The relationship betweenhealth promotion andcomplementary therapiesDean Whitehead

The underlying philosophies of health promotion and complementary therapies are veryclosely related and, consequently, share many similarities; yet such similarities that existbetween these two disciplines are rarely expressed, acknowledged or explored. It would bealmost impossible to practice complementary therapies without incorporating elements ofhealth promotion within them, whether this is done so knowingly, or not, by thepractitioner. This account sets out to establish the nature of such a relationship andhighlights the common advantages and dilemmas in recognizing such a relationship. It seeksto determine the validity of closer collaboration (between the two disciplines) in order toprovide a collective consensus for like-minded nurses to move towards a more holistic andempowering paradigm. It concludes by suggesting that, in order to move the shared aims ofhealth promotion and complementary therapies forward, closer ties need to beestablished, between the disciplines, and built upon. 1999 Harcourt Publishers Ltd

Dean Whitehead MSc.PGDipHE. PGCE. RGN.lecturer. University ofHull. Faculty of Health, EastRiding Campus, BeverleyRoad. Willerby. Hull HUIO6NS.UK.Tel.: 01482466739;Fax: 01482466686;Email: d.whitehead fl)health.hull.ac.uk =

INTRODUCTION

According to Tones and Tilford (1994), anyhealth promotion activity is seen as any health-related intervention that is deliberately designedto promote health incorporates all strategiesthat are related to health. In its 'broadest' sense,one must assume that any activity associatedwith complementary therapies is, consequently,health-promoting. One could argue, at the sametime, that the relationships between these twodisciplines are more than just broad and as suchcould be viewed as being mostly integral andsymbiotic. The underlying ideology and philoso-phies of these approaches are very closelyrelated; noticeably so within particular ap-proaches to health promotion and particularlyso for the health promotional strategies that havebeen endorsed at an International/Nationalpolicy-level, over recent years, i.e, educational,empowerment and socio-political approaches tohealth. The individualistic, empowering and'holistic' nature of such approaches to health-care provision closely reflects the intended natureof complementary therapies. On the other hand,it does have to be said that some health-promotion approaches are deemed to be morebiomedical, disease-focused, reductionist and

limiting in their nature and, subsequently, arealso seen to oppose much of what complemen-tary therapies stand for: namely the medical andpreventative approaches to health. This could beseen, by some, as a problematical 'state ofaffairs'and serves to highlight the dichotomous natureof health promotion and the problems this maypose in establishing links with the disciplines ofcomplementary therapies.

This account aims to identify the extent towhich complementary therapies and health pro-motion are inter-related, as well as explore thenature of any existing relationships, both posi-tive and negative. This is done so, acknowledgingthe limitations of drawing upon little existingliterature, that has previously attempted toexplore such issues in any real depth. Theexception, of note, that makes any reference tothis relationship, at all, is that of Mitchell andCormack (1998 p 25), who state that:

Most complementary practitioners aim topromote health ... while many complementarydisciplines have as their foundationapproaches to healthy living, practitionershave not attempted to implement these ata collective level in an analogous way toorthodox health promotion. It is, of course,possible that in the future complementary andorthodox health care concepts may be

Ccmplementary Therapies in Nursing & Mi

... many, ifnot most,complementarytherapists mightwell regardthemselvesas healthprotnotionalists ...

172 Complementary Therapies in Nursing & Midwifery

integrated into health promotion work, adevelopment awaited with interest.

Such sentiments do mirror the experiences of thisauthor who, likewize, also anticipates any futuredevelopments with interest.

RELATIONSHIPS BETWEEN HEALTHPROMOTION ANDCOMPLEMENTARY THERAPIES

According to Benson and Latter (1998), the keyfeatures of health promotion include 'holism,equity, participation, collaboration, individualiza-tion, negotiation, facilitation, and support' allof which, one could argue, are also integraland key components of complementary therapies.Labonte (1993) goes on to add several otherdesirable properties to this list, such as auto-nomy, egalitarianism, partnership, accessibilityand self-determination (CaeIIi 1998) which areimmediately identifiable with the nature andpractices of complementary therapies (Elliot1997). Much in the same vein, Hartrick et aI.(1994) sees health promotion as a 'synergisticprocess' that incorporates participatory dialogueand listening skills, as well as a commitment toenvision action and promote positive change.From such statements it can be seen, if notalready acknowledged, that the similarities be-tween the disciplines of health promotion andcomplementary therapies are readily identifiable.As such, it is possible safe to assume that theunderlying philosophies, of each discipline, are,subsequently, somewhat similar. From a healthpromotion perspective, its underlying philosophyis designed to be essentially empowering andholistic in nature, even though some of itspractices and approaches may appear contraryto that fact. As such, Lindsey and Hartrick (1996)identify that the philosophy of health promotion isconsistent with the human scienceparadigm whichadvocates an egalitarian approach to promotingautonomy and empowerment within an indivi-duals experience of health and healing.

