We have just celebrated forty years of
health promotion at Leeds Metropolitan University. We gathered together
previous and current students and staff and Emeritus Professor Sylvia Tilford
talked about the early development of the course at Leeds Met, whilst Emeritus
Professor Jackie Green joined us in a pre-recorded piece, as she was overseas
on the day. Professor Jane South talked about her current work on healthy
communities and I talked about some of the global dimensions of our work.
I need to qualify the description ‘forty
years of health promotion at Leeds Metropolitan University’ though, as when the
course started in 1972, we were still Leeds Polytechnic and only became a
University in 1992, when all polytechnics in England became universities. (For anyone unfamiliar, we haev two universities in Leeds - Leeds Met and Leeds University). Also,
we started as a health education course, as ‘health promotion’, as we all know,
didn’t really take off as a term until the mid 1980s. But – our achievements
are significant whatever we call them. In 1972, we were one of three higher
education institutions in England asked by the government to develop and
deliver health education training for health education officers. Keith Tones
was responsible for this development; he of course went on to contribute so many
papers and books outlining the principles and practice of health promotion, and
commented in the early days about the importance of empowerment (Tones 2001).
Shortly after, Sylvia Tilford joined the
department, along with John Hubley and Faith Delaney. Sylvia and Keith, along
with Yvonne Robinson produced the key textbook ‘Health Education: Effectiveness
and Efficiency’ in 1990, one of the first texts aimed at Masters’ level study.
It went through a number of revised editions and was later simply referred to,
when we were recommending books, as ‘Tones and Tilford - Health Promotion’.
The course in its earlier days concentrated
on the Postgraduate Diploma, as this was the qualifying course to become a
health promotion officer. The course was closely tied to practice and students
were only accepted with several years of work experience. The primary aim was
to provide the theoretical underpinnings to professional practice. In the 1980s
and 1990s it was not difficult for students to find work. UK students were
employed by local authorities and health services, and those many students who
came to us from Africa and Asia were employed in a variety of roles within
health and social care, community work and education.
By the time I arrived in 1991, after a
decade or so of developing health promotion schools and working in Africa, the
course had both health promotion and health education in its title. Keith,
Sylvia, Faith, John and I taught the course but we were also developing a
research profile and John in particular was doing consultancy work overseas. He
contributed mainly in the international sphere, and was a master at producing
accessible books aimed at practitioners. He wanted to improve the practice of
front line workers. For many years we ran a one-year diploma course at
undergraduate level for such workers, which attracted students from all over
the world. Some later went on to our Masters’ course. His book ‘Communicating
Health’ remains a practical and useful book used in the field, and he went on
to produce, with June Copeman, the book ‘Practical Health Promotion’.
Tragically, he died at the age of 58 just before this book was published. A
second edition has just been produced, being brought up to date and joined as
an author by James Woodall.
A couple of years after I joined the team,
Jackie Green came to work with us, having been a practitioner at Leeds Health
Promotion Service. She went on to
produce another useful book with Keith
Tones, (Tones and Green) which in its second edition became Green and Tones
(2010).
A major development occurred in 1997, when
we set up the Centre for Health Promotion Research, and Sylvia Tilford, who up
to that point was the head of the team, took a sideways move to head up the
Centre, and I was promoted to head the staff team. The creation of a formal research
centre enabled us to house the burgeoning research activity taking place. One
of the first major contributions was a piece of research which took forward
understanding of the processes of intersectoral collaboration, and one of the
papers from that study is still used as seminal
piece today (Delaney 1994). Faith moved on in the 1990s.
The course was popular, and went through a
series of name changes to reflect developments in the field. We would spend
hours debating what to call the course! In the 1990 and early part of the 21st
century, health promotion was being renamed and ‘rebranded’ variously as
‘health improvement’, ‘health development’ and ‘public health’. There was
criticism that health promotion had no delivered its intended promises (French
and Milner 1993). Several Masters courses in England changed their names at
this point but we felt we wanted to keep the term ‘health promotion’. We did however
bend to market demands and call the course ‘Public health – Health Promotion’ –
clumsy perhaps, but students were demanding that public health appear in the
title, as government ideology had swung away from health promotion and towards
retrenching health promotion within the broader (and less radical) public
health function. The current fortunes of health promotion in England are
described in chapter 6 of the book I mention below (Dixey 2012).
