HEALTH PROMOTION INTERNATIONAL
© Oxford University Press 1996
Vol. 11, No. 3
Printed in Great Britain
Impediments to health promotion in developing countries:
the way forward
Health promotion is rapidly establishing itself as
an approach to health development in several,
especially the economically developed, countries.
The tremendous progress registered by the discipline during the last decade is presented in
Vol. 11, No. 1 of this journal which appeared
earlier this year (Catford and St Leger, 1996).
While the development of health promotion is
so rapid and visible in the more economically
developed countries, progress towards establishing it in the less economically developed countries
has been slow. A number of conditions and
factors account for this. In the following paragraphs, these conditions and factors are discussed.
By far the most critical obstacle in the development of health promotion in developing countries, especially Africa and Asia, may be termed
as professional competition. In most such developing countries, well established disciplines such
as public health, medicine and nursing are in stiff
competition over control of the health development process. Each of the listed cadres seeks to
occupy the top niches in the planning and administration of health development programmes. The
entry of health promotion is viewed as making
the competition stiffer and thereby raising the
stakes. The practitioners who have already
entrenched themselves in the health development
hierarchy do not wish to welcome another potential competitor into the arena. As a discipline in
the making, health promotion very easily arouses
the envy and jealousy of the more established
disciplines because of a number of factors relating to its very nature.
• Firstly, health promotion embraces several
strategies which span many technical subjects.
This means that it attracts students and practitioners from a wide range of backgrounds. The
possibility of flooding the arena of health
development with the entry of health promotion is therefore real.
• Secondly, health promotion deals with
resource allocation, legislation, policy, information and advocacy (among other things), all
of which are very potent in terms of health
development politics. The discipline's entry
into an arena already saturated with jostling
for power raises many eyebrows.
• Thirdly, there is also the fact that health promotion deals with the public more directly and
progressively than most other health disciplines. This directness and progressiveness
unsettles those professionals involved in
health development who do not have easy
access to the general public.
Because of this perceived threat to other health
disciplines, health promotion practitioners have
to contend with a situation where they receive
little support and meagre resources for their
programmes in the developing countries. In
some cases, programmes in health promotion
have been denied clearance by government
authorities because of the alleged potential
threat to political stability; with such perceived
threats in most cases being championed by health
practitioners who stand to lose status and power
as health promotion expands. This has been the
case in a number of African countries.
Another obstacle facing health promotion in
developing countries is its relative newness as a
discipline. Its theoretical bases and implementation strategies are not well understood by most
planners and policy makers in the health sector.
Because of this lack of understanding, health
promotion is equated to public health or health
education, both of which are better established.
Even in some academic institutions, health promotion is dismissed as mere advertising or marketing. Such misperceptions reduce the level of
support and funding for the discipline.
There is a third impediment to health promotion in developing countries which is as important
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David Nyamwaya
as the two already discussed. This impediment
relates to the lack of a sizeable pool of professional practitioners in the discipline. In most of
Asia and Africa, it is only recently that a few
health and social scientists have taken an interest
in health promotion. Most of such enthusiasts
have received short-term training in developed
countries where the discipline is more established.
On coming back, such enthusiasts have to face
opposition from the conventional disciplines as
indicated above. In any case, most of the skills in
health promotion acquired in the developed countries are not, in many cases, directly applicable to
the circumstances in the developing countries. In
fact, even most of the publications on the discipline relate more to the conditions in the developed countries. There are cases where health
promotion has been dismissed as a luxury which
only the richer countries can afford. Needs such as
drugs and food for patients are cited as being
more urgent than health promotion. All this
occurs contrary to the generally accepted thinking
that promotion (read prevention) is better and
cheaper than cure.
Another obstacle to health promotion stems
from the relatively long time it takes to realise the
impact of interventions. It is not easy, therefore,
to convince planners and community leaders to
divert resources since they are told by professionals that results from health promotion interventions may take several years to achieve.
Curative services tend to be more appealing
because their impact can be seen soon after an
intervention.
It is not the intention here to paint a glum
picture of health promotion in the developing
countries. The discipline is definitely here to stay
and several programmes based on its concepts
and strategies are in place. However, there is need
for a number of actions to be undertaken in order
to propel the discipline fully fledged into the 21st
century.
The problem of professional competition may
never be eliminated completely, since such competition exists among other disciplines, for example, between health education and public health.
What needs to be done is a professionalisation of
health promotion practice to a point where its
practitioners can interact, compete and collaborate with other health professionals on an equal
footing. There is need for university and college
courses geared towards health promotion in
developing countries. Academic publications
such as this and other journals have a role to
play in this.
There is need for advocacy in support of health
promotion at all levels. This includes action by
the International Union of Health Promotion
and Education (IUHPE) through its conferences
and publications. Activities of the Union need to
be promoted more in developing countries.
As we move towards the 21st century, there is
need for alliances and networks to be built
between developed and developing countries in
the health promotion arena. Conferences such as
that on health promotion held in 1991 in Sundsvall, Sweden, can help to strengthen the alliances
and networks. The recently held IUHPE conference at Makuhari, Japan should be seen in the
same light.
In conclusion, it may be argued that health
promotion has an in-built survival kit, since it
deals with not only disease prevention, but the
changing or promotion of conditions within
which health can thrive. Health promotion
seeks to promote conditions supportive of
health improvement and for this reason, both
the developed and developing countries must
co-operate to ensure that the discipline is well
established in the latter countries. The problems
listed in the foregoing can only be solved if there
is concerted action between the North and South
and the West and the East. Such action should
occur at the professional, political and academic
levels. Production of this journal is one such
action, since it involves scholars and readers
from both developed and developing countries.
David Nyamwaya
Regional Editor for Africa
REFERENCE
Catford, J. and St Leger, L. (1996) Moving into the next
decade—and a new dimension? Health Promotion
International, 11, 1-3.