Evidence and causality in health promotion practice

1. Evidence and causality in health promotion practice - the view from anthropology Morten Hulvej Jørgensen The 5th Nordic Health Promotion Research ConferenceEsbjerg 2006

2. An anthropological analysis of health promotion practice - complementing causal evidence Morten Hulvej Jørgensen The 5th Nordic Health Promotion Research ConferenceEsbjerg 2006

3. Background Intervention Outcome What works?

4. Background Intervention Outcome ? How does it work in practice?

5. Aim of presentation • Case: Health promoting activities and alcohol use among teenagers in a Danish rural community • Health promotion seen as a social practice • Focus on interaction between actors • Theoretical distinction between • Strategic action • Tactical action

6. Methods • Ethnographic fieldwork in a Danish rural community • Approximately 2,000 inhabitants • Participant observation among 13 to 16-year-olds (n=93) • 2 two-month periods • In school, at leisure activities, private parties, soda pop discos • Semi-structured interviews • Self-selected friendship pairs or small groups • Interviews with 32 boys and girls in the 15-16 age group • 4 interviews with teachers and municipal staff

7. The soda pop disco • Rules: • Age limit: 12-15 years • No alcohol inside • Intoxicated persons are not allowed to enter • Control by adults: • Municipal street worker • Door men • Front desk • Surveillance inside

8. Warm-up sessions • Get-togethers in private homes • Small groups of teenagers • Eating, drinking alcohol, socialising Getting in the right mood Anticipating adult control Timing of alcohol intake and intoxication

9. What happens? • Soda pop disco ~ health promotion practice • Salutogenetic approach • Preventive approach • Interaction between adults and teenagers • Different positions in intergenerational social space (power)

10. Strategic versus tactical action • Michel de Certeau, The Practice of Everyday Life. University of California Press, London, 1984 Strategic action (adults) - presupposes a position of power - defining, surveilling and ruling a social space Tactical action (teenagers) - ”must vigilantly make use of the cracks that particular conjunctions open in the surveillance of the proprietary powers” (p. 37)

11. Conclusion Intervention Outcome ? How does it work in practice?

12. Conclusion ? Soda pop disco Reduction ofalcohol use

13. Strategies Tactics Conclusion Soda pop disco Timing of alcohol use

14. Collaborators • Julie Bredenfeld Thomsen • Mette Riegels • Morten Grønbæk • Nina Lyng • Pia Haudrup Christensen • Tine Curtis