Column

Health promoters must be unprofessional

I had three hours to spend in Heathrow before taking yet another plane. Wearily waving my BA frequent flyer card I approached the Club Lounge. With greater disdain than I thought anyone wearing a bright purple top hat could muster, the doorman dismissed me. ‘You need more than that to get in here... Sir’ he spat. A trivial slight, yet I remember it because like most people I have a primitive desire to belong, and rejection hurts.

To avoid similar indignities health workers set up professions. These clubs have advantages, but they are not without problems, and can sometimes be self-defeating. Take health promotion for example.

Health promoters face two barriers in their quest for professional status. First: unlike professions that gain identity through their unique function (like law, architecture and mathematics) or their public image (like nursing and teaching) health promotion is kleptomanic. Its practitioners are drawn from everywhere – education, psychology, medicine, social science, the humanities – and they undertake extraordinarily diverse projects – advertising, lobbying, epidemiology, marketing, training, community development, behaviour modification, and social and environmental campaigning. Second: health promoters cannot agree on a definition of health.

As a result, health promotion has no identity and is unable to offer a coherent account of its purpose. But health promotion’s leaders are unfazed. Cunningly, they exploit these ambiguities to attract as many as possible into the emerging professional fold. Conceptual fuzziness means that people with different interests can identify with an apparently consolidating ideal (I am for health – I belong to the health promotion movement). Lack of precision can even make conflicting policies seem harmonious – perfect for political clout. But to set up a profession merely because everyone else has one is to place recognition before integrity.

I wanted to get into the Club Lounge. Health promoters want to join the professional clubs. It is understandable. But the price is too high.

The desire for professional status is a manifestation of health promotion’s ethical dyslexia – health promoters set out to help people choose better lives but end up telling us how to live. Most health promoters value democratic involvement and grass roots action, yet it is in the very the nature of professions to shun informed participation from non-members. Professions make their own rules, covet their own knowledge, discipline their own people, and teach their own students. Professions never ask the public’s permission. Professions are exclusive – and so they exclude.

Critics are ignored when political image is what matters most – they are not qualified to express an opinion, they are voicing views already well-known, they are being provocative, they don’t understand. ‘You need more than that to get a reasoned response from us... Sir’, the professionals spit. This is not so much of a problem in law or architecture (if you’re lucky you can keep away from barristers and steer clear of ugly buildings). But it’s insidious in health promotion.

Because we want to belong we form groups that close the door on everyone else. We cooperate, but only to become pathetically strong in professional isolation. Tragically, we are unable to extend our need for human association to the logical and harmonious conclusion that we all belong to each other - the thought behind most health promotion rhetoric.

Like the ‘toff’ doorman on poverty trap wages, by setting itself up as something it is not health promotion is undermining itself. There is a chance health promotion could chart the way to universally humane co-operation – but only if it takes a visionary step now, before it is too late. To promote health, health promoters must disown professionalism.