How health promotion prevents itself from tackling health inequalities. A critical analysis of Dutch health promotion's paradigm through its handbooks (1995–2022)

SSM - Qualitative Research in Health, vol. 7, pp. 100533

Abstract

Health inequalities are a central concern within the field of health promotion. Yet, for over four decades, research has consistently shown that socioeconomic health inequalities in Western Europe persist and, on some measures, even have widened. Explanations are typically sought in the behaviours or personal characteristics of ‘unhealthy populations’ or in neoliberal policies. However, the role that health promotion itself, through its central theories, methods and assumptions, plays in the persistence of health inequalities is rarely considered. This study addresses this gap: it explores how health promotion's paradigm informs professionals to reduce health inequalities. Since paradigms are conveyed through handbooks, we conducted a qualitative content analysis of multiple editions of three key handbooks used in Dutch graduate health promotion education, published between 1995 and 2022. Using Science and Technology Studies's notion ‘paradigm’ and the theoretical lens of formal, hidden, and null curricula from Critical Education Studies, we show that Dutch health promotion professionals have been socialised into a remarkably consistent paradigm for three decades. This paradigm, which draws heavily from socio-cognitive psychological models, teaches professionals to prioritise individual behaviour change and not to challenge sociopolitical actors whose actions contribute to ill-health. Justifications remain limited to considerations such as convenience, ease and cost-effectiveness. The handbooks that convey this paradigm continue to be used in Dutch graduate education, training the health promotion professionals of the future. We argue that, at least in the Netherlands, the prevailing paradigm of health promotion is a significant, yet overlooked, factor in the persistence of health inequalities.

Authors 3

1. Ilse Dijkstra corresponding

   Maastricht University · Department of Health · Department of Health Services

   Affiliation as printed

   Department of Health Ethics & Society, Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht PO Box 616, 6200 MD, Maastricht, the Netherlands

2. Bart Penders Aachen Käte Hamburger Kolleg "Cultures of Research" (Core)

   RWTH Aachen University · Maastricht University · Department of Health · Department of Health Services

   Affiliation as printed

   Department of Health Ethics & Society, Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht PO Box 616, 6200 MD, Maastricht, the Netherlands

   Käte Hamburger Kolleg “Cultures of Research”, RWTH Aachen University, Theaterstraße 75, 52062, Aachen, Germany

3. Klasien Horstman

   Maastricht University · Department of Health · Department of Health Services

   Affiliation as printed

   Department of Health Ethics & Society, Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht PO Box 616, 6200 MD, Maastricht, the Netherlands