Column

Give us the money and let the evidence speak

Health promotion experts have combined forces in a new publication, The Evidence of Health Promotion Effectiveness. Their subject: is there evidence that health promotion works? Their verdict: of course there is.

The authors report success after success. Legislation to make cycle helmets compulsory: IT WORKS, NO WORRIES. A law to reduce the heat of tap-water in Washington State: IT WORKS, NO WORRIES. The effectiveness of health professionals advice on smoking: IT WORKS, NO WORRIES.

They do not report a single failure. Apparently the evidence is incontrovertible: health promotion is effective and essential — the only problem is that there isn’t enough of it.

Convinced? I’m not. I don’t doubt the veracity of the studies listed, but I think there is room for a little scepticism.

I can understand the motivation. If I were a ‘happiness promoter’ determined to evidence my success I probably wouldn’t specify happiness. Nor would I bother to categorise different ‘happiness outputs’. I’d lump everything together. That way I’d be sure not to miss even borderline instances of ‘promoted happiness’. And I certainly wouldn’t cloud the issue by citing ‘non-health outputs’ caused by my interventions (‘mild irritation’, ‘lingering unease’ or ‘happiness obsession’, for example).

And there is an even more obvious reason why the latest ‘proof’ that health promotion works should be viewed quizzically. The report was compiled and published by the International Union for Health Promotion and Education (IUHPE). The report’s authors are members of the organisation. They are hardly going to say they have been wasting their time for the last twenty years.

Here’s how it goes. The IUHPE gets money from the European Commission (EC) in order to publish a document saying how well it is doing. The publication repeatedly suggests that more resources are needed for new health promotion projects. Thus the document itself becomes ‘evidence’ that health promotion is effective. And no doubt it will be used and cited to secure further EC money to fund projects favoured by the IUHPE.

For an organisation apparently so keen to ‘empower’ ‘participation’ in all ‘communities’ it is at best ironic that its publication contains no independent assessment of the evidence, and includes not one dissenting voice.

I am in favour of health promotion and would like to think it works. But I cannot be sure unless it is assessed without bias. So I’d like to make a suggestion to the IUHPE.

The next ten times you receive money to promote health, please divide the fund in two: one half you can spend as you wish (as you normally do), but you must give the other half away. Select ten groups of people at random. Tell them you would like them to use the grant to promote health, but otherwise there are no strings attached. It is up to them. You’ll come back in a couple of years — with independent assessors — to see how they have got on.

What do you say? Do you trust us enough? Do you back yourselves that the money is better spent on projects (and reports) designed by health promotion specialists? ‘Empower’ us with half your money and then we’ll have real evidence to consider.

Such an experiment would require clear definitions, commensurable notions of success, and unequivocal measurement techniques — but surely these are necessary to prepare any report on the effectiveness of health promotion. And of course there is just a chance that the results would not be in your interests — but isn’t that the beauty of disinterested science?

Go on. Give us the money and let

the evidence speak for itself.