The terms “health promotion” and “disease prevention” refer to professional activities. But a “health promoter” has also come to denote a profession, with an alternative agenda compared to that of traditional public health work, work that by some is seen to be too medically oriented, too reliant upon prevention, risk-elimination and health-care. But is there really a sharp distinction between these activities and professions? The main aim of the paper is to investigate if these concepts are logically different, or if (...) they are just two extremes of one dimension. The central concepts, health promotion and disease prevention, are defined, and it is concluded that health promotion and disease prevention are logically distinct concepts, although they are conceptually related through a causal connection. Thus, logically, it is possible to promote health without preventing disease, even if this is not so common, in practice, but it is not possible to prevent disease without promoting health. Finally, most health promoting interventions target basic health, not manifest health, and often also thereby reduce future disease. (shrink)

This paper is in three parts. In Part One we briefly explain that an unsophisticated form of utilitarianism—economic rationalism (ER)—has become dominant in many health systems. Its proponents argue that one of ER’s most important effects is to increase consumer choice. However, evidence from New Zealand does not support this claim. Furthermore, the logic of ER requires the construction of systems which tend to restrict individual participation.In Part Two we argue that although some have advocated an ‘ethic of care’ in (...) an attempt to counteract ER’s utilitarianism, two decades of campaigning have had little influence on health policy. ER’s pro-care adversaries have failed to make an impact because they have not developed a taxonomy of care—they have not established a language compatible with, or as powerful as, ER’s.In Part Three, in an attempt to raise the conceptual and practical status of caring in contemporary health systems, we distinguish four different forms of care. In opposition to those who believe the ‘ethic of care’ can adequately direct health care practice, we demonstrate that care is a secondary notion. We show that in order for a carer to decide which form of care to adopt in different situations she requires a more powerful idea. We contend further that health care ought to be governed by a theory of health, and suggest that ‘the foundations theory of health’ should be adopted by planners searching for a more humane alternative to ER. We conclude that ER’s dominance can and must be challenged. However, only those arguments which offer detailed theoretical analyses of health care, as well as meticulously derived practical policies, have any chance of success. (shrink)

This study examines truthfulness through eight dimensions to explicate truth in health communication and explores the relationships between message truthfulness and message attributes and audience characteristics. A content analysis of 974 television antismoking ads from the Centers for Disease Control (CDC) reveals a high degree of truthfulness. Message truthfulness is related to thematic frames, emotion appeals, source, age, social role and smoking status, and positive framing of consequences. Ads targeted at teens/youth and smokers tend to have lower message truthfulness than (...) ads targeting older age groups and non-smokers. Ads with humor and fear appeals are found to be less truthful. (shrink)

Knowledge is a presumed motivator for changed consumption practices in ethical eating discourse: the consumer learns more about where their food comes from and makes different consumption choices. Despite intuitive appeal, scholars are beginning to illuminate the limits of knowledge-focused praxis for ethical eating. In this paper, we draw from qualitative interviews and focus groups with Toronto mothers to explore the role of knowledge in conceptions of ethical foodwork. While the goal of educating children about their food has become central (...) to Canadian and American discourses of “good” mothering, we identify a paradoxical maternal expectation surrounding meat consumption: to raise informed child consumers who know where their food comes from, and to protect children from the harsh realities of animal slaughter. Rather than revealing the story behind the meat on a child’s plate, mothers seek to shield children from knowledge of meat production. Our analysis of the child consumer contributes to ethical eating scholarship and illuminates a larger paradox surrounding knowledge of meat in an industrialized food system. In the practice of feeding children, mothers confront the visceral discomforts of meat consumption; their reactions speak to discordant feelings involved with eating meat in a setting far-removed from the lives and deaths of animals. Ultimately, the paper illustrates the limits of consumer-focused strategies for food-system change that call on individual mothers to educate young consumers and protect childhood innocence, all while getting ethically-sourced meals on the table. (shrink)

It appears that there are two distinct practices within public health, namely health promotion and disease prevention, leading to different goals. But does the distinction hold? Can we promote health without preventing disease, and vice versa? The aim of the paper is to answer these questions. First, the central concepts are defined and the logical relations between them are spelt out. A preliminary conclusion is that there is a logical difference between health and disease, which makes health promotion and disease (...) prevention two distinct endeavours. However, since disease is defined in relation to health, as those kinds of internal processes and states that typically lead to ill health, the difference is smaller than it might appear. Second, in order to answer the practical question whether it is possible to promote health without preventing disease, and vice versa, several kinds of public health interventions are discussed. The conclusion is that while health promotion and disease prevention can be distinguished conceptually, they can hardly be distinguished in practice. Most general measures do both at the same time. (shrink)

The author responds to Professor Kottow's criticisms, explaining numerous errors and misconceptions.

This paper responds to Dr Cassell's request for a fuller explanation of my argument in the paper, Against medical ethics: a philosopher's view. A distinction is made between two accounts of ethics in general, and the philosophical basis of health work ethics is briefly stated. The implications of applying this understanding of ethics to medical education are discussed.

In modern representative democracies, much healthcare is publicly funded or provided and so the question of what healthcare systems should do is a matter of public policy. Given that public resources are inevitably limited, what should be done and who should benefit from healthcare? It is a dilemma for policymakers and a subject of debate within several disciplines, but rarely across disciplines. In this paper, I draw on thinking from several disciplines and especially philosophy, economics, and systems theory. I conclude (...) that economist and philosopher John Broome’s writing provides the framework for an answer: a healthcare system in a democracy should do as much good as possible, although sometimes we should sacrifice some overall good for the sake of fairness. This leaves open some detailed questions about what in practice we consider to be good and fair, and about when some good should be traded off in order to be fair. The answers to these questions depend on our values, or as explained by systems theory, our weltanschauung. How policy decisions should be made when citizens’ values differ is a subject of extensive academic debate. However, it is a separate question. Representative democracies have mechanisms for resolving such debates. (shrink)

This paper looks at how the strategies of mediaand cultural studies can be applied to thehealth studies field. This relationship,however, has been met with resistance due to anumber of status debates. We argue theimportance of fostering links between these`disciplines' namely because the definition ofwhat constitutes `health' has been broadenedand is inscribed in most forms of popularmedia. Using the example of the `health andlifestyle' debate, we argue that the mediainforms cultural understandings aboutrequirements for living and is therefore acrucial area of analysis (...) for health studies(and cultural/media studies) students. We arealso concerned with analysing how the mediacontributes to the construction and regulationof `healthy' subjects making links with publichealth discourses and current debates in thefield of media and health. (shrink)