Bureaucratic logic in new social movement clothing: the limits of health promotion research

This paper discusses theoretical, methodological and politicalproblems in the field of health promotion research. It arguesthat these problems result from a partial and contradictoryappropriation of the discourse of new social movements. Politically,the health promotion movement is largely confined within thestate, rather than the expression of a social movement againstthe state. The direction of health promotion research and policyis, therefore, caught in the bureaucratic logic of ‘trappedadministrators’, and results in contradictory emphaseson problems like the development of ‘health promotionindicators’, which show little result in informing a broaderbut coherent conceptualization of health, let alone in effectingchange in health policy and outcomes. Such political problemsreflect parallel confusions about theory and methodology. Theoretically, the field relies heavily on a critique of bio-medicalscience, but fails to move beyond a rhetorical outline of analternative to systematic arguments about what promotes health.In this regard, the literature on health promotion remains unawareof important conceptual developments in the social sciences,relies on imprecise specifications of major constructs likecommunity empowerment, and has no conception of the state. Methodologically,the literature is influenced by contradictory epistemologicaltendencies which reflect a positivist inspiration (as in thesearch for indicators) and an anti-positivist emphasis on agencyand social change through the collective action and the discursivereconstitution of social identity, value and meaning. In regardto these questions, this paper is critical of observers whosuggest that the way ahead is to embrace post-modern researchstrategies. Movement in this direction would tend to diffusean already desultory research practice and depoliticize socialstruggles for meaningful change. The paper ends by suggestingthat the field of health promotion needs a more serious engagementwith critical social theory to construct a rigorous conceptualizationof health and its social correlates and to develop a coherentresearch practice and political project.