Spiritual_Wellness_Holistic_Health_and_the_Practic

192 Philosophical Foundations of Health Education
isolation and learned helplessness engendered by poverty (Seligman, 1975). Some of
the women, with the support of the health promoter, organized a community action
group which, on its own and in coalitions with other organizations, lobbied for reform.
The primary care teams also took case stories of these women ’ s lives. These stories
wove a tapestry with the studies collected by the health administrators in a powerful
policy statement advocated by the board. Center staff, through their professional associations,
lobbied senior government bodies, issued press releases, and joined with
coalitions advocating reform. Board members met with politicians, met with media,
addressed protesting rallies, made deputations before committees, and linked with
social movement groups in their effort to locate the reforms within a larger social justice
agenda. For a brief period of time much of the internal squabbling that often characterizes
agencies and institutions disappeared in a focused endeavor, in which every
staff person and citizen volunteer could see their role and its relation to other roles.
Although the Holosphere model of empowerment has proven a useful educational
device in many public health settings, the health center story also implies a few of its
difficulties.
1. Linkage across the spheres tends to occur in response to a particular crisis. It is
hard to cross discipline and sectoral boundaries in “ normal ” service delivery situations.
2. A large internal investment of time is required if staff are to engage in the critical
peer reflections necessary to move through their disciplinary boundaries.
3. The ability of different professions to support each other around the Holosphere
may be constrained by status and financial inequities (power relations) between
the professions themselves. For example, physicians are relatively free to expand
their practice frames to small group, community organizing, or coalition politics,
particularly when they work in salaried settings. Community workers or public
health nurses do not have the reverse privilege of expanding their practice frames
to personal service modalities monopolized by physicians.
4. The larger an institutional organization, the more difficult it becomes for the different
hierarchical layers to maintain the informal contacts necessary for different
staff to know when and how issues can be supported around the Holosphere.
Moreover, the Holosphere model presumes that professions and bureaucratic
institutions are capable of transformation, meaning that their behaviors can change so
that, on measure, they are less disabling than before. This presumption is akin to
Wildavsky ’ s dictum that “ each policy solution is the beginning of the next problem,
and success is when the next problem is smaller than the one for which it was a solution
” (O ’ Higgins, 1992, p. 2).
This presumption, finally, is an act of faith. Faith, according to theologian and literary
critic, Northrop Frye (1991), “ starts with a vision of reality that is something
other than history or logic . . . and on the basis of that vision begins to remake the