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Health promotion community development and the tyranny of individualism

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  • A. Shiell
  • P. Hawe

Abstract

Economic evaluation of health promotion poses few major difficulties when the theoretical approach of the programme and the evaluation of cost and benefits are confined within the context of the individual. Methodological individualism has a long history in economics and the techniques of microeconomics are well suited to the examination of individually focused behaviour change programmes. However, new developments in community health promotion pose special challenges. These programmes have the community, not the individual, as the focus of programme theory and ‘community’ means something completely different from the sum of individuals. Community empowerment and promotion of the community's capacity to deal with health issues are the goals of such programmes. To reflect these notions, sense of community and community competence should be considered as ‘functionings’, an extra‐welfarist constituent of well‐being. Their inclusion as outcomes of community health promotion requires a shift from individualist utilitarian economics into a communitarian framework which respects the programme's notion of community. If health economics fails to develop new constructs to deal with these new approaches in health promotion, the application of existing techniques to community programmes will mislead health decision makers about their value and potential.

Suggested Citation

  • A. Shiell & P. Hawe, 1996. "Health promotion community development and the tyranny of individualism," Health Economics, John Wiley & Sons, Ltd., vol. 5(3), pages 241-247, May.
    • Handle: RePEc:wly:hlthec:v:5:y:1996:i:3:p:241-247
    DOI: 10.1002/(SICI)1099-1050(199605)5:33.0.CO;2-G
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    References listed on IDEAS

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    1. McKinlay, John B., 1993. "The promotion of health through planned sociopolitical change: Challenges for research and policy," Social Science & Medicine, Elsevier, vol. 36(2), pages 109-117, January.
    2. Thurow, Lester, 1983. "Dangerous Currents: The State of Economics," OUP Catalogue, Oxford University Press, number 9780198771838.
    3. Hodgson, Geoff, 1986. "Behind Methodological Individualism," Cambridge Journal of Economics, Cambridge Political Economy Society, vol. 10(3), pages 211-224, September.
    4. Engleman, Stephen R. & Forbes, John F., 1986. "Economic aspects of health education," Social Science & Medicine, Elsevier, vol. 22(4), pages 443-458, January.
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    1. Jan, Stephen & Pronyk, Paul & Kim, Julia, 2008. "Accounting for institutional change in health economic evaluation: A program to tackle HIV/AIDS and gender violence in Southern Africa," Social Science & Medicine, Elsevier, vol. 66(4), pages 922-932, February.
    2. Stephen Jan, 2000. "Institutional considerations in priority setting: transactions cost perspective on PBMA," Health Economics, John Wiley & Sons, Ltd., vol. 9(7), pages 631-641, October.
    3. Wakefield, Sarah E.L. & Poland, Blake, 2005. "Family, friend or foe? Critical reflections on the relevance and role of social capital in health promotion and community development," Social Science & Medicine, Elsevier, vol. 60(12), pages 2819-2832, June.
    4. Nikki McCaffrey & Meera Agar & Janeane Harlum & Jonathon Karnon & David Currow & Simon Eckermann, 2015. "Better Informing Decision Making with Multiple Outcomes Cost-Effectiveness Analysis under Uncertainty in Cost-Disutility Space," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-19, March.
    5. Hazel Squires & James Chilcott & Ronald Akehurst & Jennifer Burr & Michael P. Kelly, 2016. "A systematic literature review of the key challenges for developing the structure of public health economic models," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 61(3), pages 289-298, April.
    6. Shiell, Alan, 1997. "Health outcomes are about choices and values: an economic perspective on the health outcomes movement," Health Policy, Elsevier, vol. 39(1), pages 5-15, January.
    7. Mooney, Gavin, 2005. "Communitarian claims and community capabilities: furthering priority setting?," Social Science & Medicine, Elsevier, vol. 60(2), pages 247-255, January.
    8. Thiede, Michael, 2005. "Information and access to health care: is there a role for trust?," Social Science & Medicine, Elsevier, vol. 61(7), pages 1452-1462, October.
    9. Stephens, Christine, 2008. "Social capital in its place: Using social theory to understand social capital and inequalities in health," Social Science & Medicine, Elsevier, vol. 66(5), pages 1174-1184, March.
    10. Currie, Melissa & King, Gillian & Rosenbaum, Peter & Law, Mary & Kertoy, Marilyn & Specht, Jacqueline, 2005. "A model of impacts of research partnerships in health and social services," Evaluation and Program Planning, Elsevier, vol. 28(4), pages 400-412, November.
    11. Borghi, Josephine & Jan, Stephen, 2008. "Measuring the benefits of health promotion programmes: Application of the contingent valuation method," Health Policy, Elsevier, vol. 87(2), pages 235-248, August.

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