Promotion

MENTAL HEALTH PROMOTION 39
health promotion and listed a number of priorities, the first four of which had emerged
at the 1997 Jakarta Conference:
• promote social responsibility for health;
• consolidate and expand partnerships for health;
• increase community capacity and empower the individual;
• secure an infrastructure for health promotion;
• strengthen consideration of health requirements and promotion in all policies;
and
• adopt an evidence-based approach to health promotion policy and practice using
quantitative and qualitative methodologies.
Interestingly the important emphasis of health promotion on the reduction of health
inequalities was not explicitly brought out in this list of priorities.
Having set out in some detail the development of health promotion and its
constituent principles, with particular reference to the WHO literature, it is important
to emphasize that the term is not always conceived in the way outlined so far. For
example, in some contexts of health care practice while the use of health promotion
as a term has largely replaced health education the activities have continued to focus
predominantly on education directed towards individuals with little, if any, recognition
of social contextual influences on health and the importance of complementing
education with healthy public policy.
Differences in interpretation of the nature of health promotion and its activities
have been formalized into a number of ‘approaches’ or ‘models’ specifying alternative
goals and the processes for achieving them, and underpinned, to some extent, by
distinctive sets of values. These approaches were initially developed within health education
then taken over within health promotion. Typologies of approaches, differing in
sophistication, have been developed. Some simply map the content of practice while
others present alternative ideological positions. Naidoo and Wills (2000) list preventive,
medical, empowerment and social change approaches. Tones’ categorization has
changed in a number of ways over the years and most recently he has distinguished
preventive, educational and empowerment models (Tones and Tilford 2001; Tones and
Green 2004). Approaches are fully described and reviewed in general health promotion
texts (Naidoo and Wills 2000; Ewles and Simnett 2001; Tones and Tilford 2001; Tones
and Green 2004).
A specific model of health promotion practice that is widely used was developed by
Beattie (1979, 1991). It presents a 2 × 2 relationship of processes and levels of action
distinguishing between ‘top–down’ and ‘bottom–up’ in identifying a range of mental
health promotion activities which can be related to different value positions as
illustrated in Figure 3.1.
Running through the different typologies are distinctions between levels of action
– micro-, meso- or macro-level and the purposes of action at the respective levels. For
example, there is a clear distinction at the micro-level between the widely used preventive
medical and empowerment models. Work informed by the former is designed
to provide information and build knowledge, form and change attitudes, and to
develop new or change existing behaviours linked, on the basis of evidence, to health