Whilst I was head of the team (1997- 2011),
we appointed Mima Cattan, who produced a key book on mental health promotion with
Sylvia Tilford, and who drew attention to the issue of loneliness in old age
through her PhD studies. Mima is now a Professor at Northumbria University. We
also appointed John Barron, a practitioner in young people and schools. Sadly
John died suddenly at the age of 48 from a congenital heart condition. He was passionate about the neglected issue
of the mental health of young people, supporting a charity called ‘Young
Minds’. Mary Green was another appointment at that time, and she was to prove
so instrumental in setting up, with me, the delivery of our Masters’ course in
Zambia.
We had become aware that it was proving
expensive to study in the UK for students from developing countries. Mary
already had a partnership with Chainama College in Lusaka and so we set about
seeing if we could deliver the course there. This proved possible when we were
awarded scholarships from the Commonwealth Scholarships Commission through
their new distance learning committee. We therefore developed a separate
course, suitable for Zambia, which we delivered by relays of staff from Leeds
going out to Zambia for two-week teaching blocks several times a year (Dixey
and Green 2009). We saw this as a way to develop a sustainable workforce in
Zambia and since it started in 2004, we have educated successive cohorts, with
the seventh cohort about to start in January 2013. Later we also took the
course to The Gambia, again on the request of our alumni. We have educated
three cohorts there, with the second about to graduate. We again had the
welcome scholarships from the Commonwealth and also the generous support of the
National AIDS Secretariat in The Gambia which meant that we could educate
larger groups (e.g. 37 and 32 in the second and third groups). This way of
delivering course is a creative solution to the lack of higher education infrastructure
in Africa, and is also, through capacity building, contributing to the
development of that infrastructure, as well as building up the health promotion
workforce (Dixey 2012). During the time the course has been running in The
Gambia, health promotion has been more firmly embedded as a separate unit
within the Ministry (Dixey and Njai in press). Mary Green retired three years ago, leaving a
wonderful legacy, as our partnership with Chainama College remains strong.
During the late 1990s and into the 2000s, a
number of staff joined the team. Joy Walker was with us for a few years, and
Jane South, Ruth Cross, Diane Lowcock, Ivy O’Neil, James Woodall all joined and
stayed. Sally Foster has been an essential part of the team since before I
arrived, but as a sociologist and health promotion graduate, she was located in
social sciences; she and Louise Warwick Booth (a social policy and sociology
expert) and Chris Spoor (a health economist) only formally joined the health
promotion group in the early part of the 2000s.
Two very experienced practitioners also joined us - Judy White from
years of practice in health promotion in Bradford, and Skye Hughes from working
for NGOS and at Universities in Kenya and Botswana. Skye left in 2012. James originally did his PhD with us, one of a
large number of PhD students in our thriving research student community.
My initial expertise was in development and
I had worked in Africa, as had Mary, John Hubley, Sally, Ruth and Skye. We were
also joined in this African work by Zac Mwanje, a Zambian based in Leeds. The
opportunity to deliver our course in two African countries has been a highlight
of my career and it’s something I feel especially proud of. We have all gained hugely
from experiencing the warmth of people in these very two different countries, working
with colleagues in Zambia and The Gambia and enjoying developing additional collaborations
and projects (Foster et al 2012). We are
planning to deliver our Masters’ course in Ghana, which will begin in
2013.
