Towards an expanded health field concept: conceptual and research issues in a new era of health promotion

• Published in: Health Promotion (Oxford) 1988, Vol.3 (4), p.383-392
• Main Authors: RAEBURN, JOHN M., ROOTMAN, IRVING
• Format: Article
• Language: English
• Subjects: Debate
• ISSN: 0957-4824; 0268-1099; 1460-2245
• DOI: 10.1093/heapro/3.4.383

The concepts of health promotion contained in the Ottawa Charter for Health Promotion and the new Canadian government policy are changing the face of health promotion. But these concepts have yet to be formed into a cohesive framework for the efforts of policy-makers and others. As part of the Canadian policy development exercise, the health field concept of the Lalonde report was re-examined, since it had been influential in shaping earlier policy. In this article, some of the fruits of that examination are presented, along with a proposed expanded health field concept that takes account of the new concepts. The aims of the expanded health field concept are threefold: to guide policy, to argue for resources and to provide an analytical framework suitable for programme development and research. Emphasis is put on five areas outside the original health field concept: output aspects of the health promotion process (not just input); positive aspects of input and output (not just negative); subjective aspects of input and output (not just objective); increased emphasis on social and environmental input; and clarification of the relationship between health and quality of life. It is suggested that, on the input side, the five action areas of the Ottawa Charter be used as a starting point, and that on the output side, measures focus on four areas: morbidity and mortality, positive health indicators, subjective perceptions, and functional capacity and coping. The expanded health field concept represents an evolutionary step beyond the old concept, and is presented as a stimulus to discussion rather than as the final word.