Why health promotion is an old crock
No doubt the Ottawa Charter signatories had the best of intentions but it seems to me that the principles underpinning the Charter have had little real effect when it comes to the way health promotion is practised in New Zealand – and elsewhere for that matter. Although health policy tends to pay lip service to all the particular “actions” embedded in the Charter, in reality the main focus is on individual behaviour change through education.
The idea that telling people what they should or shouldn’t do, and why, will make them change their behaviour is a load of old crock. In fact the only people who do sometimes respond to such messages are usually those who have other things to fall back on. Middle class people give up smoking but can resort to other ways to relieve stress. And when it comes to diet, they can more easily afford the expensive low-fat cuts of meat and healthy bread options. It is no accident that the poorest people are the fattest.
Similarly, middle class teens have opportunities that teenagers from poorer families don’t have, or at least don’t feel they have. For teenage girls from poor families, pregnancy is often seen as a solution to a problem. But by presenting teenage birth as a problem its real cause – poverty and disadvantage – can be conveniently ignored. Even in the Netherlands, which has one of the lowest teen birth rates in the world, teenage mothers are from the poorest socio-economic group.
But for those in positions of power, it is much easier and cheaper to keep on at people to do something themselves than to change the social structures which work to maintain the status quo. Blaming (albeit indirectly) people for their health problems means that governments can turn a blind eye to the powerful duopolies which supply our supermarkets and inflate prices. They can turn a blind eye to our city designs which encourage driving at the expense of people who prefer to cycle and walk. And they turn a blind eye to the failure to make enough jobs meaningful and well-paid so young women can make a real choice between motherhood and paid work.