Settings for Health Promotion: Linking Theory and Practice


Edited by: Blake D. Poland, Lawrence W. Green & Irving Rootman

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  • Back Matter
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  • Dedication

    This book is dedicated to Ron Draper (1934–1997), pioneer and leader in health promotion, the first Director-General of the Canadian Health Promotion Directorate and consultant to the World Health Organization on Healthy Cities.


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    David V.McQueen

    Recently, there was an opening of a health promotion center at a community hospital affiliated with a prestigious New England University. The hospital was the setting for a participatory action approach to health promotion. Even to one long associated with health promotion, it may come as a bit of a shock to think of the hospital as a place for health promotion. Upon reflection, of course, it is a most appropriate place. Where else does one encounter an organization so predominantly focused on the theater of health and illness? Where better to play out the full drama, the full dimensions of health promotion? In its seeming antithesis of health promotion, the hospital reveals the power of settings as a place for health promotion.

    The World Health Organization defines settings for health as the place or social context in which people engage in daily activities in which environmental, organizational and personal factors interact to affect health and well being. Thus, settings provide a critical proving ground for health promotion theory and practice. There is clearly a fundamental need for a book that examines the interaction between settings and health promotion theory and practice. Poland, Green and Roadman have produced such a book.

    This book, however, is not simply a summary of the state-of-the-art. By interweaving definitive chapters with critical commentary and discourse, it gives the reader a tremendous insight into the knowledge base revealed in the work that has taken place. It also reveals the depth and usefulness of the postmodern discourse when juxtaposed with the concrete attempts to intervene in practice. It is this interplay throughout the work that gives it that added value.

    The book also reveals all the issues around settings as the context in which evidence for health promotion success may be found. At first glance, settings appear like a place bounded, controlled, and therefore subject to a certain rigor in intervention that will show how health promotion works. But this is illusory, because the apparent bounded nature gives way to an incredibly rich complexity where interactions are multivariate, layered, dynamic, and synergistic. Thus settings reveal all the complexity with which health promotion must contend. This book takes us further down that complex path.

    David V.McQueenNational Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention, Atlanta

    We wish to thank Linda Sagar, Joanne Taylor Lacey, and Veronica Dooley for their superb editing and clerical support and the Centre for Health Promotion, University of Toronto, Canada for making the contributions of Linda and Joanne possible.

    We thank Dan Ruth, Sanford Robinson, and Linda Gray at Sage for their patience, faith, and continued enthusiasm for this project.

    We thank our spouses and families for their loving support and understanding during the 2 years required to put this volume together.

    As editors, we wish also to thank the many contributing authors to this volume, without whom this project would not have been possible.

    Blake D.Poland, University of TorontoLawrence W.Green, University of British Columbia (now at Centers for Disease Control and Prevention, Atlanta)IrvingRootman, University of Toronto
  • About the Editors

    Blake D. Poland is Assistant Professor in the Department of Public Health Sciences at the University of Toronto, Affiliate Scientist with the Centre for Addictions and Mental Health, and Director of the Masters of Health Science program in Health Promotion at the University of Toronto. He received his Ph.D. in geography from McMaster University and was a postdoctoral fellow with the Centre for Health Promotion before joining the Addiction Research Foundation in 1994. His research is informed by critical social theory and relies primarily on qualitative methods. His research interests include governmentality and processes of spatial and social exclusion and their implications for health promotion, community development as an arena of practice for health professionals, and interactions between smokers and nonsmokers in public and private spaces.

    Lawrence W. Green was Director of the University of British Columbia Institute of Health Promotion Research and Professor in Health Care and Epidemiology while this book was in preparation. He is now Distinguished Fellow and Visiting Scientist in the Office on Smoking and Health of the National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control. He has worked in health promotion at local, state, federal, and international levels, at several universities in the United States, Canada, Australia, and the Netherlands, and as a practitioner or researcher in community, school, clinical, and workplace settings.

    Irving Rootman is Director of the Centre for Health Promotion and a Professor in the Department of Public Health Sciences at the University of Toronto. Prior to joining the university in 1990, he worked for Health and Welfare Canada in a number of senior positions in the Health Promotion and Non-Medical Use of Drugs Directorates. He has published widely in the field of health promotion, his most recent book being People-Centered Health Promotion (1998) with John Raeburn.

