This
WHO description emphasizes both individual lifestyle and social factors in its
health promotion strategy. In addition, according to WHO (2017), the goals of
health promotion are to improve health equity, reduce individual risks of developing
diseases or injury, encourage healthy lifestyle, and to address the problems
regarding the determinants of health.

            Within
nursing practice, the focus on health promotion has been based on disease
prevention and behaviour change, with the view that peoples’ poor health status
is the result of their behaviour and misconduct therefore, they must be
responsible for their health status (Baum, & Fisher, 2014; Kemppainen,
Tossavainen, Turunen, 2013). From
Williams (1989) perspective, this assumption is premised on the idea of
individualistic approach to health promotion. Thus I argue that this assumption
indicates the grounding of health promotion in the neoliberal ideology of
individualism (McGregor, 2001).

Similarly, the WHO (1984) states
that health promotion programs can be misunderstood, and it is at times
interpreted as putting the responsibility of a person’s health and wellbeing on
that individual. Thus the WHO reaffirmed that health promotion also focuses on
wider social context including socioeconomic and political structures since
these have an impact on peoples’ ability to make healthy choices. It is argued
that, as an approach to health promotion, the focus on modifying an
individual’s behaviour rather than taking into account the wider context, can
be problematic (Browne, 2001; Williams, 1989). Evidence shows that the rates of
disparities in health are rising as a result of economic and social change both
in developed and in developing regions (Baum, & Fisher, 2014). What
ideology underlies nursing health promotion theory and practice? Is the
existing approach oriented to individual’s interest? What transformations are
necessary for nursing to fully embrace health promotion practice?

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The purpose of this paper is to
consider the potential contribution of Habermas’s Theory of Communicative
Action (TCA) as a framework for enhancing health promotion theory and practice
in nursing. The paper argues that the practice of health promotion in nursing
is underpinned by neoliberal assumptions of “…individuals as rational and
freely choosing” (Browne, 2001). Therefore, the outline of the argument is as
follows: the practice of health promotion is defined; the concepts of
communicative action are reviewed; a critique of the individualistic approach
is presented from the perspective of TCA; the neoliberal assumptions underlying
the existence of individualistic approach to health promotion is discussed, and
the potential contribution of communicative action and its implications for
nursing the and practice are identified.

Health
Promotion

Health promotion has been
identified as holding a central role in nursing practice, where nurses promote
the wellbeing of the individual by encouraging them to adopt healthy lifestyles
(Raingruber, 2017). The five principles of health promotion determined by the
WHO include: 1) focusing on peoples’ health in the context of their everyday
life experience; 2) it’s multi-dimensionality, that is, it is designed to
address the physical, mental and social dimensions of health; 3) that
government is accountable; 4)  community
participation and 5) it is directed toward the social determinants of health
and their influence on population health outcomes (WHO, 2005).

In practice, health promotion
intervention occurs in two ways – through primary care setting and through the
public health. Primary care health promotion focuses on providing health
education to individuals and their families through holistic approaches by
providing health education to client about behaviour modification (Kemppainen
et al, 2013). For example, health promotion strategy to prevent coronary heart
disease have been based on behaviour modification and health education, while
from public health perspective, preventive strategy employed have focussed on
creating environment that facilitate heart-healthy behaviour including
awareness campaign (Williams, 1992; Stanhope, and Lancaster, 2016, p. 458).
Furthermore, evidence have shown that there is a relationship between
individual behaviour and socioeconomic factors with regard to coronary heart
disease (Brenner, 1997). The premise of this approach in the above stated
example is that the circumstances within the individuals control and behaviour
determines individuals’ health status (Wiliams, 1992). This substantiate the
claim that behaviour- centred strategy within the context of individualistic
approach to health promotion is not oriented to serving the interest of
individuals.

Overview of Habermas’s Theory of
Communicative Action

Habermas’s TCA is oriented to
social subjectivity of mutual understanding that that is oriented to rational
use of language to arrive at consensus, where rationality is devoid of coercion
(Brand, 1990; Cody, 1992). The TCA is based on two distinct concepts; the
instrumental rationality or strategic action and the communicative rationality
(Finlayson, 2005). The idea of rationality is oriented to how people acquires
and uses knowledge, with the underlying assumption that knowledge is socially
constructed (Cody, 1992; Kim, & Holter, 1995).

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