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Bureaucratic logic in new social movement clothing: the limits of health promotion research

1991; Oxford University Press; Volume: 6; Issue: 4 Linguagem: Inglês

10.1093/heapro/6.4.281

1460-2245

H. Michael Stevenson, Mike Burke,

Global Public Health Policies and Epidemiology

This paper discusses theoretical, methodological and political problems in the field of health promotion research. It argues that these problems result from a partial and contradictory appropriation of the discourse of new social movements. Politically, the health promotion movement is largely confined within the state, rather than the expression of a social movement against the state. The direction of health promotion research and policy is, therefore, caught in the bureaucratic logic of ‘trapped administrators’, and results in contradictory emphases on problems like the development of ‘health promotion indicators’, which show little result in informing a broader but coherent conceptualization of health, let alone in effecting change in health policy and outcomes. Such political problems reflect parallel confusions about theory and methodology. Theoretically, the field relies heavily on a critique of bio-medical science, but fails to move beyond a rhetorical outline of an alternative to systematic arguments about what promotes health. In this regard, the literature on health promotion remains unaware of important conceptual developments in the social sciences, relies on imprecise specifications of major constructs like community empowerment, and has no conception of the state. Methodologically, the literature is influenced by contradictory epistemological tendencies which reflect a positivist inspiration (as in the search for indicators) and an anti-positivist emphasis on agency and social change through the collective action and the discursive reconstitution of social identity, value and meaning. In regard to these questions, this paper is critical of observers who suggest that the way ahead is to embrace post-modern research strategies. Movement in this direction would tend to diffuse an already desultory research practice and depoliticize social struggles for meaningful change. The paper ends by suggesting that the field of health promotion needs a more serious engagement with critical social theory to construct a rigorous conceptualization of health and its social correlates and to develop a coherent research practice and political project.