    About the Contributors

    L. Kay Bartholomew is Assistant Professor of Behavioral Sciences at the University of Texas School of Public Health and is also affiliated with the Center for Health Promotion Research and Development. For 15 years, she directed patient education at a large teaching hospital, and she has conducted research on the self-management of chronic diseases such as asthma and cystic fibrosis.

    Karen Basen-Engquist, Ph.D., M.P.H., is Assistant Professor in the Department of Behavioral Science at the University of Texas M. D. Anderson Cancer Center. She received her Ph.D. in community psychology from the University of Texas at Austin and her master's degree in public health from the University of Texas School of Public Health. She conducted research on adolescent and school health for approximately 11 years and served as co-principal investigator on Safer Choices, a randomized trial of a school-based HIV, STD, and pregnancy prevention program. In addition, she is currently conducting research on the health behavior and quality of life of cancer survivors and the effect of innovative cancer-screening technologies on patients.

    Robert L. Bertera is currently an independent investigator and consultant. He previously held management and research positions in health promotion and health care services at the DuPont Company. He led the company's efforts to design, implement, and evaluate health promotion and clinical preventive services for over 300,000 employees, pensioners, and family members. The C. Everett Koop Award for excellence in program design and evaluation recognized the published record of this effort. His primary research interests are the health of older workers and the evaluation of workplace and community programs that focus on health, educational, behavioral, socioeconomic, and environmental factors.

    Marie Boutilier holds a status appointment as Assistant Professor in the Department of Public Health Sciences, University of Toronto. For several years, she was the Senior Research Associate in Community Action Research with the North York Community Health Promotion Research Unit, a partnership of the Centre for Health Promotion, University of Toronto, and the North York Public Health Department. Her research has focused on increasing the capacity of professionals and community members to work together on health issues. This has involved participatory action research projects with grassroots community groups, health organizations, and professionals, integrating participatory and action research into public health practice. She is currently working on a study of community action and public health across Ontario.

    David Butler-Jones is the Chief Medical Health Officer for the Province of Saskatchewan and is Assistant Clinical Professor in the Faculty of Medicine, University of Saskatchewan. He is President of the Canadian Public Health Association, Vice President of the American Public Health Association, International Regent for the American College of Preventive Medicine, and Past Chair of the National Coalition on Enhancing Preventive Practices of Health Professionals. In 1992, he received the Distinguished Service Award for contributions to Public Health in Ontario. He trained at the University of Toronto and Queen's University and is a Fellow of the Royal College of Physicians, Fellow of the American College of Preventive Medicine and a Certificant of the College of Family Practice of Canada. He is married to a United Church minister, and they have three children.

    Shelley Cleverly has been the Project Coordinator for a study of Indicators of Community Capacity, based at the University of Toronto and funded by the National Health Research and Development Program. For 5 years prior to this project, she was Research Officer and Co-Investigator with the North York Community Health Promotion Research Unit on other community health and action research projects, including Indicators of Empowerment in Public Health Practice and a study of the North York Community Systems Alliance as a Model for Managing Change and Supporting the Development of Communities. Between 1984 and 1991, she worked as a nurse and hospital systems analyst at the Toronto Hospital. The primary foci of her work and volunteer activities are community development, health promotion, social development, strategic planning, and advocacy for people with disabilities. Currently, she is working toward a master's of science degree in community health at the University of Toronto.

    Evelyne de Leeuw has been involved in WHO health promotion endeavors since the Ottawa Conference and attended all subsequent international health promotion conferences; at the fourth one (Jakarta, 1997), she acted as conference rapporteur. Since its initiation, she has been active in the international Healthy Cities movement, from 1992 as Director of the World Health Organization Collaborating Center for Research on Healthy Cities at the University of Maastricht. Between 1992 and 1998, she served two terms as Secretary-General of the Association of Schools of Public Health in the European Region. After a master's in health policy and administration from the University of Maastricht (1985), she acquired an M.P.H. at the University of California at Berkeley in comparative health systems research (1986) and a Ph.D. on the feasibility of true health policy in the Netherlands (Maastricht, 1989). She has produced several textbooks on health promotion and health policy, published over 100 articles, and enjoys writing “lighter” material in the form of weekly newspaper columns and novels. Her current research interest focuses on the interface between health, urbanization, and globalization.

    Joan M. Eakin is Associate Professor in the Department of Public Health Sciences at the University of Toronto. She is a sociologist with a general focus on the social dimensions of illness and health care and a specific focus on the relationship between work and health and work-related health promotion and prevention, particularly in the small workplace and contingent employment sector.

