Health promotion in changing and challenging times

CHPR Blog July 2018 – Louise Warwick-Booth

Our previous blogs have tended to focus upon the research that we deliver within the Centre, however many of us also teach health promotion.  Our course provision is delivered in classroom contexts in England, and further afield such as in Zambia and Ghana. The Distance Learning course is also accessible to wider populations.  Our team have been delivering health promotion education for 40 years drawing upon the social model of health to underpin our teaching, as well as our research practice (https://courses.leedsbeckett.ac.uk/healthpromotion_msc/)

Recently some of us wrote about how times are changing in England.  In our retrospective reflection, published in Health Education Journal (2018) (http://journals.sagepub.com/doi/10.1177/0017896918784072), we discuss many of the changes that health promotion education has faced in recent times, specifically in England.  Some of these changes offer interesting opportunities for expanding the reach of education such as the development of free massive open online courses (MOOCS).  Others are more challenging including the impact of market forces limiting education to those who can afford it and perhaps changing the expectations of the students who are studying. An issue recognised more broadly across the Higher education sector, not just within health promotion (see https://www.bbc.co.uk/news/education-44373231).  This has implications too for staff delivering the teaching, in terms of their own wellbeing when in many places there have been cuts to staff numbers, and consequently increased workloads (https://theconversation.com/uni-cuts-will-lead-to-health-problems-for-academics-13875). There has been a general reduction in workforce numbers in England (fewer practitioners delivering health promotion) due to the wider policy context, in which restructuring and budgetary changes have negatively affected public health provision.

Internationally there is a slightly more positive policy picture in terms of the creation of The Vienna Declaration on public health, (https://ephconference.eu/repository/publications/Vienna_Declaration_final_version.pdf), the Shanghai Declaration on promoting health in Sustainable Development (http://www.who.int/healthpromotion/conferences/9gchp/shanghai-declaration/en/_ and of course the United Nation’s Sustainable Development Goals (https://sustainabledevelopment.un.org/?menu=1300).  These fit the ethos and values of health promotion as it was envisaged in the Ottawa Charter in 1986 (http://www.who.int/healthpromotion/conferences/previous/ottawa/en/). The evidence base related to the impact of the social determinants of health also continues to grow academically.  Daily media coverage aside of the ongoing Brexit dissection is also highlighting the challenges faced by public services (https://www.bbc.co.uk/news/health-44895002), in the wake of budget cuts and increasing pressures.

Despite these positives we end our debate with several questions that we have not addressed, but which still need consideration:

  1. how can we tackle the social determinants of health through education, in a difficult climate?
  2. How do health promotion values relate to current policy approaches, if they do at all? Is there simply an ideological mismatch between prevention focused health promotion and individualistic focused discourse?
  3. Where do we go from here? As we state in our article, there is an evident need for health promotion education as a mechanism to begin to tackle inequalities and improve health. Yet the English context remains challenging due to policy direction, neoliberalism and marketisation, without this diminishing population need.

 

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