Being managed : explorations in reflexivity in health promotion
The thesis maps out my experiences of, and thinking about, health promotion over my fifteen-year career as a health promotion specialist and lecturer. It adopts an exploratory, reflective approach starting with an account and analysis of health promotion as I experienced it in practice from the mid 1980's onwards, and ending with an exploration of the way reflexivity works in a medium-sized health promotion department in England. This exploration took place in 2000 at a time when the department like many others were facing an uncertain future and a possible merger with a department of public health. The thesis begins with my reflections on health promotion and its theory, and my personal experience of being managed in a health promotion department. This account forms the first step of a research process, and the role of reflexivity in this process is highlighted. Using qualitative techniques of data analysis, themes emerge relating to the way the accounts were written, the social and psychological processes being acted out; and the emotional tapestry involved. A co-operative research encounter based on the story-dialogue method with a medium-sized health promotion department generated six streams of qualitative data. The separate analyses are combined to produce overall meta-themes which tell a collective story of the hidden scripts and conventions operating in the health promotion department at the time. These include limits to what can be said, associated avoidance and cynicism, and an acknowledged lack of reflexivity. There was an embedded rhetoric about democracy, valuing and consultation that was vulnerable to being over-ridden or diminished. Similarly, there was a lack of specificity about what health promotion as an entity and team working actually means to the department. Within this scenario, staff became individual tacticians and placed high regard on their autonomy. Reflexivity facilitated and legitimised through story-dialogue enabled emotional expression, criticism, and agreement and appreciation. Reflexivity in the encounter translated hope and uncertainty into future-facing and future action. It helped re-establish and specify a collective identity and it provided some detail about nature of health promotion and team working. These meta themes are discussed in relation to changes and movements in contemporary health promotion in England including the life and meaning of 'health promotion' discourse and the creation, reification and impact of 'tribal' discourses in health promotion and public health. These discourses based on difference are shown to be questionable and point to a demise of reflexivity in more recent health promotion discourse. Adherence to this discourse is argued to leave health promotion open to charges of elitism and has hindered searches for common values, language and standards. Moreover, it has meant a failure to articulate a new health promotion.