Table Of ContentPromoting Health
To Jon and Sara
Commissioning Editor: Mairi McCubbin
Development Editor: Sally Davies
Project Manager: Elouise Ball
Designer: Kirsteen Wright
Illustration Manager: Merlyn Harvey
Promoting Health
A Practical Guide
Angela Scriven
BA(Hons) MEd CertEd FRSPH MIUHPE
Reader in Health Promotion, Brunel University, London, UK
Forewords by
Linda Ewles BSc MSc MA
Ina Simnett MA(Oxon) DPhil CertEd
Bristol, UK
Richard Parish BSc Med PDHEd CBiol MIBiol FRSPH FFPH CMIPR HonMAPHA
Chief Executive, Royal Society for Public Health, London, UK
SIXTH EDITION
EdinburGh London nEw York oxford PhiLAdELPhiA St LouiS SYdnEY toronto 2010
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Third edition 1995
Fourth edition 1999
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Sixth edition 2010
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
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v
Contents
Forewords vii 8 Skills of personal effectiveness 107
Preface xi
Acknowledgements xiii 9 Working effectively with other people 121
PART 1 THINKING ABOUT HEALTH PART 3 DEVELOPING COMPETENCE
AND HEALTH PROMOTION 1 IN HEALTH PROMOTION 131
1 What is health? 3 10 Fundamentals of communication 133
2 What is health promotion? 17 11 Using communication tools in health promotion
practice 147
3 Aims, values and ethical considerations 31
12 Educating for health 163
4 Who promotes health? 45
13 Working with groups 177
PART 2 PLANNING AND MANAGING FOR 14 Enabling healthier living 191
EFFECTIVE PRACTICE 61
15 Working with communities 207
5 Planning and evaluating health promotion 63
16 Influencing and implementing policy 223
6 Identifying health promotion needs
and priorities 77 Glossary 235
7 Evidence and research in health Index 241
promotion 91
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vii
Foreword
We are delighted that Promoting Health is now in its and amalgamated) approached us for an updated
sixth edition. edition.
We embarked on writing the first edition back But the last request for a new edition came at the
in the early 1980s. One of us (Linda Ewles) was stage in our lives when we had both retired from
then working at Bristol Polytechnic (now the Uni- work in health promotion. We felt that the update
versity of the West of England) running one of should be done by someone in closer touch with
the three postgraduate Diploma courses in health current professional thinking and practice. We are
education which existed in the UK at that time. The delighted that Angela Scriven undertook the task
other (Ina Simnett) had recently moved to Bristol and has given the book a new lease of life with a
and was working in health education in the NHS. thoroughly updated version which still retains the
We had each independently recognised the need style and scope of its predecessors. We are very
for a health education textbook; amazing as it grateful to her for her excellent work.
seems now, at the time there were none in the UK. Twenty-five years after the first edition was
We were put in touch with each other by Jane written, we can look back and see that some themes
Randell who did much to develop educ ation and we wrote about then are still totally relevant today.
training at the national Health Education Council. Health promoters still need to explore what ‘health’
It was the start of our long collaboration and means, understand the underlying values and
friendship. approaches in health promotion, think about ethical
We put together an outline of the book’s pro- issues, base their work on evidence of effectiveness
posed content, drawing heavily on our combined and learn skills of communicating and managing,
experience and training. We typed the chapters on planning and evaluating. A surprising amount
a manual typewriter (no word processors then) and of the sixth edition has scarcely changed since the
laboriously looked up all the references in libraries first one.
