Moyra Sidell

Debates and Dilemmas in Promoting Health

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Dying in long-term care facilities: support needs of other residents, relatives, and staff.

This paper explores the support needs of residents, relatives, and care staff when someone dies in a facility for older people. The authors draw on the qualitative findings from an English study, which investigated the case for applying the principles and practices of palliative care to people dying in these settings. Relatives need practical as well as emotional support, which is often not met adequately by nursing home staff. Managers varied in the extent to which they recognized other residents’ emotional needs or supported relatives. Care staff members acknowledged needing practical and emotional support, but management was often unable to deliver it. Lack of training in recognizing and addressing needs in addition to financial and staffing constraints were factors that prevented managers from providing support for staff, residents, and relatives.

The Future of Health Promotion

What is the future of health promotion? Will it become a mainstream activity within the health sector and across other areas of public policy? What are the priorities for action in health promotion? What should be our vision as we move into the twenty-first century? This final chapter brings together different visions of the future for health promotion for the UK and internationally. We asked a range of people, some working at the ‘grassroots’ level and others in key health policy arenas, to discuss their priorities for action. The authors weigh up the successes and failures to date of different visions of health promotion, and contemplate how some of the successes can be sustained within a changing economic climate.

Men’s Health in Perspective

Men’s health as a distinct area has been the focus of increasing interest during recent years. The importance of addressing men’s health was raised by the Chief Medical Officer’s report The State of the Public Health 1992 (DoH, 1993a). 1995 saw the launch of two magazines dedicated to men and health, the first national conference in Britain on men’s health, and a ‘Men and Health’ module included in at least one health studies undergraduate degree programme. There is now a Men’s Health Helpline (Bradford, 1995). Health care workers and the general public are showing more interest in men’s health, but why this explosion of concern now?

Community Action for Health

In the previous chapter the role of the primary health care team in promoting the health of their community was examined and some innovative strategies were suggested for PHCTs to be much more active in the community. In this chapter we explore how the community can act to promote its own health. Community action for health is based on the premise that health chances and health choices are shaped to a great extent by the social, political and economic conditions in which people live. The ability of individuals to control and shape these wider structures is limited. Community action involves individuals in collective activity to change the socio-economic environment and to redistribute power and resources in order to enhance the health chances of hitherto disadvantaged groups. It requires the participation of local people in working together to promote health: their own and that of others, and is based on the principles of collectivism rather than individualism. Within a collectivist ideology individuals combine and take responsibility for each other’s health and well-being. The individual is not submerged or lost in the collective but is located within it rather than existing in isolation and competition with others (Collins, 1997). A more individualistic approach lays responsibility firmly on individuals. They, therefore, may need to compete with others to improve their own health and well-being.

Social Science and the Future of Population Health Research

In this chapter we define our area of concern as the future of research concerned with the health of populations. There are four main reasons for this emphasis. First, as we are not epidemiologists — not even ‘social’ ones — it seems inappropriate for us to address the likely developments in a discipline that is not our own and which has its own very complex and particular history and culture. Secondly, in our writing on different aspects of public health and health research, we have always argued that the enquiry into the health of populations should be both multi- and inter-disciplinary (Popay and Williams, 1994, 1996).

The Politics of Health Promotion

In Chapter 6 we noted how building healthy public policy had become a central concern of health promotion at international level (WHO, 1986; 1988; 1992) and how it connected to a longer tradition in the UK of using public policy to protect and enhance health. This chapter explores initiatives within the UK health sector in the 1990s and assesses their impact on health promotion. It looks at some of the political struggles over healthy public policy, in particular those relating to the restructuring of health care and creation of national health strategies. It asks what opportunities for health promoters are offered by recent policy changes and what constraints are evident, and highlights the changing role of health promotion specialists and public health specialists within the health care market.

Evaluating Community Action

This chapter discusses the main questions that need to be addressed when planning, carrying out or just using evaluations of the types of activity we have described as community action for health. Very often it is the people most directly involved in community action, rather than external ‘experts’, who initiate and conduct evaluations in this field, frequently with few resources and, perhaps, feeling insufficiently trained. When a sample of health education officers, for instance, were asked about their current work and training needs in community development initiatives, they identified ‘methods of evaluation and monitoring’ as among the top three areas of training need. (Adams et al., 1989). This chapter aims to meet some of that need and begins by looking at the reasons for evaluation and the different forms evaluation may take.

Collaboration: United we Stand, Divided we Fall?

Collaborative working between professions, agencies and sectors became significant not only in health promotion but throughout the health and community care services in Britain in the 1990s. In this chapter we ask what a united stand might mean and whether divisions between professions, agencies and individuals imply the failure of collaborative policies?

Partnerships and Collaborations: The Promise of Participation

The last chapter focused on groups of people working at the local level to define and promote their collective concerns in relation to health. Enabling and encouraging people to participate in that process is a key aim. If community groups operate in isolation they will not make an impact on the organisations and agencies which affect their health and well-being. Indeed many of the criticisms and potential handicaps of the community action approach are that it marginalises the community and does not challenge or influence wider stakeholders and policy makers. Chapter 1 on the other hand explored the potential within general practices for a community-oriented approach which would explore the health needs and encourage the involvement of local communities in their services. How providers of services and local communities can ‘meet in the middle’ to define their needs and plan and provide services is the subject of this chapter.