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Mass media are very influential in shaping discourses about health but few studies have examined the extent to which newspaper coverage of such stories reflect issues embedded in health policy documents. We estimate the relative distribution of health stories using content analysis. Nine meta-topics are used to sort stories across a range of major influences shaping the health status of populations adapted from the document Toward a Healthy Future (Second Report on the Health of Canadians (1999)) (TAHF). A total of 4732 stories were analyzed from 13 Canadian daily newspapers (10 English, 3 French language) using a constructed week per quarter method. Stories were sampled from each chosen newspaper for the years 1993, 1995, 1997 and 2001.72% (n = 3405) of stories in this analysis were from English-language papers, 28% (n = 1327) were from French-language papers. Topics related to health care (dealing either with issues of service provision and delivery or management and regulation) dominated newspaper stories, accounting for 65% of all stories. Physical environment topics accounted for about 13% of all stories, the socio-economic environment about 6% of stories, personal health practices about 5% of stories, and scientific advances in health research about 4% of stories. Other influences upon health identified in TAHF were rarely mentioned. The overall prominence of topics in newspapers is not consistent with the relative importance assigned to health influences in TAHF. Canadian newspapers rarely report on socio-economic influences frequently cited in the research literature (and reflected in TAHF) as being most influential in shaping population health outcomes. Keywords: Canada; Population health; Public policy; News media; Socio-economic environment; Determinants of health; Discourse; Content analysis

This paper reports on findings from an ethnographic study of female sex workers who work in the indoor sex markets in a British city. An unexpected finding was the collective narratives that sex workers construct to rationalise their involvement in the sex industry. Fifty-five respondents who took part in in-depth interviews maintained that prostitution is a useful occupation and function in society. Narratives included providing emotional support to male clients; a service for men who are socially or physically disabled; preventing men having adulterous affairs; and health education, disease prevention and as therapists for sexual dysfunction. This paper evaluates how the latter narrative of sexual health promotion is an example of how sex workers are ideally placed to work as health educators with men who buy sex. Arguing against gender specific sexual health policies, men who buy sex are described as a 'high risk' group who are also a hidden population. Limitations posed by ideological, ethical and practical concerns relating to the specific conditions of the sex industry suggest that this proposal could be partially successful. In conclusion, I suggest the sexual health of the nation and the place of sex workers in society must be considered with regard to recent policy debates on the management of prostitution and the cultural construction of the sex worker. Keywords: Sex workers; Prostitution: Male clients: Health promotion: Sexual health; Health education: UK

UK health policy is concerned with emphasising nutritional status as a factor in the relationship of social inequalities to health outcomes. This paper examines pupil and parent responses to an after-school 'Food Club' designed to promote food preparation skills and healthier food choices amongst 12-13 year olds in low-income areas in North East England. The rationale for the intervention was a series of distinct but connected premises: food preparation skills are essential to inexpensive healthier eating; practical cooking skills are given limited emphasis in the secondary school curriculum; children have some choice over what they eat and may serve as a conduit of influence within the family. The qualitative investigation used group discussions and individual interviews with participating pupils and their parents. Most participating pupils enjoyed the practical emphasis upon food preparation, believed their skills developed, and were aware of the underlying message about healthier eating, but only made limited changes to their diet. Interviews with parents showed most to be positive about their child's involvement in such a club, though they varied in their attitude to its underlying message. There was some evidence of children being more involved in cooking at home and making some specific requests about food, but little to suggest they were influencing family food consumption. The findings suggest that an extra-curricular Food Club is an appropriate and feasible approach to developing food preparation skills with pupils in this age group. These findings raise questions about children's opportunities to exercise food preparation skills and make food choices within families, and the extent to which barriers to dietary change may be lowered through educational initiatives directed at pupils. Keywords: Children; School; Food preparation skills; Health promotion; Food choices; UK

Health information is everywhere, but can it be presented to better promote behavior? Past research finds that framing messages can effectively motivate health behaviors. This article briefly summarizes the role of message framing in health promotion in the general population, investigates findings for medically underserved populations, and discusses the influence of targeting to group characteristics on increasing the persuasiveness of framed messages. The conclusion is that theory-driven approaches lead to more persuasive messages across socioeconomic status. Keywords: message framing; persuasion; health disparities; ethnicity: health promotion

The authors present a program of research that focuses on reducing health disparities among African American populations through innovative health communication and health promotion interventions. Research on tailored communications ranges from investigating efficacy, manipulating communication variables, and comparing tailored print versus other state-of-the-art intervention modalities to integrating tailored materials into public health interventions based on a socioecological model. Examples from other research, as well as advantages and disadvantages of these approaches, are discussed. The purpose of the overall research program is to develop effective and cost-effective health communications for promoting health behavior change that also are culturally relevant and potentially sustainable in communities. Keywords: tailoring; community interventions; health communication; health disparities; minority health

This paper considers the discursive properties of public health literature produced around AIDS in the 1980s and early 1990s. Attention is focused upon the role of health promotion in the UK government's response to the epidemic and on the language used in the educational campaigns conducted by the Health Education Council and its replacement the Health Education Authority. Using an analytical approach influenced by the work of Michel Foucault, the paper argues that the knowledges of AIDS produced by these various public health institutions constructed discursive boundaries between the idea of 'normal' and 'abnormal' behavioural practices. The notion of risk, produced as it is from epidemiological knowledge, is a central mechanism in this process. It is through the production, articulation and normalisation of 'at risk' groups that society is fragmented and hence subject to the governance strategies of late-modern liberal economies.