    Lawrence Fisher, Ph.D., is Professor in the Departments of Family and Community Medicine and Psychiatry, University of California at San Francisco. He was formerly on the faculty at the University of Rochester and is the author of over 65 published papers. His most recent work addresses the family context of care in the management of chronic disease across the age range, with special emphasis on Type 2 diabetes in adult couples and Alzheimer's disease in three-generation families. He maintains an active practice based in a primary care medical setting. He received his Ph.D. at the University of Cincinnati and was a postdoctoral fellow at the University of Colorado School of Medicine.

    John W. Frank is a Senior Scientist at the Institute for Work & Health, a Fellow with the Canadian Institute for Advanced Research, and Professor at the University of Toronto in the Department of Public Health Sciences. As a physician-epidemiologist with a special interest in prevention, his main area of interest is the determinants of health status at the population level. He is currently a visiting professor at the School of Public Health, University of California (Berkeley).

    Vivek Goel is Associate Professor and Chair of the Department of Health Administration at the University of Toronto and Adjunct Senior Scientist with the Institute for Clinical Evaluative Sciences in Ontario. He is a community medicine physician with a master's of science in health administration from the University of Toronto and a master's of science in biostatistics from the Harvard School of Public Health. He is the Scientific Program Leader for the Health Evidence Applications and Linkages Network of Centres of Excellence. His research interests include population health status assessment and the evaluation of health services, particularly medical-screening interventions. He practices health promotion in a preventive oncology program.

    Joy L. Johnson, Ph.D., R.N., is Associate Professor in the School of Nursing, University of British Columbia, and National Health Research and Development Program Scholar. She conducts research in the field of health promotion, behavior change, and disease prevention and holds a number of nationally funded research grants. Her work also focuses on examining how health professionals can best incorporate health promotion strategies into their practices. She received her Ph.D. in nursing at the University of Alberta in 1993 and has been the recipient of several research awards and prizes. She has authored numerous publications and chapters and has spoken nationally and internationally on the topics of health promotion, the reorientation of health services, and the implementation of research findings in practice.

    Ilze Kalnins is Professor in the Department of Public Health Sciences, Faculty of Medicine, University of Toronto and Associate Director of the M. H. Sc. Program in Health Promotion. Her teaching, research, and professional activities encompass both basic research on children's concepts of health, health decision making, and health behavior as well as more applied work on the development and evaluation of programs that promote children's and family involvement in health promoting community development activities. As a member of the Health Behaviour in School-Aged Children: A WHO Cross-National study (HBSC), she is actively engaged in international research on children's health with a special interest in developments in Eastern Europe and the Baltic States.

    Steven H. Kelder, Ph.D., M.P.H., is Associate Professor of Epidemiology and Behavioral Science, Associate Director of Design and Analysis at the CHPRD, and Director of the Outreach and Distance Education programs at the University of Texas–Houston School of Public Health. He also is a Research Fellow with the CDC working to develop an implementation assessment tool for school-based nutrition and physical activity programs and is a member of the Behavior Change Expert Panel for the White House Office of National Drug Control Policy's National Youth Anti-Drug Media Campaign (1998–2004). He has over 10 years' experience in design and evaluation of child and adolescent health promotion research. He received his Ph.D. in epidemiology at the and his master's of public heath in community health education at the University of Minnesota.

    Marshall W. Kreuter was President of Health 2000, a public health consulting and technical assistance firm in Atlanta, Georgia. Now Associate Director of the division of Chronic Disease Control and Community Intervention at the Centers for Disease Control and Prevention, his current research interest focuses on measuring social capital in the context of public health programs.

    Ronald Labonte is Director of the Saskatchewan Population Health Evaluation and Research Unit and Clinical Professor of Community Health and Epidemiology at the University of Saskatchewan. He also heads his own consulting firm (Communitas Consulting) and has held a variety of visiting and adjunct university appointments in Canada, Australia, and Aoteraora/New Zealand. Most recently, he was Visiting Professorial Fellow in Health Promotion at Deakin University in Melbourne. He worked as a health educator and health promoter for 18 years with provincial and municipal governments in Canada before turning his attention to consulting and academic work. He has been an adviser with the WHO, PAHO, and UNICEF and works frequently with government and nongovernmental organizations in Canada, Australia, Aotearoa/New Zealand, Europe, and the United States. His recent books include A Community Development Approach to Health Promotion (1998) and Power, Participation and Partnerships for Health Promotion (1997). Active in many professional public health and health promotion associations, he has recently turned his attention to the effects of global “free” trade and investment agreements on health, and policy options for more health-promoting forms of global regulation and governance.

