Spiritual_Wellness_Holistic_Health_and_the_Practic

New Health Promotion Movement 259
This paper will explore the various meanings that surround these terms as well as the
very notion of health. By getting underneath the meaning of the words and concepts
used to frame community health promotion, this paper also seeks to unpack some
of the underlying ideological conflicts and accompanying turf battles that have arisen
in the wake of the new directions that health promotion has taken.
A fundamental ideological conflict exists about the goal of health promotion:
Should the goal be improved health status (individual and collective) — health as an
end? Or should the goal be social justice (Beauchamp, 1976) — health as a means?
Emerging from that conflict are other related ideological conflicts, including micro -
level (individual) change versus macro - level (structural) change; individual lifestyle
strategies versus community - based approaches; and professional ownership versus
public ownership.
We will demonstrate that much of what is contested in relation to concepts like
empowerment and community participation, and their operationalization in health
promotion practice, can be understood as boundary issues. What is contested frequently
depends on whether we take a macro or a micro view of the meaning of health
and the ways to achieve it. Because this macro/micro perspective is a critical lens
through which we will examine in more detail these contested domains, it is important
to say something briefly about this analytical framework.
Although it is true that the larger structural (economic, political, cultural, organizational)
forces (the macro level) in any society shape the everyday lives of individuals
(the micro level), it is also true that the everyday practices of individuals shape
those same larger structural forces. This position tempers the notion of sociological
determinism with the notion of human agency. To illustrate in the health arena: On the
one hand, many epidemiological studies demonstrate the often profound role of poverty
and other social, economic, and political factors in influencing individual health
status (Ehrenreich & English, 1990; Haan, Kaplan, & Camacho, 1987; Marmot, Rose,
Shipley, & Hamilton, 1978; Miller, 1990; Ratcliffe, 1978; Syme & Berkman, 1976;
Syme, 1986). On the other hand, individuals have been able to reshape the social context
within which they live, and thus affect their health.
For example, although the multibillion - dollar cigarette industry promotes tobacco
subsidies, the right to advertise through the mass media, and other government policies
that in turn encourage and support smoking on the individual levels the individuals
who mobilize their colleagues to achieve a smoke - free workplace, or who lead a
fight to curtail cigarette advertising targeted at people of color in poor neighborhoods,
may also be contributing to broader institutional and/or policy level change. Similarly,
disability rights groups, such as the Independent Living Movement, have enabled persons
with disabilities to reframe as social pathology what previously had been framed
as individual pathology. That is, disability was reconceptualized as resulting from a
social environment that disregarded the existence of people with disabilities by making
it difficult, if not impossible, for them to participate in public life. The solution
was, in part, to reform the social and physical environments by making public spaces
accessible to persons with disabilities (Driedger, 1989). In C. Wright Mills ’ terms