Module 6: Cripping Health Promotion
Defining Health: Disability and the Aims of Health Promotion
How did this new understanding of health contribute to changing meanings of health? Unfortunately, despite advancing greater recognition of the public’s role and social and environmental factors in health outcomes, the changes left key elements in the dominant understanding of health unchallenged. For instance the women’s health movement contended that women should understand their bodies and that their perspectives should be respected within the healthcare encounter, but health was still understood as the absence of disease. In many cases these health movements served to reify and entrench biomedical approaches to understanding health into a broader ideology of upheld by an ever-increasing range of social functions (Crawford, 1980). The prominent (biomedical) conception of health, seen as a sense of well-being achieved through the mitigation of disease, illness, injury, and social impairments, was coming to be understood as not only a medical diagnosis but also as a matter of individual responsibility (Berthelot-Raffard, 2018; Crawford, 1980). Robert Crawford (1980) describes the emergence of healthism as a new health consciousness that situated the “problem” of health as primarily an individual issue and product of personal actions, attitudes, and behaviours, achieved through modifications in lifestyle and sometimes with the help of therapeutic services. Health promotion entailed providing individuals with the necessary knowledge to make healthy choices that encourage healthy behaviour, resisting harmful influences, and reforming their mental responses to social stressors. In effect, the new health consciousness movements laid the groundwork for an “age of medicalization” in which the pursuit of health became a fundamental characteristic of popular culture and everyday life. As Crawford states, “while modifications of dominant medical practices [were] being adopted, some of the most fundamental and disabling medical and other dominant cultural conceptions have remained untouched” (p. 369).
Media Moment
Take a moment to engage with the following public health promotion videos created by ParticipACTION, a Canadian nonprofit charitable organization promoting physical activity. You can watch the videos below or access the transcripts.
Time: 30 seconds
Time: 4 minutes, 35 seconds
ParticipACTION Workout Videos | Break from Busy
Reflection Moment
How do these two health promotion interventions conceptualize health and disability?
What assumptions do they make about what it means to be healthy, active, or responsible for one’s health?
In the readings associated with this module, Agnès Berthelot-Raffard (2022) discusses the gap between the public health profession on the one hand and disability rights activists and scholars on the other in terms of how they conceptualize health and disability, and how these concepts frame health promotion. While the disability community has advocated for the inclusion, de-stigmatization, and de-institutionalization of people with disabilities as central aims in health promotion, the definition of health that has persisted in the public health field is rooted in the absence and prevention of disease, illness, injury, or other impairments to “normal functioning” (Berthelot-Raffard, 2022; Crawford, 1980). In this definition, disability is seen as a form of deviance understood in contrast to the state of health, which is defined in terms of biostatistical markers of “normal functioning” based on the most common levels of functioning for people of a particular age and sex (Berthelot-Raffard, 2022; Foucault, 1961). Critical theorists such as Michel Foucault have illustrated how the administration of normalizing biomedical categories have served as a form of population control from which conceptions of “deviance,” “pathology,” and “madness” arose. These concepts have long characterized people with disabilities as social “problems” to be solved, treated, or extradited (Tremain, 2015; Foucault, 1961). In this framework, health is seen as the absence of impairment, and the role of public health is to minimize, prevent, and treat conditions that limit normal functioning to the greatest degree possible (Berthelot-Raffard, 2022).
Media Moment
Read this infographic or access the PDF here:
What Can Happen to Your Hands and How to Protect Them
Consider the ways that the disability rights community and the public health field each conceive of the aims of health promotion. What are their shared aims and how do they differ?
The process of assigning medical meaning to behaviors and conditions, and positioning medical practices as the primary method of treatment or resolution. It often results in the lives of disabled people being imbued in medical meaning.
