3.2 Summary
Interpreting health requires an holistic approach as to how the variables of health and well-being interact rather than seeing them as simply independent and others dependent. Since the Renaissance, biomedicine has focused on reductionist theory in the study of disease.
The assumption that reducing the incidence of infectious disease will make people healthier is not supported by evidence. Tones (2001) states that health is too important to be left to the medical profession and there must be reorganisation of the health service. The reliance of the NHS and high tech intervention is not sustainable in the long term. Since medical services often do not meet the expectations of the public this can be disempowering and they should be reformed.
Demedicalisation is an important goal of health promotion because it seeks to shift the balance of power from the medical establishment to the public and seeks to acknowledge the contribution of factors beyond medicine towards optimal well-being.
Moynihan and Smith (2002) recommend that doctors become the pioneers of demedicalisation by handing back power to the patients and encouraging self care and autonomy. There is a need for world wide distribution of simple effective health care which has been achieved in Cuba despite the US blockade which has reduced their dependence on the pharmaceutical industry (MacDonald, 2000). In Cuba the de-professionalisation of primary care has been promoted using health promotion and the education and health departments working closely togther.
It is quite possible immunisation has a role to play, especially in the third world, but methods used must be ethical and in line with the concept of empowering people to make the decision for themselves and their community.
Macdonald (1998) argues that empowerment requires advocacy and suggests that rather than common values being taken as the touchstone, alternative views might form a competitive testing ground on which advocacy groups fight it out. However this could give an advantage to those groups with money and power in a consumer driven society, therefore the rights of the individual must always be considered with the rights of the community. To be an advocate people need knowledge and the self- esteem to use it so their decisions regarding any medical intervention would be made on that basis.
There is no doubt that a child with a weakened immune system is at greater risk from infectious disease than a well nourished child, but the fact remains for promoters of health that there is no evidence that vaccinations make people healthier and there is a possibility that the efforts to defeat disease with over use of antibiotics and possibly vaccinations themselves has resulted in an exchange of what were normal childhood illnesses thirty years ago to normal child hood illnesses today, such as asthma.
Health Promoters must question the wisdom of vaccinating generations of children without long term studies to show benefits to health. The advice sheets GP Peter Mansfield gives to his patients is a basis for providing honest information regarding vaccination enabling people to be proactive in achieving optimal well being. Mansfield was charged by the GMC for “putting children at risk” for giving this advise and providing single vaccines. The case was later dropped for lack of evidence (Redlich 2000), however it raises questions regarding the commitment of the GMC. to enabling people to make informed decisions.
The public must question the reasoning that implies medical knowledge produces images of the world that then operate as if they were true (Canter, 2001) He argues that health care professional must recognise that they do not have such a privileged position the they and they alone recognise all medical truths. Medical paradigms come and go and medicine will develop new paradigms Canter questions the idea of simply “handing over power” to the partners, when at the heart of the discussion is the very nature of medical knowledge itself.