Health promotion, health education, and the public’s health

Health promotion is a complex, ambiguous concept and set of practices. While many have linked it, primarily, to a revolution in health education, its roots go much deeper into the history of public health. It had its beginnings in the throes of the backlash against bureaucratic and professional dominance exemplified by the new social movements of the 1970s and 1980s. At its heart, health promotion is centred on the values and principles of equity, participation, and empowerment. These concepts are embedded in health promotion’s founding document, the Ottawa Charter for Health Promotion. However, exactly how these values are articulated is often ambiguous. In this chapter, the authors contend that health promoters must intensify their reflection on these core values and principles; particularly in the light of the tendency to slip back into a comfortable paternalism, which reinforces existing power imbalances. We are specifically concerned with the precise interpretation of health equity in health promotion. In order to pursue a deeper level of reflection on the meaning of equity, it is argued that health promotion must engage more deeply with recent developments in political philosophy and political economy. Furthermore, health promotion must be much more active in supporting the global efforts to address equity in health and development represented by work on the United Nation’s Millennium Development Goals and with the World Health Organization’s Commission on the Social Determinants of Health.