Health Promotion: Philosophy, Prejudice and Practice
Authors: Joann Sy, Anthony Kessel
Journal: Journal of the Royal Society of Medicine (2005)

Underpinning Seedhouse's book, now updated in a new edition, is the belief that health promotion has no account of its purpose, is muddled with contradictory ideas and practices, and is ultimately misguided. He is dismissive of its practitioners, working in a 'magpie profession' that has accumulated bits and pieces from other disciplines, with little theoretical development of its own.

In part one Seedhouse describes the limitations of contemporary western health promotion, with its deliberately vague statements, illusions of shared meaning, confusion between facts and values, and superficial frame-works and models. In part two he deconstructs health promotion, exposing its (generally unacknowledged) prejudices and political roots. It is in part three that Seedhouse offers his own 'foundations theory of health promotion', developed further from descriptions in his earlier books. He argues that health promotion should be eclectically, and openly, based on political philosophies of social justice, egalitarianism, liberalism and utilitarianism. His theory, however, is largely egalitarian, resting on the premise that people are of equal worth even if they have unequal talent or ability; it promotes the centrality of expanding autonomy. Seedhouse's foundations are states of being within which one should strive to develop, for instance with regard to education. These states of being indicate the degree to which a person is functioning successfully, and therefore via his states of being is in [good] health. Seedhouse's foundations include basic needs, education, and community environment. Through cultivating foundations one gains autonomy and, thereby, has the ability to accomplish future goals or improve one's present situation. The health promoter should work with the client to fill in gaps within the foundations, from where the client now is to where the client wants to be (i.e. the client's goals).

To a degree, however, Seedhouse is promoting the very theory he believes to have failed—the good life/wellbeing theory. He defines good life promotion as follows: health promotion should seek to bring about 'positive health' or wellbeing, it should create 'good lives'. While he argues that the relationship between health and wellbeing/good life is contingent, whether the relationship is contingent or necessary is not the question here. For it seems that Seedhouse's theory wants to argue that if one has all the foundations one is deemed healthy. Even if all his states of being are not related to health per se, they could work towards a better life and consequently promote objectives of a good life theory.

Seedhouse's concepts are not necessarily new, and his foundations theory is comparable to the economist Amartya Sen's capability argument. Within Sen's capability argument, one has capability to choose the kind of life one values. Sen's main idea in his capability concept is the emphasis on expanding one's freedom. That is to say, capabilities are different states which one can choose, all of which can interrelate to each other, ultimately enabling one to expand one's freedom. This is similar to Seedhouse's foundations and autonomy, as each foundation may interrelate with another, and one foundation may greatly help in advancing another foundation, and ultimately increase one's autonomy. For Sen, expanding human freedom must include freedom of action and decision, and must involve working to eliminate deprivations such as starvation and deprivation. Seedhouse endorses an analogous notion, arguing that the purpose of health work inevitably must entail the removal of obstacles to human potentials.

Seedhouse's book is a terrific teaching aid. Throughout it the author uses staged dialogues, case studies, and other creative methods to illustrate his points, and to be available as teaching tools. The style may not be to everyone's taste, at times verging on the pompous, but this book is a must-read for all students and practitioners of health promotion.