The Centre for Health Promotion Research
went from strength to strength, firstly under Sylvia’s leadership, then under
Jackie Green’s once Sylvia semi-retired. Jackie and Jane South wrote a useful
book on evaluation (Green and South 2006), and many of the projects the Centre
has undertaken have been evaluations of health promotion initiatives. After
Jackie left us, the Centre was co-directed by Jane South and Mima Cattan, and
once Mima left, has been very ably led by Jane South. She has developed special
strengths in community engagement and in people-centred public health, ideas
formulated into a recently published book with Judy White and Mark Gamsu, our visiting professor (South, White and Gamsu
2012). We have contributed a lot to the development of empowerment approaches,
through a series of reports commissioned by Altogether
Better (see for example, Woodall et al 2010). Gianfranco Giuntoli,
Anne-Marie Bagnall and Karina Kinsella work with us in various research roles,
delivering the work of the Centre alongside the rest of the team, all of whom
also teach. Our output can be seen through these pages: http://www.leedsmet.ac.uk/hss/research_centre_for_health_promotion_research.htm
Louise, Ruth and Diane have made important
contributions to the health studies literature (Warwick Booth et al 2012 and
Warwick Booth et al forthcoming), and since 1990 when it was established, we have
all contributed to the degree in Health Studies run at Leeds Met.
Our main UK based Masters remains the MSc
Public Health – Health Promotion, and the current course leader is James
Woodall. In the past, the course has been led by Sylvia, myself, Mary Green,
Ruth Cross and Ivy O’Neil. We have been fortunate to have had a number of
external examiners attached to the course, all large figures within the
epistemic health promotion community – Amanda Amos, David Stears, Jane Wills,
Angela Scriven, and currently, Peter Duncan.
Our recent book (Dixey 2012) comes out of
our experience of running the course, comprises an overview of all our ideas
about health promotion and is designed to be applicable globally. It reasserts
the radical intention of health promotion, seeing it as a social movement to
bring about health justice. In the introduction, we say:
“What our book does aim to do is to set
out some of the key principles and ideas, or in more academic terms, to explore
the discourse surrounding health promotion in the twenty first century. It not
only attempts to explore what health promotion is, but also to ask some
uncomfortable questions about health promotion – in short, to be critical of
it. Being critical, according to some, is what defines our age (Jencks, 2007) –
being sceptical and asking questions…As such then, this book does aim to be a guide to ‘how to think
about health promotion’.”
At the end of chapter one, we write:
“For now,
distilling the key points from this discussion, we propose (in no
particular order), that health promotion therefore should:
1. Resist
biomedical models of health and advocate for the broader social model of health
to be adopted at policy making levels;
2. Place empowerment and the redistribution of
power at the centre, so as to bring transformation to individuals, communities,
organizations and societies with the aim of produce greater health;
3. Involve
collaborative working and strong partnerships;
4. Take a
salutogenic approach and promote the importance of ‘good health’;
5. Take an
assets perspective (rather than a deficits one), with a stress on capability;
6. Prioritize
the most vulnerable and disadvantaged communities, thus tackling areas facing
the worst inequities;
7. Start with
where people are, use ‘constructionist epistemologies’, respect and value local
knowledge and lay epidemiologies;
8. Use ethical
change processes;
9. Have
capable, skilled health promotion workers working alongside communities as
allies;
10. Adopt
anti-oppressive practices, challenge racism, sexism, disablism and any other
practices and institutions which oppress people;
11. Adopt
ecological principles, sustainability and a concern for the environment;
12. Invest in
the capabilities of the health promotion workforce (both professional and lay),
paying attention to life-long learning;
13. Use
evidence-based practice, ‘real world’ evaluation methods.
14. Produce
‘big picture’ change at the societal level and also ‘small picture’ change,
working with communities and individuals.”
Whether the book ‘works’ as a guide to
health promotion in the 21st century and is applicable to all countries, no
matter what state of ‘development’ remains to be seen. Please let us know!
(You can get in touch through the comment
facility of this blog, or email us r.dixey@leedsemt.ac.uk)
We remain passionate about tackling health
inequalities and we believe that we put our principles into practice, making
sure that in our research we are inclusive, use participative methodologies,
such as working with lay researchers; and in our teaching we are empowering
another generation of health promotion workers. Our concern with marginalized
communities can be seen in our work with, among other things, health promoting
prisons and with waste collectors. We also have a major initiative called
Health Together: Evidence, Policy and practice for Community Engagement.
