An Ecological Perspective on Health Promotion Systems, Settings and Social Processes


by

Bente Wold, Oddrun Samdal

DOI: 10.2174/97816080534141120101
eISBN: 978-1-60805-341-4, 2012
ISBN: 978-1-60805-564-7



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This e-book adds a new dimension to currently available text in health promotion by applying examples from evaluation studies to explore b...[view complete introduction]
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Table of Contents

Foreword

- Pp. i

Lawrence W. Green

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Preface

- Pp. ii

Bente Wold and Oddrun Samdal

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List of Contributors

- Pp. iii-v (3)

Bente Wold and Oddrun Samdal

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Introduction to Health Promotion

- Pp. 3-10 (8)

Oddrun Samdal and Bente Wold

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From Associations to Processes

- Pp. 11-16 (6)

Maurice B. Mittelmark

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Health Behaviour in Context

- Pp. 17-33 (17)

Leif Edvard Aaro and Alan John Flisher

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National Objectives-Local Practice: Implementation of Health Promotion Policies

- Pp. 34-39 (6)

Elisabeth Fosse

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Relationship Education to Promote Family Health

- Pp. 40-47 (8)

Frode Thuen and Oystein Mortensen

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School as a Resource or Risk to Students’ Subjective Health and Well-Being

- Pp. 48-59 (12)

Oddrun Samdal and Torbjorn Torsheim

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Depressive Symptoms During Adolescence: Gender Differences and the Role of Body Image

- Pp. 60-66 (7)

Ingrid Holsen

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Social Influence Processes on Adolescents Health Behaviours

- Pp. 67-77 (11)

Bente Wold

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Norwegian Health Promotion Policy: The Pendulum Swings from 1984 to 2007

- Pp. 78-84 (7)

Elisabeth Fosse

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The Ecology of Health Promotion

- Pp. 85-89 (5)

Maurice B. Mittelmark, Bente Wold and Oddrun Samdal

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Subject index

- Pp. 90-92 (3)

Bente Wold and Oddrun Samdal

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Foreword

As a participant in the symposium celebrating the first 20 years of research from the editors and many of the chapter authors of this book, and their colleagues associated with the University of Bergen’s Research Centre for Health Promotion at the Faculty of Psychology and its Department of Health Promotion and Development, I was humbled to consider the immensity of their productivity and contributions. I should not have been surprised, considering the number of their publications I had seen and used over those 20 years. But recognizing specific research products does not tell a larger story of the parts in relation to the whole; the findings of individual studies in relation to the systems in which they represent subsystems.

This book brings much of the prolific work of the Bergen collaborators to a fitting focus through the lens of an ecological perspective. It brings into sharp relief the contours of practice and the relationships of practice with action research and policy development opportunities. The lens is at least tri-focal, with data and reflection on the individual children affected; the relationships among children, parents, teachers, and others in the school settings; the further layering of school, family and community relationships; and ultimately the implications for national and global health promotion policy. Such layering is the necessity of ecological thinking and theorizing, but the perspectives reflected here bring more. They bring empirical data to bear on the ecological perspective and its implications for practice and policy. Inherent in these reflections is a critique of some health promotion traditions that tend to place the emphasis too exclusively on individual risk factor data, and lead too often to policies that blame the victims of ill health rather than reform the social determinants in systems and environments where their risk factors are predisposed, enabled and reinforced.

The action research lens on the data these editors and authors bring also adds a dimension of reality and generalizability that much academic research and theorizing fails to offer, and most controlled trials in the evidence-based medicine tradition cannot offer to an ecological perspective. The demands of many systematic reviews of the scientific literature in the health (and the education) fields tend to limit the qualified research to a limited range of highly controlled and randomized trials. Guidelines for professional and organizational practices derived from such systematic reviews of individual studies miss the mark of practitioner needs. What they recommend as “evidence-based practices” from such highly controlled experimental studies lack credibility, applicability, and actionability to most practitioners and policy makers because they do not reflect the reality of their practice circumstances. If we want more evidence-based practice, we need more practice-based evidence. This publication offers that, as well as its ecological and global perspectives on health promotion.

Lawrence W. Green,
San Francisco


Preface

The book is based on the past 20 years of research and teaching at the Research Centre for Health Promotion at the University of Bergen, Norway. The Centre was established in 1988, at the verge of the establishment of health promotion, and since its very origin, has been concerned with developing research that can contribute to improve health promotion practice. This goal means that the staff has been involved in action research collaborating closely with practitioners in developing strategies to promote population health in a specific setting (e.g., school), as well as giving emphasis to research on identifying determinants of health. Staff members have also been involved in several national and international task forces and networks (both practice- and research-oriented) aimed at developing global health promoting strategies that can be implemented at national and regional levels. The experiences from this practice based research are presented throughout the book.

A core perspective of the book is to criticise public health for being all too willing to merely study associations between risk factors and health endpoints, and in doing so, turning aside from the hard work of examining mechanisms that might account for associations. The book argues that there is a need for an ecological approach to health promotion, which calls for a multidisciplinary approach, acknowledging the importance of macro-level and micro-level conditions. In this book, the ecological systems approach is applied to study processes and mechanisms in a range of public health areas such as family welfare, well-being in school, subjective health and health behaviours among adolescents, and healthy public policy. Examples are provided from international as well as Norwegian research. The history of health promotion as an ideology and strategy to address public health issues is presented, including the main message from the very first charter of health promotion from a conference in Ottawa in 1986. The essence of the book addresses what is health promotion, why it is needed, who is doing it, where it is done and how it is done. The book concludes by highlighting how effective health promotion depends on reaching the settings in which people live, and understanding the processes of human interaction in these settings.

We hope the readers will enjoy to read and to learn about our 20 years of experience with health promotion research.

Bente Wold
Oddrun Samdal
University of Bergen
Department of Health Promotion and Development
Christiesgate 13, N-5015 Bergen
Norway

List of Contributors

Editor(s):
Bente Wold
University of Bergen
Norway


Oddrun Samdal
University of Bergen
Norway




Contributor(s):
Leif Edvard Aarø
Norwegian Institute of Public Health
Postbox 4404 Nydalen
OSLO, N-0403

/
Department of Health Promotion and Development Christiesgate 13
University of Bergen
Bergen, N-5015
Norway


Alan John Flisher†
University of Cape Town
Faculty of Health Sciences
Division of Child and Adolescent Psychiatry and Adolescent Health Research Unit
Private Bag Observatory
Cape Town, 7935
South Africa


Elisabeth Fosse
Department of Health Promotion and Development
University of Bergen
Christiesgate 13
Bergen, N-5015
Norway


Ingrid Holsen
Department of Health Promotion and Development
University of Bergen
Christiesgate 13
Bergen, N-5015
Norway


Maurice B. Mittelmark
Department of Health Promotion and Development
University of Bergen
Christiesgate 13
Bergen, N-5015
Norway


Øystein Mortensen
Department of Health Promotion and Development
University of Bergen
Christiesgate 13
Bergen, N-5015
Norway


Oddrun Samdal
Department of Health Promotion and Development
University of Bergen
Christiesgate 13
Bergen, N-5015
Norway


Frode Thuen
Bergen University College
Centre for knowledge based practice
Møllendalsveien 6
Bergen, N-5009
Norway


Torbjørn Torsheim
Department of Psychosocial Science
University of Bergen
Christiesgate 12
Bergen, N-5015
Norway


Bente Wold
Department of Health Promotion and Development
University of Bergen
Christiesgate 13
Bergen, N-5015
Norway




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