In discussing the underlying ideology of thesetwo disciplines, one should acknowledge thecontribution of holism (as has already beenalluded to) as a major factor in the discussion ofapproach. Indeed, it is suggested by Holt andHall (1983) that holism is a philosophy of healthcare, involving a constructive effort to establishand maintain 'optimal' health and well-beingof the 'whole' person. According to Rankin-Box(1988), holistic care, and its emphasis on thewhole advocates a shifting of focus towards astate of 'positive health' and seeks to broaden theconcept of caring, in order to accommodate themaintenance of health. Essentially, if holisticcare embraces these concerns, then it implies

that, as an underlying philosophy of both healthpromotion and complementary therapy, it isa fundamental premise of both disciplines. It isHaggart (1996 p 17), who goes some way toestablishing the link between the disciplines ofhealth/health promotion and complementarytherapies, directly via the principles of holism,by stating that:

... holism, means a bringing together of allaspects of the person in integration or balanceand health means that individual state ofbalance.

In terms of holistic practice, the above notionson holism, itself, imply that individual practi-tioners, within each discipline, are seen to bewilling to explore the potential for well-being,health and personal growth, within themselvesand others (HNA 1993, Johnson 1998).

The need for a concerted move towards amore focused client-centered, holistic regime ofhealth-care has been much debated, within bothorthodox (i.e. health promotion) and comple-mentary practices (Mitchell & Cormack 1998).On the whole, there appears to be a 'generalconsensus' that a move away from traditional,reductionist, biomedical approaches to health, infavour of more encompassing and empoweringapproaches, is the acceptable measure for currentand future nursing practice (Caraher 1994,Mackintosh 1995, Whitehead 1999a). This beingsaid, and noting the obvious similarities betweenthe aims of health promotion and complemen-tary practices, it stands to reason that a moresubstantial and pro-active lobby, for effectingsuch change, could be facilitated more cohesivelyby the 'joining of forces' of health promotionand complementary therapies. Of course, oneshould acknowledge that all complementarytherapists are, indeed, already health-promotion-alists in the strictest sense of the term; if by noother means than, as has already been suggested,the discipline shares the same underlying ideol-ogy as health promotion. One might argue,however, that such a statement is somewhatsimplistic in its viewpoint, for several reasons.Firstly, this relationship is not always realised oreven acknowledged. Secondly, whilst many, ifnot most, complementary therapists might wellregard themselves as health promotionalistsand do actually incorporate elements of healthpromotion into their practice, there is noevidence to support the fact that, on a reciprocalbasis, most health promotionalists practice, oreven have a working knowledge of, complemen-tary therapies. Thirdly, it may be somewhatflawed to assume that most complementarypractitioners do incorporate health promotionalactivities into their practice (Mitchell & Cormack1998). As such, this goes some way to provethat the sharing of a philosophy, by different

The relationship between health promotion and complementary therapies 173

disciplines, is no guarantee of shared knowledge,understanding and practice.

DILEMMAS ASSOCIATED WITHINCORPORATING HEALTHPROMOTION ANDCOMPLEMENTARY THERAPIESINTO NURSING PRACTICE

EmpowermentSuch viewpoints, as stated previously in thisaccount, can be seen as problematical due to thefact that, what is seen to be desirable withinhealth promoting and complementary practice,is not always seen as appropriate in nursingpractice. In fact, more often than not, nursingpractice tends to represent routines that areanything other than empowering or holistic,both in terms of health-promotion and comple-mentary therapies measures. In terms of philo-sophical shift, Benson and Latter (1998) informus that health promotion, as a seeminglyempowering and holistically individualizing ap-proach to health care, has proved to be one ofthe most difficult issues to address in nursingpractice. Many authors mention the fact thatinstitutionally-favoured and strongly-establishedreductionist, objective and predominantly medi-cally-focused strategies, stand as an almostinsurmountable barrier to empowerment-relatedpractices (Saks 1992, Mackintosh 1995, Haggart1996). Unfortunately, despite the fact thatadvocates of health promotion and complemen-tary therapies, on the whole, have been 'cryingout' for such change and reform, the practi-tioners themselves have often added to thebarriers presented and tended to perpetuate thestatus quo. It appears that, often, nurses workingas health promotionalists and complementarypractitioners, have incorporated reductionistelements to their practice, either unknowingly,as a means in pursuing the 'line of leastresistance', or as a mis-guided means of seekingfurther acceptance and credibility. Lindsey andHartrick (1996) identify that there is a clear needfor nurses to move away from the natural scienceparadigm, towards a broader perspective ofhealth promotion. Piper and Brown (1998)implore that, where possible, nurses shouldalways try to adopt the more 'valid' approachof 'humanistically inspired client-empowerment'.This sentiment is also broadly reflected byseveral authors specifically debating the issuesof complementary therapies in nursing (Saks1992, Wright 1995, Haggart 1996). Caraher(1994) has, however, identified that, to a certainextent, there has been some progress towardssuch a broader perspective, in that he reportsthat there has been a paradigm shift from 'health

