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J Epidemiol Community Health. 2007 December; 61(12): 1103.
PMCID: PMC2465664

Health promotion and health services. Management for change

Reviewed by Paolo Contu

Edited by Anne Johnson, Kevin Paton. Oxford: Published by Oxford University Press, 2006, £23.99 (paperback), pp 271. ISBN 0-19-555614-3

According to the Ottawa Charter, “health services need to embrace an expanded mandate, and their role must move increasingly in a health promotion direction, beyond their responsibility for providing clinical and curative services”. “Reorienting health services requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization”.

Changing health services represents a crucial challenge for health promotion in regards to different attitudes and feelings among health professionals, health managers and community leaders. Some professionals and managers are happy for the system stay just as it is not only because of the pre‐existing power relations, but also because they perceive health promotion approach as visionary, unprofessional and unsuitable to answering real health needs. On the other hand, some health‐promotion activists adopt a revolutionary approach, sometime refusing to build realistic paths towards their goals. As a result, the health sector is often abandoned to traditional approaches, and activists find it easier to work in more supportive contexts like schools, cities and communities.

In their book “Health Promotion and Health Services”, Anne Johnson and Kevin Paton combine vision and practice, offering a resources package for professionals and managers aiming to act as change agents to develop in their context a path towards health promotion.

In the first part, the authors define their vision, evidence based and rooted in health promotion principles. They find that reorienting health services is not necessary because it is ethic, but due to its effectiveness. In the rest of the book, they offer not only a range of methods but also a number of tools in order to enable the reader to act effectively for change.

The pragmatic approach the authors adopt can irritate health‐promotion activists, ready to challenge the power balance, but could be closer to the vision of managers and professionals facilitating their involvement, and therefore be more useful for action.

However, methods and tools are presented neutrally, facilitating a critical approach in reading and using the book. The reader does not need to share the vision of the authors to find useful suggestions and instruments, to reflect on his/her own setting and opportunities for change, building his/her own way to change. And, according to Voltaire,“ …the most useful books are those of which readers themselves compose half; they extend the thoughts of which the germ is presented to them; they correct what seems defective to them, and they fortify by their reflections what seems to them weak”.


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