Setting an ethical agenda for health promotion

The Bangkok Charter for Health Promotion in a Globalized Worldhas sparked lively dialogue. Welcomed by some as a Charter currentto the times, there are others who see it as an unneeded andtherefore unwelcome challenger to the Ottawa Charter for HealthPromotion. Intended or not, the Bangkok Charter seems to signala shift in discourse, from a social-ecological approach andan emphasis on individual and community capacity-building andempowerment, to an investment approach and an emphasis on globalization,macro-level factors and policy. Positively, the Bangkok Charterproclaims to build on Ottawa, and no one suggests it is meantto replace the Ottawa Charter outright. In concert with that,the dialogue today is not so much about the ascendancy of theone Charter over the other, but about the degree to which theBangkok Charter remains true to the ethic of the Ottawa Charter.It is welcome that the Ottawa and Bangkok Charters are the subjectof brisk dialogue about strategy and tactics in a rapidly changingworld, and about the foundational values of health promotion.Regarding the latter, we have unfinished work in constructingan ethic for health promotion, and the present dialogue mayinspire us to progress. Though we have the cornerstone of anethic for health promotion, in the Ottawa Charter and in otherprincipled documents that have followed, we have yet to buildsufficiently on the cornerstone; an ethic for practice has yetto be codified, and the same is true for research. Health promotionjournals, conferences and organizations can and should do moreto facilitate dialogue on ethics in health promotion, and theInternet provides the means for all to participate actively.     

Establishing local priorities for a health research agenda

Aim/Background

To describe the two‐stage prioritization process being used by the UK National Institute for Health Research''s Collaboration for Leadership in Applied Health Research and Care for the South‐West Peninsula (or PenCLAHRC) – a joint health service and university partnership and reflect on implications for the wider context of priority setting in health‐care research.

Method

PenCLAHRC''s process establishes the priorities of Stakeholders including service users across a regional health system for locally relevant health services research and implementation. Health research questions are collected from clinicians, academics and service users in Devon and Cornwall (UK) using a web‐based question formulation tool. There is a two‐stage prioritization process which uses explicit criteria and a wide Stakeholder group, including service users to identify important research questions relevant to the south‐west peninsula locality.

Results

To date, a wide variety of health research topics have been prioritized by the PenCLAHRC Stakeholders. The research agenda reflects the interests of academics, clinicians and service users in the local area. Potential challenges to implementation of the process include time constraints, variable quality of questions (including the language of research) and initiating and maintaining engagement in the process. Shared prioritization of local health research needs can be achieved between Stakeholders from a wide range of perspectives.

Conclusions

The processes developed have been successful and, with minor changes, will continue to be used during subsequent rounds of prioritization. Engagement of Stakeholders in establishing a research agenda encourages the most relevant health questions to be asked and may improve implementation of research findings and take up by service users.     

Developing a community health promotion agenda for a managed care organization

Coordination and collaboration between organizations interested in promoting the health of the populations they serve can potentially help to ensure that key services are provided as well as augment the efforts beyond that which could be accomplished by each organization alone. Understanding the perspectives of each organization can facilitate development of health promotion initiatives that will be of mutual benefit. In Maryland, when a Medicaid managed care program was initiated, Memoranda of Understanding were signed between each managed care organization (MCO) and each of the 24 local health departments; many stipulated that the parties will coordinate on community health issues. This report describes a telephone survey of the health departments that was performed by one MCO to better understand the interests and expectations of the health departments and discusses a process for developing a community health promotion agenda for an MCO.     

Building an agenda for collective oral health

After visiting 14 cities from Brazil where important efforts to improve the SUS (Unified Health System) were being made, the researcher used his main findings to propose a participant agenda-building process for collective oral health, integrated to the new scope of collective health at the municipal level. He notes the strategic role health professionals can play in a new historical proposal for Brazilian society.     

Building capacity to reduce health inequalities through health promotion in Europe

Aim

Whilst considerable attention has been paid to describing and measuring health inequalities, relatively little attention has been paid to ways to effectively reduce health inequalities within and among populations. This article presents a conceptual framework for capacity building to assist stakeholders at the regional level within Europe to maximise the potential of healthy public policies and practices to reduce these inequalities as a core part of strategic action plans to access European Structural Funds.