(no Internet). Our first publisher was John Wiley, But of course a great deal has changed, and this
and Promoting Health: A Practical Guide To Health is reflected in the current edition. We are struck by
Education was launched in May 1985 at a nursing the huge expansion of the evidence base of ‘what
conference in Harrogate. works’ and how much research and information is
We fully expected that the book would have a now available on the Internet. In terms of delivering
shelf life of a few years, and then be superseded by health promotion, the rise of partnership working
many others. Indeed, more textbooks on health between sectors and agencies and the integration of
education and health promotion (when that new health promotion specialist work in the NHS into
term started to be used) did appear – but ours con- mainstream public health (rather than remaining a
tinued to be well used. We had met a need. Every Cinderella ‘add-on’ service) are also remarkable.
few years from then on, our publisher (who changed Health promotion has become an integral part of
several times as publishing companies were sold basic training for health workers and there has
viii Foreword
been a massive growth in specialist training of Asia and the Middle East. We are pleased to think
opportunities. that we must have got something right! We would
Some health education acorns undoubtedly also like to take this opportunity to thank all those
failed to take root, but others have become sturdy people who, in so many different ways, have helped
oak trees. For example, stop-smoking group work to make Promoting Health a success.
by a few health educators has grown into a huge Of course, as Richard Parish points out in his
mainstream NHS smoking cessation programme. Foreword, health promoters now face 21st-century
A handful of health workers going into schools to challenges, such as obesity, alcohol consumption
give talks has developed into a European-wide levels, climate change and new forms of communi-
health-promoting schools network with fully- cable diseases. We hope that this edition continues
fledged personal, social and health education school to contribute to the spread of sound health pro-
programmes. motion practice in tackling these and other issues
We are gratified and humbled to think that our which undermine health today. We also hope that
book has made a small contribution to these and it helps people to continue their efforts to reduce
other developments over the last 25 years. It has health inequalities in the UK and across the
been widely used in the UK but also in over 50 world.
countries around the world. It has been translated Linda Ewles
into seven European and Asian languages and has Ina Simnett
been useful in health development in Africa, parts
ix
Foreword
The need for effective health promotion has never The challenge of better health requires action at
been greater. We face immense challenges to health all levels of society. Government and the national
as we move through the 21st century. Regrettably, agencies most certainly have a major role to play,
modern-day life is not always as conducive to not least in supporting those who work to improve
health and wellbeing as we would wish. The current health. The following pages provide an authorita-
scourge of overweight and obesity is but one tive text for everyone involved in promoting health,
measure of our unhealthy lifestyles. To this we must both informing policy makers as to what is possible
add the growing impact of climate change and the and acting as a toolkit for health promoters. From
emergence of new strains of communicable disease. planning and management to monitoring and eval-
Never before have we faced such an assault upon uation, this edition ranges across the full panoply
our health, with the disadvantaged suffering the of tools and techniques. It is genuinely a practical
greatest. guide, helping to ensure effective practice in every
The forces waged against health are complex and area of health promotion work.
comprehensive. We need a skilled and competent Promoting Health: A Practical Guide is not just for
workforce if we are to improve health for all over health promotion specialists responsible for deliv-
the coming years. The earlier editions of Promoting ering better health to the communities with which
Health: A Practical Guide have been heavily used by they work. It also describes the potential for health
students, academic staff in universities and col- promotion. As such, it is an essential tool for com-
leges, policy makers and planners, and by health missioners and those who plan and procure health
promoters going about their everyday work. This improvement services, helping to define how best
new edition will continue the tradition of this to invest public resources.
seminal publication and will strongly influence the Better health will only be achieved through
training of future practitioners. Building on its rich actions at all levels of society. The state and the
pedigree, this latest edition tackles the major health public sector, commercial organisations, voluntary
issues facing us today, focusing on practical inter- agencies and individual citizens all have a role to
ventions for better health. play. This book will help ensure effective and effi-
Many strategies and techniques in health promo- cient action. We must deploy our resources to
tion are tried and tested. There is a sound and maximum advantage, for the cost of not doing so
growing evidence base. We know what works in will be measured in avoidable ill health, unneces-
most situations, although we must be ever vigilant sary expenditure and a loss of human potential. To
in pursuing new approaches and evaluating the this end Promoting Health: A Practical Guide is a valu-
outcomes. Effective health promotion draws on able investment.
many disciplines, adapting to the emergence of new Richard Parish
evidence. This book reflects contemporary think-
ing, referring to the application of new technologies
and approaches such as social marketing.
