Spiritual_Wellness_Holistic_Health_and_the_Practic

270 Philosophical Foundations of Health Education
The new health promotion places a great emphasis on communities identifying
their own needs and strategies to meet those needs. In general, this represents a welcome
shift in health promotion practice. However, an unintended consequence of
embracing the notion of community participation is that communities may assess
social problems and propose solutions that reflect racism, sexism, ageism, or other
problematic and divisive approaches. One only has to look at the anti - gay rights groups
in Colorado and Oregon, for example, that recently sought to amend human rights
legislation by removing the prohibition to discriminate against gays and lesbians in
housing, employment, and other areas to see such troubling community mobilization
at work. Indeed, in the study referred to above, Hoffman (1989) found that professionals
were often disillusioned with the political and social conservatism of communities.
The flip side of communities being co - opted by professional agendas is the potential
for professionals to be used by communities to accomplish certain exclusionary agendas,
such as the isolation of persons with AIDS, for example (Kirp, 1989). This may
raise ethical and moral issues for health promotion practitioners when the agenda of
the community conflicts with the larger agenda of equity and social justice.
Finally, health promotion practitioners must be ever vigilant that community participation,
like the notion of empowerment, is not used as part of the rhetoric to justify budget
cuts in professional and direct services. Using the rhetoric of community participation,
medical providers may retreat from responsibility to improve health care institutions, and
public officials may retreat from responsibility to regulate providers. As true partners with
the community, health promotion practitioners may find themselves advocating for more
direct individual services, more medical care facilities, and more health care providers.
Brown ’s case study (1983 – 1984) of the role of health educators and other health professionals
who worked alongside community members to fight the proposed closure of
several county hospitals in California during the early 1980s provides an excellent example
of such advocacy. Far from disempowering communities, moreover, this effort succeeded
both in helping prevent several of the proposed closures, and in demonstrating to
low income community members the efficacy of collective action.
CONCLUSION
In the interests of not substituting one tyranny for another, the intent of this paper was
to examine critically the new health promotion movement. To that end, we have discussed
in detail the theoretical and practice implications of the concepts that form the
building blocks of the new health promotion — namely, the reconceptualization of
health, the concept of empowerment, and community participation.
We have argued that much of what continues to be contested in terms of concepts
like empowerment and community participation, as well as the very notion of health,
results from their multidimensionality. Broader socialized definitions of health, although
taking into account, the social, political, and economic factors that affect health —
thereby expanding the scope of what constitutes health promotion — may place the
realization of health further out of the reach of many people by increasing its potential