Spiritual_Wellness_Holistic_Health_and_the_Practic

Health Promotion and Empowerment 183
complicating and overwhelming peoples ’ lives by inserting into them more and more
“ urgent ” problems that they must address and “ buy into. ”
In an earlier work based on the workshops, I suggested that there are three broad
clusterings of named health problems corresponding to diseases (e.g., cardiovascular
disease, cancer, acquired immunodeficiency syndrome [AIDS], behaviors (e.g., smoking,
diet, unsafe sex), and social conditions (e.g., poverty, unemployment, discrimination,
pollution) (Labonte, 1989). Each of these clustered problems embeds a set of
assumptions, comprising three reasonably discrete approaches to health: The medical,
behavioral, and socioenvironmental approaches (Labonte, 1992, 1993b). These three
approaches represent organizational biases; hospitals tend to work from a medical
approach, state health agencies from a behavioral approach, and community groups
from a socioenvironmental approach. These biases condition and constrain the ability
of health workers to act effectively or legitimately within a different approach. They
may create a situation in which the professional is unable to enter a dialogue with his
community groups in search of some shared meaning; rather, he persists in actions that
seek to educate these groups to the terms of the health agency.
An example of this tendency comes from a PATCH (or Planned Action Towards
Community Health) program in the United States, developed by the Centers for
Disease Control. A community opinion survey found that violence and drugs were
major concerns. A behavioral risk factor survey identified heart disease. The community
opinions were put on the back burner. Screening tests, life - style counseling, and
referrals were offered, because those were the categories of the professionals to which
the community must be educated (Bogan, 1992). Some Canadian PATCH programs
have dropped the risk factor survey altogether (it is normally part of the PATCH protocol),
believing that a commitment to reducing health inequalities must proceed with
the knowledge that the most important act of power is naming one ’ s experience, and
having that naming heard and legitimized by others.
Although the behavioral or risk factor approach to health tends to take a power -
over approach to health concerns of community groups, such programs can still be
empowering, depending on how the health promoter views his task. For example: Two
health promoters are developing heart health programs. One sees her clients solely in
terms of cardiovascular outcomes. The other sees his clients in the richer terms of their
family, community, and economic lives. Outwardly, the programs may appear to be
similar, at least initially. But in the first case, heart health never transcends its encasement
by cardiovascular disease. In the second case, heart health is simply one entry
point into the more complex experiences of people that often include gendered, class -
based, and cultural forms of oppression. In the first case, when people express concerns
about these oppressions the health promoter is either deaf or shrugs that it is not
heart health, not in her mandate. In the second case, the health promoter asks of himself:
What can I and my health agency do to support these persons in these other
endeavors? Asking and answering this question distinguishes an empowering from a
disempowering health promotion practice. This distinction is most evocatively