Written by Angelina Wilson, Edited by Emily Fisher
Health promotion as a field of study and a practice has its focus on enabling individuals everywhere to live healthier lives. It has its roots in the UN declaration of human rights and the need for primary health care (1). Although its essence is undoubtedly quite evident in various regions of the world, it is known to have gained more prominence in the West. History shows that the major health promotion movements began in the West with a number of health promotion tenets based on western values (2-3). Health promotion action includes building a healthy public policy, creating a supportive environment, strengthening community actions, developing personal skills, and reorienting health services (3). Most of these tenets are applicable everywhere, but need to be adapted to suit local contexts in order to serve their true purpose. For example, in most parts of Africa health is seen as the prerogative of the health sector alone mostly because of the lack of necessary resources to incorporate other sectors in the promotion of health. Developing personal skills is very important, but in most collective societies, it is not acceptable to elevate the individual above the community. The underlying values for these actions have consequences that are not very salient and are therefore taken for granted. The resulting impact is the difficulties that have come to be associated with the transference of knowledge to local contexts.
Health promotion is becoming increasingly important especially in the global south where experts are still battling with various forms of health problems. Yet there seems to be a widening gap between the context of health problems in the global south and the knowledge base being developed in the West. It is common to find institutions that teach health promotion or related courses in the West, but this is rarer in the global south. The closest the global south has come to developing a knowledge base for health promotion is the academic field of public health. As a result of this, it is very common to find students from other parts of the world coming to the West to study health promotion. The focus of this article is to provide a global perspective on the challenges and benefits of moving from other parts of the world to the West to study health promotion and return home to practice.
Health promotion seems to be well advanced in developed countries when compared to Africa and Asia (4). Some reasons for this discrepancy include the competition of resources among already established health institutions such as public health and medical care. There is also a tendency for the professionals in these established institutions to view health promotion as a threat to their positions (4). This is because other health professionals with minimal knowledge of the scope of health promotion assume that these newly trained health promotion experts will take over their positions. As mentioned earlier, the actions of health promotion seems quite progressive and radical and therefore a threat to already established systems. Health promotion is also still relatively new as compared to other professions, and as a result of this professional ambiguity, people often equate it to public health or health education (4). South Africa, Botswana and Nigeria are a few African countries that have systems in place to aid in the development of health promotion both as a practice and a discipline (5). Ghana has also recently introduced health promotion as a program of study. A system of standardization is mostly needed to aid in the development of health promotion as a field of study and practice in the global south.
Some of the challenges that come with receiving health promotion education abroad include opposition when professionals receiving health promotion training abroad return home (4). They may have to literally defend their utility to the system that is naïve and unwilling to accept change and many of these professionals get lost in the system or practice another health-related activity instead of health promotion. One of the reasons for the need to defend one’s profession is because health promotion is not seen as directly applicable. In most developing countries, there is a huge need for professions that have immediate and practical effects such as curative services. Unfortunately, health promotion is a process which can strain resources and take a longer time to bear fruits. The scarcity of resources therefore necessitates that more attention is paid to the well established professions with evident results.
There are some ethical issues that might come up during transference of knowledge acquired in a foreign country. Ethical issues that might arise include imposition of methods and interventions from the West. There is an erroneous assumption that everything from the West is necessarily superior which results in neglecting local values, perspectives and culture. Cultural sensitivity is essential when transferring knowledge and implementing programs (6), but implementing this can be quite difficult as it requires strong collaborations which take up time and the involvement of multiple stakeholders.
This does not mean that health promotion training is not beneficial; but that its benefits, in resource-constrained contexts are not immediately evident. One benefit of an overseas education in health promotion is that the individual can be a pioneer in whatever society they find themselves. Over time, these professionals become change agents and also help in the establishment of institutions that teach health promotion in their communities: despite resistance, health promotion is gradually asserting its presence all over the world.
Going abroad to receive an education is inherently useful but transference and application of new knowledge in an unsupportive environment is difficult at best. The way forward, then, is to develop systems that make it easier to absorb professionals who receive health promotion education abroad. In addition, capacity building efforts in health promotion should increase in developing countries.
1. WHO | WHO called to return to the Declaration of Alma-Ata [Internet]. [cited 2010 Nov 13]. Available from: http://www.who.int/social_determinants/tools/multimedia/alma_ata/en/index.html
2. WHO | Adelaide Recommendations on Healthy Public Policy [Internet]. [cited 2011 May 23]. Available from: http://www.who.int/healthpromotion/conferences/previous/adelaide/en/index.html
3. WHO | The Ottawa Charter for Health Promotion [Internet]. [cited 2010 Sep 5]. Available from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
4. Nyamwaya D. Impediments to health promotion in developing countries: the way forward. Health Promotion International. 1996;11(3).
5. Onya HE. Health promotion competency building in Africa: a call for action. Global Health Promotion. 2009 May 15;16(2):47–50.
6. Resnicow K, Baranowski T, Ahluwalia JS, Braithwaite RL. Cultural sensitivity in public health: defined and demystified. Ethn Dis. 1999;9(1):10–21.
Published: May 2012, Health Promotion Connection