The construction of critical knowledge for the development of human health : an evaluation of a health promotion intervention in a rural community in Mexico, 1997-1999
This study is about the power dimensions of health promotion seen from the perspective of a rural community in Mexico. Drawing upon the conception of health promotion proposed in the Ottawa Charter 1986, health promotion is examined here as a device of hegemonic power and also as a possibility to subvert domination. The assumptions underpinning this thesis are based in the works of Antonio Gramsci, Pierre Bourdieu and Paulo Freire. The work of Michel Foucault also helped in the development of particular concepts of health and health promotion. It is argued in this thesis that the control of power is achieved by controlling meaning in social networks and that, because of the unique capacity of health to involve the objective and subjective dimensions of the human person, the discourse and practice of health promotion are outstanding means for the control of meaning. This thesis has three main components: the analysis of power and knowledge and of the official discourse and practice of health promotion; the design of a pedagogic intervention aiming to achieve changes in adult learners subordination patterns and the description and evaluation of that intervention. The pedagogic intervention focused on processes rather than on contents and brought problems of students' reality to deconstruction through dialogue. This study has a qualitative methodological approach and is presented as a case study. The empirical data were collected through fieldwork observations during the implementation of the intervention. It is proposed in this study that dialogue can be a means to triangulate data. The analysis of data is done here with the aid of process and outcome indicators capable of monitoring changes in the students' position in the face of power. This thesis showed that there was a possibility to achieve changes in students' patterns of subordination through pedagogic practices where they constructed knowledge embedded in their values and meanings to face their health problems.