Not long after I started out in public health in the 1970s, the
Labour government published its 'little red book' Prevention and
Health: Everybody's Business (1976). This manual of preventive
medicine, centred as it was on individualistic behaviour change
rooted in social psychology, could not have contrasted more with
the 1974 Lalonde report ‘A New Perspective on the Health of
Canadians’ which launched health promotion and focused on a
socioenvironmental model of health. In most free countries of
the world - sadly excluding England - both health promotion and
a socioenvironmental approach remain the key elements in the
successful promotion of population health status.
The King's Fund - which back in the late 1970s and early 1980s
was a radical organisation supporting healthy public policy and
community development - appears to have reverted to the early
1970s medical model in its current Kicking Bad Habits programme.
The first review in this series (‘Paying the Patient’ - see
below), about financial incentives to change behaviour, should
perhaps have been entitled Bribing the Poor to be Healthy.
The second volume, on behavioural interventions, might have been
called Manipulating the Poor to be Healthy. Interestingly, its
findings suggest that providing information is more effective
than psychological manipulations. Perhaps someone in the
establishment will take the point and will begin to focus on
reinventing health promotion in England?
For those – especially those in England - who are less familiar
with HP (understandable following nearly 30 years of neoliberal
hegemony), health promotion is based on a notion of citizenship
which rejects bribery and manipulation and which promotes
informed choice - even if that choice is to follow unhealthy
habits. Key approaches include working with (not on)
disadvantaged groups - community development - and creating
healthy public policies which make healthier choices easier.
Despite the theft of this phrase for the subtitle of the
Choosing Health White Paper, its actual meaning is wholly belied
by current government enthusiasms for ‘producing health’ through
behavioural interventions, motivational interviewing and
individualistic social marketing. And all this despite
continuing failures to make any progress towards meeting the
government’s headline health inequalities targets.
Paying the Patient: Improving health using financial incentives
www.kingsfund.org.uk/publications/other_work_by_our_staff/paying_the.html
Low-income Groups and Behaviour Change Interventions: A review
of intervention content and effectiveness
www.kingsfund.org.uk/publications/other_work_by_our_staff/lowincome_groups.html
Alex Scott-Samuel
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