The business of health promotion: ethical issues and professional responsibilities

Empowering individuals to integrate work and life: insights for management development

Purpose

– In efforts to improve employee recruitment and retention and enhance productivity and morale, organizations have implemented policies and practices (e.g. flextime, telework to address employee work-life concerns). However, there is mixed evidence regarding their effectiveness. The purpose of this paper is to complement work-life policies, initiatives aimed at empowering employees with the knowledge and skills to manage multiple life roles may be valuable. Little information is available regarding the nature or effectiveness of such initiatives. Through an in-depth analysis of one initiative, Total Leadership, the authors provide insights that can be used in the selection, design, implementation, and evaluation of work-life empowerment efforts.

Design/methodology/approach

– The authors use a mixed methods approach to explore the experiences of 316 participants in the Total Leadership program. Self-assessments (pre and post) were analyzed using quantitative methods (e.g. Cohen’s d-value). Inductive and iterative qualitative methods were employed to understand the types of experiments participants created as part of the program.

Findings

– The authors found that participants reported significant increases in satisfaction and performance in all domains of life (work, home, community, and self). Further, the authors identified nine types of experiments that individuals used to enhance performance in all life domains. Implications for management development specialists are provided.

Originality/value

– This study provides unique and valuable insight for those interested in supporting employee work-life development, leadership, and performance in all domains of life. It represents one of the first efforts to provide evidence-based guidance for the design and implementation of such initiatives.

Two major ethical issues in health education and promotion: assessing stage of change and cancer screening

In community health education for behavioral change, valid assessment of stage of change is critical; in health promotion screening for cancer, health insurance coverage is also critical because some communities do not have the freedom to choose to change or to get their cancer treated. Proceeding without valid assessment of stage of change or insurance coverage can cause us harm. Harm comes to the patients when providers label them negatively or cause them anxiety if they cannot afford diagnosis and treatment beyond the screening. Not doing harm, (nonmaleficence) is our most compelling ethics principle. The authors analyze these two issues through the principles of autonomy, justice, and nonmaleficence in both their practice and that of their student with US-Mexico border communities and give recommendations.

Toward a social structural understanding of occupational hazards in public health

An exploratory study was completed in 1992 in five autonomous public health unit organizations situated in urban and rural settings in northern, central, and southern regions of the Province of Alberta, Canada, with a sample of 57 staff and managerial public health nurses. Self-administered questionnaires, semi-structured interviews, and moderated focus groups were used in a two-stage data collection procedure to describe subjects' perceived work hazards, conceptualize the organizational factors underlying their work hazards, and report their suggestions for change. Frequency distributions and descriptive statistics were obtained for the perceived work hazards. Results of the constant comparative method of analysis indicate that organizational factors are inseparable from the hazards perceived by subjects in both their physical and psychosocial work environments. Moreover, elements of a grounded theory of organizational hazard surveillance emerge from the data. Running throughout the elements (conceptual categories derived from interview data) is the theme of power and dependency. The social structural factors underlying occupational hazards are discussed in terms of the organizational factors associated with the safety, physical, ergonomic, and biological hazards perceived by subjects in their physical work environments.

Health promotion: a viable curriculum framework for nursing education

Health care will be increasingly focused on the principles of health promotion and primary health care to better meet society's health needs. Nursing has an opportunity to lead the way in primary health care, however, for nurses to realize their potential, educational programs must be radically revised and be developed to teach nurses to work from a health-promotion perspective. Only when nurses have fully incorporated the principles of health promotion into their repertoire of working with clients and colleagues will they be the desired and appropriate profession to lead health care into the future.

Evaluation of a laboratory health examination programme in a Swedish industry (Volvo)

The records of 117 subjects, workers who had participated in a health examination at a Swedish industry, were studied retrospectively in order to find out which measures had been taken as a consequence of the results from the different examinations. The extensive laboratory examination programme that had been carried out seemed to be of limited value. It is concluded that the extensive examination programmes carried out in many industries should be re-evaluated more critically.

Issues of control and responsibility in workers' health

The issues of responsibility for health and control of factors influencing health are discussed with regard to workplace health programs. The role of each of the parties involved - workers, unions, management, and the government - can best be understood in relation to the interests they hold in workers' health. A matrix is presented which divides influences on workers' health according to the degree to which they are controlled by employers and workers. This matrix is used to suggest that workplace health promotion and employee assistance programs may represent employer involvement in areas over which they lack legitimate control. These programs are also criticized for their emphasis on behavior and their neglect of work-related causes of ill health and unhealthy behavior. They should be considered supplemental to a work environment which is conducive to both physical and psychosocial health; they will be most effective and appropriate with a high degree of worker involvement and control. Evidence regarding the effects of occupation and class on health and health-related behavior is presented to support the need for a comprehensive, ecological approach to workers' health. Such an approach should take into account the full range of influences and recognize the limits of legitimate control.

An ecological perspective on health promotion programs

During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.

Social marketing and public health intervention

The rapid proliferation of community-based health education programs has out-paced the knowledge base of behavior change strategies that are appropriate and effective for public health interventions. However, experiences from a variety of large-scale studies suggest that principles and techniques of social marketing may help bridge this gap. This article discusses eight essential aspects of the social marketing process: the use of a consumer orientation to develop and market intervention techniques, exchange theory as a model from which to conceptualize service delivery and program participation, audience analysis and segmentation strategies, the use of formative research in program design and pretesting of intervention materials, channel analysis for devising distribution systems and promotional campaigns, employment of the "marketing mix" concept in intervention planning and implementation, development of a process tracking system, and a management process of problem analysis, planning, implementation, feedback and control functions. Attention to such variables could result in more cost-effective programs that reach larger numbers of the target audience.