    John N. Lavis is Assistant Professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University, faculty member in the Centre for Health Economics and Policy Analysis at McMaster University, and Scientist and Associate Research Director (Strategy) at the Institute for Work & Health. His principal research interests include the social determinants of health and the role of research in policy-making.

    Zeus Leonardo earned his Ph.D. from University of California, Los Angeles, Graduate School of Education and Information Studies. He has published articles and book chapters on critical pedagogy and social theory. He is also coeditor (with Tejeda and Martinez, in press) of Charting New Terrains in Chicano [a]/Latina[o] Education. His current work can best be described as the engagement between ideology, discourse, and school reform.

    Jane Lethbridge is an independent consultant in international policy and strategy development. Most recently she was Executive Director of an international health and development nongovernmental organization working on information sharing and knowledge development. She has previously worked at a local and national level in both governmental and nongovernmental sectors. Her main interests are how international health policy can be shaped at national and local levels and in the interface between government and nongovernmental sectors.

    Warren McIsaac is a family physician at the Mt. Sinai Hospital Family Medicine Centre and Associate Professor in the Department of Family and Community Medicine at the University of Toronto. He is interested in health services research in primary care. His active area of research is determinants of antibiotic rescribing by family physicians in upper-respiratory and urinary tract infections.

    Peter McLaren is Professor, Graduate School of Education and Information studies at the University of California at Los Angeles. He is author of a number of award-winning books on critical pedagogy and the author, coauthor, editor, and coeditor of over 30 books and monographs. Hundreds of his articles, interviews, reviews, commentaries, and columns have appeared in dozens of scholarly journals and professional magazines. His most recent books include Revolutionary Multiculturalism (1997), Critical Pedagogy and Predatory Culture (1995), Schooling as a Ritual Performance (3rd ed., 1999), and Che Guevara and Paulo Freire: An Introduction to the Pedagogy of Revolution (1999).

    David McQueen is a Senior Biomedical Research Scientist and Associate Director for Global Health Promotion at the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA. Prior to joining the Office of the Director he was Director of the Division of Adult and Community Health at NCCDPHP and Director of the Office of Surveillance and Analysis at (NCCDPHP). Prior to joining CDC he was Professor and Director of the Research Unit in Health and Behavioral Change at the University of Edinburgh, Scotland (1983–1992), and prior to that Associate Professor of Behavioral Sciences at the Johns Hopkins University School of Hygiene and Public Health in Baltimore. He has served as Director of WHO Collaborating Centers as well as a technical consultant with the World Bank.

    Patricia Dolan Mullen is Professor of Behavioral Sciences and Health Education and a senior investigator with the Center for Health Promotion Research and Development at the School of Public Health, University of Texas-Houston. She has worked closely with managed-care organizations over the past 20 years—as an employee, a state regulator, a federal-level advocate for health promotion and disease prevention, and currently, as a university-based researcher conducting health promotion intervention trials.

    Guy S. Parcel is Director for the Center for Health Promotion Research and Development and Professor of Behavioral Sciences and Pediatrics at the University of Texas Health Science Center in Houston. He has held faculty positions at the University of Maastricht, University of Texas Medical Branch, Penn State University, the U.S. Military Academy, and Eastern Illinois University. He is currently conducting research to develop and evaluate effective school-based health promotion programs for children and youth. His work includes addressing diet, physical activity, and smoking prevention in children, as well as studying the process of diffusing effective smoking prevention programs into schools. He was also principal investigator on a project to evaluate a school-based intervention to reduce behaviors that result in STD/HIV infection. He has directed research projects on self-management of childhood asthma, sex education for adolescents, and preschool health education. Dr. Parcel received his B.S. and M.S. degrees in health education at Indiana University and his Ph.D. at Penn State University with a major in health education and a minor in child development and family relations. Dr. Parcel has made extensive contributions to child health fields through his many scientific and other related publications. He has authored or coauthored more than 150 papers published in scientific or professional journals, book chapters, reports, or proceedings. He received the American School Health Association 1990 William A. Howe Award for outstanding contributions and distinguished service in school health.

    Xóchitl Pérez is a doctoral student in the Social Science and Comparative Education program of the Graduate School of Education and Information Studies at the University of California at Los Angeles. Her dissertation work focuses on the role of U.S. teacher unions in promoting and assisting educational reforms. She is currently associated with the Teacher Union Reform Network (TURN).

