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Karen Wistoft

Role modalities in Urban Health Education

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An important feature of contemporary welfare state management is urban health education that includes alliances and partnerships for developing public health policies and practices that positively impact on the health of people. Health promotion in the traditional sense of the word has been replaced by new managerial institutions and new cross-professional partnerships (Pollit 2002; Christensen & Lægreid 2007). For children and young people, this managerial revolution (Kettl, 2005) has meant new roles. The premises for their inclusion into health promotion have changed.

The paper investigates role expectations in relation to urban strategies of health education and promotion in Denmark. The point of departure is a research project named “Children at Risk” running from 2007-2010 which was a joint project between the Danish School of Education at Aarhus University and Department of Management, Politics and Philosophy at the Copenhagen Business School (Wistoft et al., 2007). The research topic of the project is welfare management and health education. The general objective was to identify and compare different policies and strategies used by the Danish municipalities in the involvement of children and young people in health education activities. The study was a cross-municipality quantitative-qualitative study in five parts: I) Literature review, II) Pilot study: personal interviews and focus group interviews with managers and actors in 4 selected municipalities, III) Survey: telephone interviews with the managers of health promotion and prevention in the municipalities of Denmark (N=72 (98)), IV) Focus group interviews with pupils aged 13-15 years (N=108) in different school classes (N=19), V) Case studies in 5 selected municipalities: focus group interviews with health educators and other key persons related children and adolescent (N=34).

The paper takes upon it self a combined search for different role modalities of present health semantics aimed at children and young people. The relations between health semantics, citizen roles, and educational inclusion/exclusion are central. In order to look at health semantics at the one hand in terms of making certain roles become popular (in order for children and young people to become interested in wearing the roles and by wearing the roles becoming recognisable and communicative, that is becoming includable and included), and on the other hand as a semantic preparation for participation in behavioural activities such as co-decision making, different preventive initiatives are analysed.

The theoretical framework combines elements from system theory (Luhmann, 1995a), pedagogical studies and health education theory in order to grasp different semantic modalities of inclusion of children and young people. In a system theoretical perspective, which is the main approach so far, the matter of inclusion becomes a question of both the communication about people as certain role bearers and a question of the ways people as persons react towards generalised role communications (Luhmann 1995b; Stichweh 2005; Stäheli 2007). Taken together, the theoretical perspectives point towards an analytical tool for empirically investigations into present health promoting and preventive societies. Hence, our studies show the ways in which risk communication is involved in the strategies as well as in health educational practises. The conclusion of the project is that a new kind of identity – “the risky child” is attributed to the children as they are involved. Being confronted with different risks of childhood coming for example from eating fatty food, drinking alcohol, smoking cigarettes or having sexual relationships, the children are brought into a moral, political and lifestyle oriented discourse on risks. In this discourse their identity (as children or adolescents) is at stake as they are expected to participate as well-experienced information consumers. They are expected to be rational, qualified, and future oriented participants. Often the health promotion information concerns a distant future in which the children risk invisible threats.

Taking this quotation as one's point of departure the paper discus how to identify and compare different role expectations and strategies of involving children. This points towards a more general feature of urban health education in which citizens are taught how to enter reflexive and informational modes of relations-to-themselves. The ability to choose freely, one of the heralded identity features of welfare society today (Højlund, 2006), is basically a risk taking attitude. The individual citizen chooses what is best for him or her, and takes a, hopefully, well-informed risk. This risk taking attitude seems to be opposed by a preventive discourse in which the opposite attitude is suggested, namely, to avoid future risks are heralded. But the two discourses are only seemingly in opposition. They both participate in identity constructions that turn citizens into risky people, potentially risk bearers, risk information consumers, risk prioritisers and choosers.

Risk reflexivity is promoted as an urban education approach (Luhmann & Schnorr, 2000). The paper concerns a thesis for further development, that present welfare consumerism is accompanied by certain requests concerning the use of health information. To the individual, this means that the role as healthy involves information processing and reflexive activities modulating between being a risk-taker and risk avoider. Already in childhood, the risk-mode of relating to one self is promoted. The role as healthy is also a role of risk reflection – and the purpose of urban health education.
Original languageDanish
Publication year8 Sep 2011
Publication statusPublished - 8 Sep 2011

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