Power, identity and Eurocentrism in health promotion : the case of Trinidad and Tobago
While health promotion is ostensibly concerned with the full range of processes through which people might control and improve their health, this thesis shows that existing approaches and the literature are limited by Eurocentrism, focusing primarily on the health concerns of Western people and obscuring those of others. Following literature review, the thesis examines the historical process of the formation of health promotion as a hegemonic discourse within the West. A worldsystem approach is then used to situate health promotion in a transnational structure, and to analyse health data from Trinidad and Tobago regarding the relevance of health promotion in the Third World. Fieldwork among non-governmental organisations (NG0s) in Trinidad examines interpretations of health promotion, drawing attention to areas of difference from hegemonic discourse and the symbolic identities invoked. Health problems in Trinidad and Tobago were found to be related to patterns and fluctuations in capital accumulation on a transnational scale, with problems usually associated with "modernisation" coexisting with diseases associated with "poverty". Health promotion strategies need to take account of how both production and consumption are structured globally. In their health promotion work, most NGOs blended elements of non- Western understandings, particularly in the area of spirituality, with hegemonic concepts grounded in biomedical science. The postcolonial concept of hybridity is used to analyse responses and resistance to Western discourse. Respondents maintained that spirituality enabled people to transcend racism and to enhance subjective well-being and control over health. The results highlight that to devise appropriate health promotion strategies means to respect difference, not by adopting a position of cultural relativism but by understanding how transnational relationships of power pervade relationships between cultures and affect health. Strategies should nurture the creative expression of local views, contesting the centralisation of knowledge and material resources for health within the West.