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The interplay of structure and agency in health promotion: Integrating a concept of structural change and the policy dimension into a multi-level model and applying it to health promotion principles and practice

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  • Rütten, Alfred
  • Gelius, Peter

Abstract

The recent debate in public health about the “inequality paradox” mirrors a long-standing dispute between proponents of structuralist approaches and advocates of action theory. Both views are genuine perspectives of health promotion, but so far they have not been adequately linked by health promotion theory. Using Anthony Giddens's concepts of structure and agency seems promising, but his theory has a number of shortcomings that need to be amended if it is to be applied successfully to health promotion. After briefly assessing Giddens’s theory of structuration, this paper proposes to add to it both the concept of structural change as proposed by William Sewell and the policy dimension as described by Elinor Ostrom in her distinction between “operational” and “collective choice” level. On this basis, a multi-level model of the interaction of structure and agency in health promotion is proposed. This model is then connected to central claims of the Ottawa Charter, i.e. “build healthy public policy”, “create supportive environments”, “strengthen community actions”, and “develop personal skills”. A case study from a local-level health promotion project in Germany is used to illustrate the explanatory power of the model, showing how interaction between structure and agency on the operational and on the collective choice level led to the establishment of women-only hours at the municipal indoor swimming pool as well as to increased physical activity levels and improved general self-efficacy among members of the target group.

Suggested Citation

  • Rütten, Alfred & Gelius, Peter, 2011. "The interplay of structure and agency in health promotion: Integrating a concept of structural change and the policy dimension into a multi-level model and applying it to health promotion principles a," Social Science & Medicine, Elsevier, vol. 73(7), pages 953-959.
    • Handle: RePEc:eee:socmed:v:73:y:2011:i:7:p:953-959
    DOI: 10.1016/j.socscimed.2011.07.010
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    References listed on IDEAS

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    1. Rütten, Alfred & Abu-Omar, Karim & Frahsa, Annika & Morgan, Antony, 2009. "Assets for policy making in health promotion: Overcoming political barriers inhibiting women in difficult life situations to access sport facilities," Social Science & Medicine, Elsevier, vol. 69(11), pages 1667-1673, December.
    2. Abel, Thomas, 1991. "Measuring health lifestyles in a comparative analysis: Theoretical issues and empirical findings," Social Science & Medicine, Elsevier, vol. 32(8), pages 899-908, January.
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    Cited by:

    1. Till, Maike & Abu-Omar, Karim & Ferschl, Susanne & Abel, Thomas & Pfeifer, Klaus & Gelius, Peter, 2022. "Implementing the capability approach in health promotion projects: Recommendations for implementation based on empirical evidence," Evaluation and Program Planning, Elsevier, vol. 95(C).
    2. Langford, Rebecca & Panter-Brick, Catherine, 2013. "A health equity critique of social marketing: Where interventions have impact but insufficient reach," Social Science & Medicine, Elsevier, vol. 83(C), pages 133-141.
    3. Abel, Thomas & Frohlich, Katherine L., 2012. "Capitals and capabilities: Linking structure and agency to reduce health inequalities," Social Science & Medicine, Elsevier, vol. 74(2), pages 236-244.
    4. Judith Kohlenberger & Milda Žilinskaitė & Aida Hajro & Irina Vafiadis & Sabina Bikic, 2021. "Essential, yet invisible: working conditions of Amazon delivery workers during COVID-19 and beyond," Working Paper Reihe der AK Wien - Materialien zu Wirtschaft und Gesellschaft 230, Kammer für Arbeiter und Angestellte für Wien, Abteilung Wirtschaftswissenschaft und Statistik.

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