Subject and methods

Within the ACTION-FOR-HEALTH (A4H) project co-funded by the European Commission (EC), a conceptual framework for capacity building to reduce health inequalities was developed and evaluated. The evaluation design adopted mixed methods involving a series of focus groups (n?=?22), interviews (n?=?14) and questionnaires (n?=?34) involving the project partners.

Results

We present the A4H conceptual framework, which is based on a series of capacity-building actions comprising three key areas: (1) developing knowledge and skills; (2) building partnerships; (3) creating action plans. The evaluation data show that the project contributed to enhancing capacities in all three of these areas, at the regional, organisational, and individual levels.

Conclusion

Focussing mostly on building capacities, the A4H project has the potential to have several sustainable outcomes. Our results underscore the importance of the capacity-building approach for the reduction of health inequalities in Europe.

     

Incorporating local knowledge(s) in health promotion

Historically, Western liberal democracies have defined relevant knowledge for social and economic management as that produced by experts following established professional methods. As we experience a shift from government to governance, state departments and bodies have attempted to impose their own desire for this particular form of knowledge, typically constructed as quantitative performance measures, onto their community partners. This is done in the name of accountability. Health promotion, as practiced in government health agencies, faces these same pressures to demonstrate outcomes and successes from community work. However, this article argues that, rather than blindly following these imperatives characteristic of advanced liberalism, it will be more fruitful for health promotion to explore the potential of incorporating and employing local knowledge(s). This argument is illustrated through two brief examples drawn from population health initiatives in two regional health authorities in western Canada. Persistent pressure from community members and their advocates can open up professional and bureaucratic systems to allow new forms of information to influence judgment. Local knowledge(s) offer a unique contribution to health promotion practice. It is incumbent upon practitioners and government organizations to seek ways to engage and incorporate the insights that are only thus available.     

Building academic-community linkages for health promotion: a case study in Massachusetts

Using select practice variables from Rothman's typology of models of community organization, this case study of the Massachusetts Community-Based Public Health Consortium analyses potential sources of conflict in collaborations between academic institutions and community coalitions. Based on different socialization experiences and organizational expectations, the goals, assumptions, basic change strategies, salient practitioner roles, conceptions of the client population, and client roles of the respective organizations were found to differ between these two partners and to be a source of chronic, unproductive tensions in consortium deliberations. The article concludes with recommendations for facilitating the development of more mutually trustworthy academic-community linkages to achieve public health promotion goals. These recommendations include (1) developing a greater awareness of the respective kinds of assumptions academic and community partners are likely to bring into new partnerships and (2) developing a more highly integrated model of community-based public health that capitalizes on the strengths of both the social planning and locality development approaches.     

Patterns of health promotion programs for older adults in local health departments

Questionnaires were sent to all 2561 members of the National Association of County Health Officers in 1996; only 492 (19.2%) responded. Almost all departments have health promotion or disease prevention programs available to older adults, but only three-fifths specifically target older adults with these programs. Most of those programs are clinical preventive services, including immunizations.     

Building workforce capacity for ethical reflection in health promotion: a practitioner's experience

Health promotion does not have a code of ethics, although attempts have been made to assist practitioners in their understanding and application of ethical concepts. This article describes and analyses one such attempt, sustained from 2006 to 2014 in rural South Australia. The attempt comprised capacity‐building activities that were informed by principles of organisational change management, especially the principle of creating champions. The article also presents a framework (largely comprising ethical questions) that may help practitioners as a prompt and guide to ethical reflection. The framework was developed to be as accessible as possible in light of the diverse educational backgrounds found in rural settings. Finally, the article highlights some philosophical dimensions to the framework and defends its role, proposing that ethical reflection is integral to good practice and never simply the province of theorists. The article does all this with a view to stimulating discussion on how to increase the frequency and quality of ethical reflection undertaken by health promotion practitioners.