories of students' participation in health promotion. The different categories illustrate how the teacher in various ways can play an active role in participatory approaches as a responsible professional. The more the students are involved in health projects, the more important it will be for the teacher to provide support, insight and knowledge to facilitate the learning processes. Furthermore, the different participation categories have to be related to a number of decisions which are normally included in a school health project. The model illustrates that participation should always be viewed in relation to the context and that it makes no sense to establish a single ideal way of working with participation in a health promoting school. The theoretical models are illuminated by concrete examples from health promoting schools. The overall conclusion is that participation is a complex term and rather than providing definitive answers, the models can be used as a framework for discussion among all stakeholders in planning, implementation, evaluation and managing projects involving student participation. Finally, specific implications and challenges for future health promoting schools are outlined. These are as follows: a participatory approach does not imply that health content should be regarded as vague or superfluous; teachers need flexible educational models and resources to manage participatory projects in health promoting schools; schools have to be acknowledged as cultural systems with firmly rooted rules and routines that are often difficult to change; a participatory approach has to influence all aspects of a democratic health promoting school rather than solely the teaching strategies.     

Health for all: is there health parity between blacks and whites?

Although various health care policies and health-promoting efforts by individuals have created a climate for healthy living, minorities still face higher health risks than Whites; this is especially true for Black Americans. The latest data show Blacks are especially vulnerable to a variety of preventable diseases and premature deaths. The findings show that they are better off than Whites on only two out of 18 health indicators examined. This paper presents several strategies to promote healthier living for Black Americans.     

Health promotion. Beating the bands?

A survey of health authorities in England to establish GPs' health promotion activities found that anti-smoking and heart disease prevention were the most common initiatives. Many HAs were dissatisfied with the current arrangements, feeling that they had little control of GPs' health promotion activities. Two-thirds of HAs reported problems with monitoring GPs' health promotion activities. Few health promotion initiatives addressed mental health, cancer or accident prevention.     

Missed opportunities? Locating health promotion within multidisciplinary public health

This paper examines the complex interconnections between the development of health promotion and multidisciplinary public health, respectively. Health promotion takes a distinctive interdisciplinary and multiprofessional perspective on health. Historically, it has brought together practitioners from varied disciplinary backgrounds, education and training. It therefore brings real advantages to the public health enterprise, where the goal is to bridge organisations, professions and partners to collectively address key determinants of health in the most effective manner. This paper debates the contribution health promotion has made to the development of multidisciplinary public health over the past 30 years and explores the principles, values, professional bases and practices of both. It is argued that health promotion's contribution to the development of 'the new public health' was critical, while its status and role within multidisciplinary public health remain problematic and unresolved. The nature of these dilemmas is discussed, reflecting on missed opportunities and possible resolutions.     

Intervening via chat: an opportunity for adolescents' mental health promotion?

Mental health problems are highly prevalent among adolescents, but a majority of adolescents is reluctant to seek help at mental health services because of shame and lack of anonymity. Intervening via chat (i.e. offering online support) could be a solution to remove these barriers and to reach adolescents. The dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) served as a guiding principle for discussing the potential of offering online support via chat. It appeared that the use of chat may be an appropriate way to reach adolescents and may have a positive impact on outcome measures related to mental health. Additional efforts are needed to stimulate adoption at the individual level (target group, intermediaries) and the organizational level. Future research needs to focus on the dissemination of chat-based interventions, differences between online peer support and online professional support, and the content of conversations via chat about mental health problems.