TY - JOUR AU - P. Schelp, Frank PY - 2018/04/11 Y2 - 2024/03/29 TI - Perspectives of Health Promotion – A Personal View JF - วารสารวิจัยสาธารณสุขศาสตร์ มหาวิทยาลัยขอนแก่น JA - KKU J for Pub Health Res VL - 4 IS - 1 SE - บทความพิเศษ DO - UR - https://he01.tci-thaijo.org/index.php/kkujphr/article/view/118834 SP - 83-84 AB - <p>While strolling through a book exhibition at Khon Kaen University recently, the title ‘The new world of<br>health promotion’ drew my attention and I decided to get me the volume. A note on the cover strongly forbid to<br>sell the book in the USA even it was obviously written for students of public health there and the authors had<br>been from North America as well. Probably one has to pay more for the book over there in the states. By<br>seeping through the pages of my newly purchased ‘treasure’, I started to wonder whether it would have been<br>wise to recommend the text to someone dealing with public health in my ‘country of origin’, which is Germany,<br>since as major determinants of health, ‘individual behaviors’ and ‘environmental factors’ were highlighted by<br>the authors. Not that I wouldn’t fully agree to that statement, but while still in office as Professor of Social<br>Medicine in Central Europe some time ago, I strongly was ad odds with a number of my colleagues because of<br>fundamental differences between them and me as far as the underlying reasons for morbidity and mortality in<br>the field of chronic diseases had been concerned. So what is the perception of those, dealing with medical<br>sociology in a number of Western European countries towards the reason for most of the chronic diseases?<br>To answer this question I might refer to another statement of my newly purchased book about ‘health<br>promotion’, mentioning as leading causes of mortality tobacco, physical inactivity and diet. One may add<br>excessive alcohol consumption to this list as well. The problem is that mainly unhealthy behavior of the<br>individual is to blame for the highly prevalent chronic diseases such as heart diseases, diabetes mellitus, high<br>blood pressure, cancer and stroke. Accepting the risk factor model to explain the occurrence of chronic<br>diseases and to base health promotion on it would require to eat only ‘half of what one wants to eat’, avoid<br>sweets, exercise instead of watching television, and give up smoking and drinking too much alcohol.<br>The ultimate consequence of this line of thinking might be that those who are suffering from chronic<br>diseases are responsible for their illness because of ill behavior and why then the society should cover the<br>expenses for treatment and care? This aspect is especially important for a society in which more then 95% of<br>the population is covered by social health insurance and social security. The system requires tremendous<br>spending of money which also a rich country seems now no longer able to afford. The most radical<br>consequence to solve the problem would be to give up social health insurance and social security, which of<br>course is not feasible politically and could destabilize the country.<br>To avoid even to think along that line of argumentation, means to give up social security, the<br>advocates of social security in western European countries favor to take the individual out of her or his<br>responsibility for health and blame the society for unhealthy behavior, pointing towards ‘stress’ as the ultimate<br>reason for smoking, excessive energy intake, and alcohol consumption. The argumentation is that since the<br>society is exposing the individual to ‘stress’, thus causing the individual to adopt unhealthy behavior to release<br>the stress. Since the society is to blame for unhealthy behavior by causing stress consequently should also<br>shoulder the expenses for treatment and care.<br>An additional line of argumentation is to blame genetic factors for the occurrence of chronic diseases,<br>which might explain why ‘academic excellence’ is linked to highly sophisticated and expensive laboratory<br>investigations. It is almost unnecessary to mention that health promotion in Germany hardly focus on changing<br>unhealthy behavior.</p> ER -