Books

Health promotion at the community level

Second edition: new advances

Edited by Neil Bracht Sage Publications 292 pages£15.95 paperback£34 hardback

Ignore the dreary title. This updated and expanded collection of papers is a fascinating read for anyone concerned with health improvement. It is also a timely contribution to a fast-moving area of policy and practice. After decades of neglect and inertia, public health is back on the political agenda. Social exclusion has become a central concern for governments across Europe, and urgent attention is being given to programmes to reduce inequalities in health.

The causes of the major public health problems of our age are many and varied and the solutions promise to be no less complex. They require imaginative and sustained responses from all those concerned with social and health policy. New tools are needed to develop participative and collaborative responses to deep-rooted problems.

Better evidence is required of the effectiveness of interventions that seek to tackle the causes of ill-health.

In planning for the future, we ignore lessons from the past at our peril. The book provides a no-nonsense overview of many previous attempts to improve health through actions undertaken at community level. While it is written with passion and indignation at the injustice of global and local inequalities in health, it also communicates a careful reflection and a critical stance to its subjects.

The book's strength is that it links theories of community and social action to historical practices in a way that is both clear and accessible, without being simplistic. As a succinct history of community-based health promotion it is invaluable. More than that, it serves as a practical guide to the planning, practice and evaluation of community health promotion.

The community is a powerful political symbol. It has an intuitive appeal to those convinced of the need to pursue a social agenda to improve health. But much so-called community health promotion has consisted of little more than elaborate behavioural change programmes aimed at individuals in community settings.

Perhaps the dominant health-promoting ideology over the past 30 years has been disease prevention and risk-factor reduction at population level. As the first section of the book makes clear, vast amounts of time and effort have been poured into grand community demonstration studies around the globe.

Disappointingly, the evidence from the best-researched of these studies - from North Karelia to Minnesota - points to little, if any, significant and sustained improvements in population health and well-being. It is to be hoped that more socially informed approaches to the improvement of public health will have greater success. For too long, health promotion has been regarded as the handmaiden of medical science.

In fact, health promotion offers the potential to effect much more profound social change, concerned as it is with enabling people to increase control over - and to improve - their health. Health Promotion at the Community Level will assist planners and practitioners who wish to know how to involve and include communities in assessing, responding to and evaluating sustainable improvements in health.

Adam Crosier

Senior research manager, Health Education Authority.