Evidence-based health promotion for older people and instrumentalisation: comparing the influence of policy contexts in Austria and England

Abstract

Health promotion (HP) amongst older people is an increasingly prominent policy concern for governments. The development of an evidence-base and the advocacy of effective interventions in the light of this act as legitimation tools for the overall HP phenomenon – assisting the growth of state and non-state funding for public health initiatives for older people. In structuring decision-making as to which individual projects/initiatives receive funding, frameworks for acknowledging efficacy impact on formats of HP work both positively and negatively. Drawing on recent research across the EU and focusing on the specific national contexts of Austria and England, this comparative policy analysis triangulates best-practice modelling, evaluation data and interviews with project coordinators to explore how policy contexts impact on the nature and format of HP interventions. Amidst a developing awareness of what effective practice looks like, successful HP initiatives must advocate their legitimacy within narrow rules of quality, where measurable outcomes have become the keys which unlock financial resources. Findings across both countries suggest that this instrumentalisation of legitimation, driven by economic pressures and bureaucratic generalisability, threatens the rationality of HP. From a Habermasian perspective, tensions emerge between projects’ remaining reflexive towards processes and their need to articulate the ‘success’ of the interventions in a language of outcomes. Over time, in an era where resources are increasingly scarce and competition over these intensifies, a danger exists whereby the instrumentality of HP begins to separate from, and impinge upon, the capacity for projects to think and act holistically.

Keywords:

• health promotion
• older people
• legitimacy
• funding
• commissioning
• Habermas

Acknowledgements

PB analysed the England data, developed the theoretical framework and wrote the majority of this article. GL and KR analysed the Austria data and wrote the Austria-related parts of the analysis. GL and KR developed key parts of the overall study design. The authors are very grateful to Jenny Billings for her input into the overall study and moreover the England data analysis. The overall study was funded by the European Commission's Public Health Programme (2003–2008), DG Health and Consumers (SANCO) [Grant Agreement No. 2005318].

Notes

Notes

1. The 11 countries: Austria, Czech Republic, Germany, Greece, Italy, the Netherlands, Poland, Slovakia, Slovenia, Spain, the United Kingdom.

2. This is in comparison to a number of other nine European countries with decidedly limited provision.

3. The inclusion criteria are listed here: multi-agency working; conducted evaluations; multi-faceted and holistic approach; sustainability; included voice of older people; involved visible and invisible target groups; considered social diversity; geographical and physical accessibility; well-grounded theoretical approach; gender sensitive; cost effective; sought to empower; demonstrated transferability; considered consumer satisfaction; applied innovative strategy.Projects did not have to fulfil all these categories but those that were seen as satisfying a large number of criteria (based a standardised scoring procedure) were then included in the database.