(leedsmet.ac.uk/healthtogether).
This round up of health promotion at Leeds
Met is inevitably personal and partial, so I’m sorry if I’ve missed anything
out. It’s been a fabulous journey for me and I’m proud to have been a part of
health promotion at this University. I stepped down from managing the team in
2011 so that I could concentrate more on writing and other projects and also on
the professorship that I was given in 2008. (My inaugural lecture is on youtube, as will be Jane South’s later
in 2013). There are not many professors in health promotion, but we have two –
myself and Jane South. I think it’s fair to say too, that we are one of the
largest specialist academic health promotion departments anywhere. The research
centre has become a part of the Institute of Health and Wellbeing, enabling us
to gain synergies from a wider research community through collaborating with
other Centres in the University. Just recently I have been given a part time
role in the University as Director of Postgraduate Students which means I have
a responsibility for the 650 PhD students across the University. Playing this
role I can see that there is all sorts of health promotion research and
teaching going on other parts of the University – in the Carnegie Faculty for
example, focusing on physical activity, lifestyle and weight management. And as
the Arts, sustainable building, healthy cities, politics and social policy and
so many other disciplines all have a bearing on health, we are at the centre of
a huge amount of creativity as far as health promotion and wellbeing are
concerned.
References:
Cattan,
M. & Tilford, S. (2006) Mental Health
Promotion: A lifespan approach, McGraw Hill International, Maidenhead
Delaney, F.
(1994) Muddling through the middle
ground: theoretical concerns in intersectoral collaboration and health
promotion, Health Promotion International.
9(3), 217-225
Dixey,
R, (2012) Health Promotion: Global
Principles and Practice. Wallingford: CABI Press
Dixey, R. and
Green, M. (2009) Sustainability of the Health Care Workforce in Africa: A Way Forward in
Zambia, The International Journal of Environmental, Cultural, Economic and
Social Sustainability, 5(5), 301-310
Dixey,
R. and Njai, M. (2012) The Call to Action: Health Promotion in The Gambia -
Closing the Implementation Gap? Global Health Promotion (in press)
Foster, S., Dixey, R., Oberlin,
A. and Nkhama, E. (2012) ‘Sweeping is women's work’: employment and empowerment
opportunities for women through engagement in solid waste management in
Tanzania and Zambia. International Journal of Health Promotion and
Education. 50 (4) July, pp.203-217.
French, J. &
Milner, S. (1993) Should we accept the status quo?, Health Education Journal, 52(2), 98-101
Green,
J. & South, J. (2006) Evaluation, Open
University Press, Maindenhead
Green, J. &
Tones, K. (2010) Health Promotion:
Planning and Strategies 2nd edition, Sage, London
Hubley, J. (1993)
Health Communication: An action guide to health promotion and health education.
MacMillan
Hubley, J.,
Copeman, J., and Woodall, J., (2012) Practical Health Promotion. Polity Press,
Second edition.
South, J., White,
J., and Gamsu, M. (2012) People Centred
Public Health: Policy and Practice. Polity press.
Tones, K. (2001) Health promotion: the
empowerment imperative, in Scriven, A. & Orme, J. (eds.) Health promotion: professional perspectives 2nd
edition, Palgrave, London
Tones,
K. & Tilford, S. (1991, 2001) Health
Promotion, effectiveness, efficiency and equity, Nelson Thornes, Cheltenham
Tones, K. & Green, J. (2004) Health
promotion: Planning and Strategies, Sage, London
Warwick- Booth, L., Cross, R. and Lowcock, D. (2012) Health Studies: An Overview Of Contemporary Perspectives, Polity
Press, Cambridge
Warwick-Booth, L.,
Cross, R., & Lowcock, D. (forthcoming) Health
Studies: A Contemporary Overview, Polity Press, Cambridge
Woodall,
J., Raine, G., South, J. & Warwick-Booth, L. (2010) Empowerment & health and well-being: evidence review, Leeds,
Centre for Health Promotion Research, Leeds Metropolitan University
