Dealing with uncertainty – Comments on the methodological analysis of opportunities and risks in health promotion
Eberhard Göpel, Hochschulen für Gesundheit e.V., Berlin
With health promotion being established in society as a systemic practice of encouraging health development, in addition to the growing professionalization of the stakeholders, the temptation increases to trim the systemic change processes, as outlined in the Ottawa Charter for Health Promotion, to a social technology with linear effects and to market it as a suitably packaged range of services for standardized social change processes.
This temptation is stimulated, above all, by the interest of the funders who, wishing to simplify administration, favor programs of "health management" with a comprehensive guarantee for effectiveness.
The core idea of participatory social responsibility in health promotion is often reduced to formal surveys or questionnaires about predefined measures. This avoids jeopardizing the achievement of anticipated results and eliminates taking risks in the implementation process.
Such risk-minimized "health management" is both absurd and misleading. It is absurd because health promotion has nothing to do with an educational act of dressage which can be "managed" with tricks involving behavioral psychology or behavioral economics. Above all, it has to do with a creative, coherent arrangement of complex communication processes between people with their own way of thinking who wish to continue thinking for themselves. It is misleading because the "gold standard" in health promotion— in contrast to efficacy testing for pharmacological drugs in medicine— consists in raising the awareness of the stakeholders so that they can take responsibility for the change processes in question and to leave as little as possible to chance. At this point it is worth recalling the process-related systemic definition of health promotion in the Ottawa Charter.
In that context, health promotion is also explicitly a program to re-socialize healthcare ("reorient health services"), linked with the demand to take personal responsibility where it is primarily about establishing a coherent, meaningful communication process. We (and fortunately also others) are not in absolute control of our lives. A quote from Paul Virilio says that while life can perhaps be understood in retrospect, it has to be lived looking to the future. Life is necessarily full of uncertainties and risks that we have to deal with, but offers even more opportunities and chances.
Health promotion focuses primarily on the latent potentials of healthier lifestyles and environments that are just waiting to be exploited. This is what motivates the search for opportunities for a personal and socially more coherent life, despite resistance and conflicts. Risk assessments related to different aspects of daily life and the future can help protect from recklessness and negligence. This applies similarly to both our personal and professional life.
In this newsletter, the elements that are presented in favor of systematic risk analysis for the planning and implementation of health promotion programs, primarily raise awareness for the complexity of social transformation processes where success depends, above all, on the consent and participation of stakeholders. Anyone who reads the extensive list of possible problems in the contribution on risk analysis could, however, be slightly discouraged. I would urge readers, therefore, to establish an additional mental list of opportunities to round up the picture and strengthen personal motivation for action.
The practice of health promotion requires a healthy dose of optimism based on positive experiences, which remind us that new opportunities and possibilities may emerge from behind the many risks and crises. Relevant assessments can be organized in the form of a SWOT or force field analysis and are useful for gaining a comprehensive view of the processes in question. This, together with intuition gained by experience, may become the basis for managing multiple uncertainties with calm and optimism.
The following overview by Ralph.D. Stacey (1999) makes it clear that certainty and security can only be gained by keeping as closely as possible to proven standards.
The really interesting, complex questions will, however, only arise if we knowingly accept greater uncertainty and keep a certain distance to the mainstream. Opportunity and risk analysis can help develop a more complex practice of health promotion and counteract the looming trivialization of social health practices.
In the land of mountaineers, this might represent an incentive to try and climb to the summit, so as not to miss out on the view from the top.
Stacey R. D. (1999). Strategic management and organisational dynamics: the challenge of complexity. New York: Financial Times/Prentice Hall.