Resource Reviews Health Promotion: Philosophy, Prejudice and Practice David Seedhouse John Wiley, Chichester, 1997, ISBN 0 471 9391 07 In Health Promotion: Philosophy, Prejudice and Practice, David Seedhouse seeks to expose the fallacy of pretending that the notion of good health, and thus the promotion of good health, is value-neutral, a fallacy undermining the integ- rity of the health promotion profession. Types of health promotion, he argues, are inextricably bound up with views as to how people should and should not behave and with notions of the good society. It is only by facing up to the inescapably evaluative nature of health promo- tion that health promotion professionals can replace unexamined prejudices with mature moral positions clarified in the light of philo- sophical analysis, thereby overcoming the theor- etical vacuousness at the heart of health promotion. Health promotion does not possess a `unifying rationale' (p. 27). There is no con- sensus within the profession as to what is the point and purpose of health promotion prin- cipally because there is no consensus as to what health consists in. This fact is reflected in some official definitions of health promotion, such as, `any planned measure which promotes health' which, as Seedhouse caustically points out (p. 20), is hardly illuminating in the absence of any generally accepted definition of health. Seedhouse begins his analysis of the various possible conceptions of health and health promo- tion with the view assumed, often tacitly and uncritically, by most health promotion officers (and indeed most governments), where health is defined as the absence of disease or illness, and health promotion is about `good preventive work' to ensure `that the least possible number of patients present themselves at the doors of the medical profession' (p. 70). This conception, which he labels medical health promotion, is, he argues, prudent, utilitarian and conservative (p. 88). He contrasts this conception with social health promotion which he sees as inspired by such political ideologies as anarchy, social demo- cracy, socialism, Marxism and egalitarianism (p. 91) (although utilitarians could conceivably be in favour of social health promotion and hedonistic disease-inducing behaviour). Social health promoters, inspired by leftist political ideology, are more likely to be concerned with health inequalities, with poverty and unem- ployment. Medical health promoters, on the other hand, are more likely to focus their concern on specific behaviours associated (an association, Seedhouse argues, which is usually overstated) with disease, smoking, heavy drinking, etc. But both medical and social health promoters share a concern with less mortality and morbidity which rather begs the question. Disease-inducing beha- viours may in fact be means to self-fulfilment for the persons concerned: `If a person chooses a ``hard living'' lifestyle, even if that person becomes diseased as a result, this does not auto- matically mean that his was a bad choice (not if this is the life he genuinely wanted to live)' (p. 79). He then turns to good life promotion where health promotion is subsumed under the wider goal of promoting the good life, arguing that good life promotion represents an `illegitimate extension of health promotion'; health promotion, Seedhouse argues, `is about promoting healthÐnot about promoting good lives' (p. 94). This critique leads the reader into the most significant section of the book, part three, in which Seedhouse outlines his own theory of what health and health promotion ought to be about, the `foundations theory of health promo- tion'. He defines health in terms of autonomy. This is not unusual. Many writers, including myself, see the promotion of autonomy as the HEALTH PROMOTION INTERNATIONAL Vol. 13, No. 1 # Oxford University Press 1998 Printed in Great Britain 87 c:/hptemp/130087.3d ± 18/3/98 ± 11:1 ± disk/sh