Health Promotion: Effectiveness, Efficiency and Equity
by Keith Tones and Sylvia Tilford
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(3rd ed.), Cheltenham, England: Nelson Thornes 2001 (orig. 1990) 525pp, each chapter well referenced, $37.50
Keith Tones and Sylvia Tilford provide an excellent, thorough discussion of the history, concepts and practices of health promotion and the empowerment model within the framework of epidemiology.
Modern medicine is failing to adequately address major health and illness problems nationally and internationally. The focus of modern medicine on the physical body as the point of intervention ignores cultural, socio-economic and environmental factors that impact on health.
Citing R. Dubos (1959), they point out:
The concept of perfect and positive health is a utopian creation of the human mind. It cannot become reality because man will never be so perfectly adapted to his environment that his life will not involve struggles, failures, and sufferings.
. . . we are more exacting than our ancestors in matters of health, and expecially are we less willing to accept the infirmities, pains, and blemishes, the catarrhs, coughs, and nauseas that use to be regarded as inevitable accompaniments of life. . . it is also true that the modern ways of life are creating problems of disease that either did not exist a few decades ago or are now more common than in the past.
Nevertheless, the utopia of positive health constitutes a creative force because, like other ideals, it sets goals and helps medical scient to chart its course toward them.
They discuss holistic health in epidemiological terms, citing (p. 6) evidence (Bunker et al 1994) that “life expectancy in the USA increased from 45 to 75 years during the 20th century. Using a variety of evidence and a raft of measures, they calculate that 5 years of the 30 year gain (17%) was due to medical services.” Taking coronary heart disease as an example, they point out (p. 7) that “after fifty years of massive effort, all of the risk factors we know about, combined, account for less than half of the disease that occurs. . . “ (Syme 1996). Tarlove (1996) suggests that between 25 and 60% of the health gain was due to “health-related behavioral risk factors.”
This thoughtful book moves towards holistic health, considering factors of environment, distribution of health care services, and other epidemiological issues. However, if we just consider environmental factors, Tones and Tilford identify physical, social and cultural issues. They briefly mention but do not address the individual, psychological and relational issues that definitely impact quality of life and as certainly influence health.
Again citing Dubos (quoted in McKeown 1979) (p.4):
The myths of Hygieia and Asclepius symbolize the never-ending oscillation between two different points of view in medicine. For the worshippers of Hygieia, health is the natural order of things, a positive attribute to which men are entitled if they govern their lives wisely. According to them, the most important function of medicine is to discover and teach the natural laws which will ensure a man a healthy mind in a healthy body. More skeptical, or wiser in the ways of the world, the followers of Asclepius believe that the chief role of the physician is to treat disease, to restore health by correcting any imperfections caused by the accidents of birth or life.
The more subtle bioenergetic issues which are the focus of IJHC take these considerations even further, perhaps accounting for some of the unknown factors that influence health and illness.
References:
Dubos, R. The Mirage of Health, New York: Harper and Row 1959, 346-347.
McKeown, T. The role of Medicine: Dream, Mirage or Nemesis? Oxford: Blackwell 1979, 3.
Syme, S.L. Control and health: a personal perspective, In Steptoe, A. and Apples, A. (eds), Stress, Personal Control and Health, New York: Wiley 1989.Burton Silver and Heather Busch, San Francisco: Chronicle 1999 96pp $16.95.
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