Health promotion epistemology
: from disciplinary development to evidence of effectiveness

  • Gordon Macdonald

    Student thesis: Doctoral Thesis


    The discussion surrounding the development of health promotion in the last thirty years has been a contentious one. Concern with the terminology, the disciplinary base and the effectiveness and quality of practice have characterised much of the debate. This may have appeared as a negative force in its development. It really served however, to demonstrate a more positive approach, by harnessing the vitality and critical awareness of academics and practitioners in the field who wished to take the debate forward.

    This overview and supporting projects A and B, demonstrate the author's original contribution to the knowledge base within health promotion. The discussion on the semantic differences between health education, health promotion and public health had been largely resolved by the late 1980s, and attention turned to other intellectual and practical issues. The author introduced the discussion on the disciplinary base of health promotion by co-editing the first text in this area in 1992. It demonstrated that the disciplinary roots of health promotion helped to form an organised body of knowledge, which, together with health promotion as a practitioner discipline, fuelled the rise of multi-disciplinarity in thinking and practice. From this disciplinary base the author contributed original ideas, through published papers and conference presentations, on the role theory should play in health promotion and the need to have a theoretical bases for interventions. In particular the author posited the idea that theory should form a critical and integral part of the input stage of an intervention. These particular contributions to knowledge form the bases for the first project, Project A 'Grounding and developing itself.'

    The author was also instrumental in synergising quality assurance with effectiveness in a second co-edited book and related journal articles. Here, the contribution to knowledge accepted standard quality assurance programmes' contribution to health promotion but moved the thinking forward. The book highlighted quality assurance measures which were unique to health promotion, that were distinguishable from mainstream health care developments, but critically also linked them to effectiveness studies.

    This second contribution forms the second project, Project B ' Proving and improving itself. Together these contributions to developments, through their search for the epistemological roots of health promotion, helped to establish health promotion as emerging disciplinary force.

    The aim of the portfolio is to demonstrate, through this overview and the two projects, the intellectual history of health promotion through the 1990s. This is achieved by first examining the disciplinary and theoretical roots to health promotion as inputs to practice; and secondly by analysing the approach to evidence and quality assurance in health promotion as aspects of the output in health promotion interventions.

    The portfolio overview firstly examines the development of health promotion in the last quarter of the last century before focusing on the disciplinary roots and the contribution of theory to that development. It then critiques the emerging debate on evidence based health promotion and the concern with quality. These twin themes are addressed making use of the arguments and concepts developed by the author over the last ten years indicating his essential and original contributions to the debate. The overview makes use of recent policy papers and strategies to illustrate these developments. Finally the overview concludes by illustrating the author's contribution to the emergence of health promotion as a 'discipline' and field of study with a unique three stage model designed to summarise his work in this area.
    Date of AwardOct 2000
    Original languageEnglish


    • Health promotion

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