Evidence and causality in health promotion practice
- the view from anthropology
Morten Hulvej Jørgensen
The 5th Nordic Health Promotion Research ConferenceEsbjerg 2006
An anthropological analysis of health promotion practice
- complementing causal evidence
Morten Hulvej Jørgensen
The 5th Nordic Health Promotion Research ConferenceEsbjerg 2006
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 3
Background
Intervention Outcome
What works?
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 4
Background
Intervention ? Outcome
How does it work in practice?
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 5
Aim of presentation
•Case: Health promoting activities and alcohol use among teenagers in a Danish rural community
•Health promotion seen as a social practice•Focus on interaction between actors
•Theoretical distinction between • Strategic action• Tactical action
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 6
Methods
•Ethnographic fieldwork in a Danish rural community• Approximately 2,000 inhabitants
•Participant observation among 13 to 16-year-olds (n=93)• 2 two-month periods• In school, at leisure activities, private parties, soda pop discos
•Semi-structured interviews• Self-selected friendship pairs or small groups• Interviews with 32 boys and girls in the 15-16 age group• 4 interviews with teachers and municipal staff
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 7
The soda pop disco
Rules:•Age limit: 12-15 years•No alcohol inside• Intoxicated persons are not allowed to enter
Control by adults:•Municipal street worker•Door men•Front desk•Surveillance inside
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 8
Warm-up sessions
•Get-togethers in private homes•Small groups of teenagers•Eating, drinking alcohol, socialising
Getting in the right mood
Anticipating adult control
Timing of alcohol intake and intoxication
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 9
What happens?
•Soda pop disco ~ health promotion practice• Salutogenetic approach• Preventive approach
• Interaction between adults and teenagers
•Different positions in intergenerational social space (power)
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 10
Strategic versus tactical action
Michel de Certeau, The Practice of Everyday Life. University of California Press, London, 1984
Strategic action (adults)
- presupposes a position of power - defining, surveilling and ruling a social space
Tactical action (teenagers)
- ”must vigilantly make use of the cracks that particular conjunctions open in the surveillance of the proprietary powers” (p. 37)
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 11
Conclusion
Intervention ? Outcome
How does it work in practice?
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 12
Conclusion
Soda pop disco? Reduction of
alcohol use
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 13
Conclusion
Soda pop discoTiming of
alcohol use
Strategies Tactics
An anthropological analysis of health promotion practice
Esbjerg 2006 | Morten Hulvej Jørgensen Slide 14
Collaborators
Julie Bredenfeld ThomsenMette Riegels Morten GrønbækNina LyngPia Haudrup ChristensenTine Curtis