Policymakers in many countries seek to contain health care costs over the long range by promoting health and more effective health behavior. Such efforts can be directed at entire populations, at members of a health plan, at defined risk groups or single individuals at risk. Many health risks are associated with socio-economic status and social inequalities but these are often difficult to address because of social and political conflicts. Health, also, is often a product of culture and other social circumstances. Health may be promoted through non-health interventions or through more targeted health efforts seeking to effect behavior change. Preventive screening is of growing importance but such efforts often out-pace evidence of efficacy or cost-effectiveness. Many opportunities exist to build on new clinician - patient partnerships to make patients better informed and to effect positive health behavior. New technologies, and particularly the internet, offer new ways to promote health and more constructive illness behaviors. Keywords: Health promotion; Prevention: Social inequalities; Behavior change: Screening; Health status

This paper presents a textual analysis of a key Canadian health policy document - Achieving Health for All (AHFA). It begins by establishing the importance of policy language and an interpretive approach to reveal dominant meanings and assumptions. This approach points out the significance of language and its contexts (text and intertext) and of developing a formal analytic strategy, based on semiotics. The paper concludes with a detailed, illustrated analysis of AHFA, suggesting that the document's discourse, through appealing to all, with emphases on the nation, community and all Canadians, establishes a frame of individual responsibility and rights, health promotion and broad health determinants - a frame that resonates with the cost-constrained nature of health care delivery - as found in provincial reform documents in the 1980s and 1990s. Key words - policy language, textual analysis, health promotion, Canada

Medicine is the practice of humanitarianism. Its purpose should be to help others with benevolence and love. One must not think of one's own interest but should save and help the people who were created by Heaven and Earth (Veatch R. M. A Theory of Medical Ethics, New York: Basic Books, 1981) [1]. Key words - health promotion, individuals

Over the past few decades perspectives derived from critical social theory and other critical perspectives have infused the discourse on health, illness and healing, and have heightened awareness of the ways in which social and economic inequities experienced by particular groups determine their health. The influence of these paradigms in the health sciences occurs, simultaneously, with other movements in health care services and delivery. There has been major overhauling of health care delivery systems in many western nations with concomitant call for greater public participation and individual responsibility for health and health care (self-care). As these movements have gained momentum, ideas that suggest how people will be enabled both to attain greater social equality and to take increased responsibility for their health have flourished, and patient/consumer empowerment has become a central concept in the discourse on health. Drawing on research data from multiple sources I begin to interrogate what the notion of empowerment might mean for patients living with a chronic illness, particularly women who have immigrated to Canada; I examine the multiple layers of contexts that organize their experiences of illness. Building on earlier research that explicated the unstated ideologies that underpin the self-care movement, I extend this analysis to examine the conceptual underpinnings of 'empowerment'. While not dismissing the idea of 'consumer empowerment' I question whether unreflexive use of this notion within the 'health care industry' might deflect our attention from the structures that perpetuate social inequities. I conclude by arguing for a perspective that will allow us to address issues pertaining to the notion of empowerment in the lives of patients, generally, as well as those who are marginalized and disadvantaged. Keywords - empowering patients, health promotion, health care reforms

The health transition ushered into the world in this century calls for a reorientation of traditional health services to manage the new causes of morbidity and mortality, renewing interest in disease prevention and health promotion. Community-based health promotion emphasizes prevention and community participation with people's empowerment to overturn current inequities and increase control over their health. Encouraged worldwide by the World Health Organization for the last two decades, some community health promotion programs have been implemented and lessons learned. However, the shift in focus required means nothing less than a paradigm change demanding not only a reorientation of professional training, but also a reorganization of social structures in communities. This article discusses nine of the interrelated obstacles that must be overcome to further develop community health promotion. Key words - community health, health care, health promotion, prevention

Although health promotion has become a critical concept in public health, both research and practical projects in this area are almost devoid of theory. The present article uses a theory of complexity and structure to organize the different elements of health promotion in a new perspective. This perspective involves (1) new ways for looking at patterns of behavioral risk factors and health-related lifestyles. It (2) relates health promotion to policy making. In particular, it (3) focuses on a comprehensive model of the implementation process, revealing the true interrelationship of relevant elements to the concept of health promotion. In this context, it (4) becomes obvious that the reflexivity and recursiveness of scientific analyses are an integral part of the structure of health promotion. Thus, the professional role of the social scientist with regards to the implementation and utilization of scientific knowledge in the field of public health policy will be discussed. Finally, the role of appropriate theory is emphasized as a strategy for improving the practice of health promotion and to further the development of a new public health. Key words - health promotion, lifestyle, policy analysis, implementation model, applied science

This study examined determinants of vigorous physical activity in a community sample of adults over a 24-month period. Social learning theory predicts that causal relationships between determinants and behavior are bidirectional, and both the behavior and its influences are subject to change over time. Thus, dynamic variables were expected to account for more variance in excercise change than static baseline variables. Over 86% of respondents to he baseline mail survey completed follow-up surveys 24 months later, yielding a final sample of 1739. Two physical activity change indices were constructed that were adjusted for baseline exercise and demographic variables, so that the effects of social learning variables could be isolated. In a two-step hierarchical regression analysis, physical activity measures were regressed onto 21 static and six dynamic independent variables. Baseline self-efficacy was a significant predictor of exercise change for both dependent variables. Four dynamic social learning variables were significantly associated with both exercise change measures: self-efficacy, perceived barriers, family support, and friend support. Social learning variables accounted for 12.3-15.5% of the variance in exercise change over 24 months. The results provide strong support for bidirectional causation between behavior and determinants and suggest hypotheses to be tested experimental studies.