Editorials

The limits to health promotion

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6960.971 (Published 15 October 1994) Cite this as: BMJ 1994;309:971
  1. N C H Stott,
  2. P Kinnersley,
  3. S Rollnick

    Everybody knows that prevention is better than cure, but the opposite, equally attractive, principle of paying tomorrow for what you can have today is an efficient way to use your resources: health economists call it “discounting.”1 Discounting is efficient because resources usually devalue over time, and numerous unexpected events are likely to overtake the person who delays gratification. To “eat, drink, and be merry for tomorrow we die” is a discounting approach to life. This is a challenge to the health promotion movement, particularly in relation to those in their teens and 20s, for whom tommorrow is a long way off. Health promotion has, of course, been achieved through traditional public health measures - for example, clean water and air and manipulation of the population2,3 - but success in local communities and with individuals is more controversial when people's choices are an important factor. Indeed, the limits to health promotion lie in the paradox that “a measure which brings large benefits to the community offers little to the participating individual.”2

    Health is not a unidimensional concept, and many research workers have found that personal concepts of health vary according to context.*RF 4-7* Energised, health seeking people or families8 remain a minority in our society because most people regard health as a free asset to be used or enjoyed.*RF 5-9* Health can certainly be viewed as a resource that will devalue through aging and accidents. Most people struggle to modify their …

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