Spiritual_Wellness_Holistic_Health_and_the_Practic

260 Philosophical Foundations of Health Education
(1959), disability rights advocates succeeded in recasting their personal troubles as
public issues.
Much analytical and operational power is lost by setting up the ideological dichotomy
of the macro level versus the micro level referred to above. A much more constructive
approach is to frame these two spheres as being in a dialectical relationship
with each other: Each informs, produces, and reproduces the other, mediated by the
mid - level sphere of social organizations (Bellah, 1991; Glendon, 1991; Moody, 1988).
Such organizations, often referred to as “ mediating structures ” (Berger & Neuhaus,
1977), typically include churches, neighborhood organizations, schools, service organizations,
and other such voluntary organizations and groups, as well as the networks
which link them.
We suggest that to understand the new health promotion movement — indeed, for
the community health promotion movement to move beyond the present internecine
turf battles — the three spheres of health, empowerment, and community participation
must be disentangled and critically examined, both separately and in relation to each
other. Within the new health promotion there is much overlap between these spheres,
both conceptually and in practice. However, in the interests of making explicit some of
the ideological issues underlying the new health promotion, we shall examine each
of these spheres in turn.
RECONCEPTUALIZING HEALTH
One of the major contributions of the new health promotion movement has been to
broaden the conceptualization of health to include an understanding of the social,
political, and economic determinants of health. In this spirit, WHO (1986a) now
defines health as
the extent to which an individual or group is able, on the one hand, to realize aspirations
and satisfy needs; and, on the other hand, to change or cope with the environment.
Health is, therefore, seen as a resource for everyday life, not the objective of
living; it is a positive concept emphasizing social and personal resources, as well as
physical capacities. (p. 73)
In this macro or socialized version of health, health is seen as instrumental, a
means rather than an end. Health is what one must have to accomplish other things in
one ’ s life. Although in general this broader concept of health captures more accurately
the complex dimensions of health, at the same time it makes interventions to achieve
health more difficult not only to define but to implement.
More narrow medicalized or micro conceptualizations of health tend to identify
people with their illness, lack of health, or disability, lapsing at times into blaming the
victim. Indeed, we have seen evidence of this in the case of acquired immunodeficiency
syndrome (AIDS), where people who are diagnosed with AIDS, and even those
diagnosed as human immunodeficiency virus (HIV) positive, have become stigmatized
as the agents of disease in the classical epidemiological triangle of host, agent,