    Cheryl L. Perry is Professor in the Division of Epidemiology, School of Public Health, at the University of Minnesota. She began her career as a junior high and high school teacher, and junior high school vice principal in Sacramento and Davis, California. She then received her Ph.D. from Stanford University and worked with the Stanford Heart Disease Prevention Program prior to joining the faculty at the University of Minnesota in 1980. At the University of Minnesota, she served as Director of Youth Health Promotion Research and was responsible for the youth and parent component of the Minnesota Heart Health Program from 1980 to 1993. She has published over 180 articles in the peer-reviewed literature on health promotion programs with children and adolescents, including papers on health promotion theory, design, implementation, and outcomes. She was the senior scientific editor of the 1994 Surgeon General's Report on Preventing Tobacco Use Among Young People and was an expert witness in Minnesota's landmark trial against the tobacco industry. Currently, she serves as principal investigator of a community-based evaluation of Dare and Dare Plus, the Cafeteria 5-a-Day Power Plus study in 26 schools in Minnesota, and Project Northland, a 28-community trial to reduce alcohol use among adolescents. Her book, Creating Health Behavior Change: How to Develop Community-Wide Programs for Youth, was recently published by Sage (1999).

    Michael F. D. Polanyi is Research Associate at the Institute for Work & Health and a doctoral student at York University in Environmental Studies. His research focuses on organizational change and its impact on health. He helped coordinate a major research project on musculoskeletal disorders among newspaper workers. He holds a master's degree in political science from the University of Toronto.

    Louise Potvin, Ph.D., is Scientist, Medical Research Council of Canada, Groupe de Recherche Interdisciplinaire en Santé, Faculté de Médecine, University of Montreal. She is also Professor, Department of Social and Preventive Medicine, University of Montreal. Her research program focuses on the evaluation of community health promotion programs and on linking community and family health promotion processes with social and structural conditions.

    John Raeburn is Associate Professor of Behavioral Science at the University of Auckland, New Zealand. He has had a long-term association with health promotion, and his research and teaching have been especially in the area of grassroots community approaches to health promotion. He is coauthor with Irving Root-man of the 1998 book People-Centered Health Promotion.

    Harry S. Shannon is Professor in the Department of Clinical Epidemiology and Biostatistics and Director of the Program in Occupational Health and Environmental Medicine at McMaster University. He is seconded to the Institute for Work & Health as a Senior Scientist. He holds a Ph.D. in Applied Statistics from the University of London, England. His current research focus is on organizational factors and health, work-related injuries, and musculoskeletal disorders.

    Hassan Soubhi, M.D., Ph.D., is currently a postdoctoral fellow at the Department of Health Care and Epidemiology at the University of British Columbia. His research focuses on the family as an interface between external influences from the general environment, including health promotion programs, and family members' health and health-related behavior. A former Assistant Director of a Community Health Center in Morocco, Dr. Soubhi has worked for 5 years as a family physician with families living in a shantytown in the suburban area of Casablanca. He also has a master's in public health from the School of Public Health at the Free University of Brussels, Belgium.

    Terrence J. Sullivan is President of the Institute for Work & Health. He has played senior roles in a number of Ministries of the Ontario government. He maintains an external appointment at the faculty of medicine at the University of Toronto and is Adjunct Professor in the Graduate Program in Sociology at York University in Toronto. He recently edited Injury and the New World of Work (1999) and is coeditor with D. Drache of Health Reform: Public Success/Private Failure (1999).

    Jane G. Zapka is Professor of Medicine in the Division of Preventive and Behavioral Medicine at the University of Massachusetts. She is a behavioral scientist with extensive experience in health policy and management teaching and research. She has expertise in primary care and prevention services, with a focus on program evaluation, quality improvement, and managed care. She is an adjunct faculty member of the Center for Quality at the Harvard School of Public Health, where she collaborates on research related to quality improvement measurement. She has coordinated community-based projects involving work with providers and public education for improving quality of, and participation in, breast cancer screening and evaluating coordinated screening programs within community health centers serving primarily Latino clients. She is interested in research related to women's health and is an investigator on the NIH Women's Health Initiative. Currently, she is involved in evaluation studies for the Massachusetts Department of Public Health-funded smoking cessation projects and Breast and Cervical Cancer Screening Program. Both projects involve educational activities within primary care settings.

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