persuasion' towards personal counselling. Suchperson-centered counselling initiatives are seento share parallel characteristics with empower-ment approaches to health, in that such anapproach recognizes the need to harness andunleash latent health-related resources that liewithin the clients influence and fosters a 'growth-conducive climate between client and health-promoter'. (Mackintosh 1995).

HolismAnother dilemma, for all nursing practitioners ofhealth promotion or complementary therapies, isthe criticism's 'laid at the door' of holism andholistic practices themselves. There is a view,supported by some, that the term holism hasbeen 'hijacked' by certain professions in anattempt to distance itself from 'undesirable'elements of biomedical practice. As such it hasdeveloped as a part of a philosophical 'counter-force' against reductionist and atomistic perspec-tives, and may have become an 'empty' term(Dacher 1997). Pietroni (1997), subsequently,states that such an exisiting state of affairs iscounterproductive and unhelpful, in that itcauses wholesale misunderstanding of the con-tribution to be made by orthodox medicine andreduces the debate to a simple notion of 'good'and 'bad' practice, perpetuating what he calls a'sterile circular debate leading nowhere'. Addedto this dilemma, is the notion that, despite therebeing evidence of some movement towardsholistic views on health and health-care provi-sion, there is little translationof such viewpointsinto specific skills and knowledge, leading toa 'holistic health rhetoric' prominent withinmedical model 'healthism' related approaches(Delaney 1994).

Contentious, as it may seem, however, onemight argue that most of health promotion'scredibility comes from a research base that has apredominantly biomedical basis, albeit contraryto its overall philosophy and in spite of the factthat it can draw upon many different types ofapproaches, other than a biomedical modelapproach. It could be argued that in order tobuild up a similar 'sound' research base, com-plementary therapies might be advised to de-velop a similar biomedical arm as part of its'inventory' and, subsequently, develop differentapproaches to its discipline. Some complemen-tary therapists already argue the case for bring-ing in elements of structured, quantitative,biomedical approaches to their research andtheir practices (Buckle 1993, Wall & Wheeler1996). At the other end of the health spectrum,another possibility for progression and reform,within complementary therapies, is to develop anapproach that recognizes the socio-environmen-tal influences of complementary therapies on a

.. . goodopportunities forcollaborativepractice may besignificantlyaffected by theclinical settingitself.

174 Complementary Therapies in Nursing &Midwifery

clients health and well-being. Health promotionutilizes such strategies as a valid and recognisedapproach to its discipline. Currently, it is seenthat complementary therapies do not attempt toapply such approaches to its practice and,consequently, this is seen to be part of itscontinuing dilemma (Pietroni 1997).

CollaborationIn order that we offer and provide therapeuticpartnerships in health care, both between profes-sionals and clients and professionals themselves,close collaboration between all health-care profes-sionals can only serve to promote and integratecomplementary therapies within orthodox prac-tice (Rankin-Box 1995). It appears, from theevidence so far, that this is primarily the casewhen identifying practitioners who are involvedwith health-promoting practices and initiatives. If,according to Pietroni (1997), complementarypractitioners 'continue to work as isolated in-dividuals within their own isolated disciplines', itwould seem that this remains a somewhat elusiveexercise, for those concerned, and presents a cleargoal to work towards. It could be argued thatcollaboration with health-promotionalist specia-lists, within nursing or allied fields, would be of

particul~Hbenefit to complementary practitioners,especially as health promotion is seen to have amore proven and credible research base to itsactivities. It is currently seen that good opportu-nities exist, for complementary practitioners tocollaborate with medical/medically-allied profes-sions, working side-by-side in developing useful'evaluative' strategies, for certain therapies (Ersser1995). What should be noted at this point,however, is the fact that good opportunities forcollaborative practice may be significantlyaffected by the clinical setting itself. There isevidence to suggest that the integration ofcollaborative practices and, indeed the scope ofhealth-related interventions, is influenced bywhether the activities occur within a community-setting or a hospital-based setting (Whitehead1999b). Collaborative practices are seen to bemore prevalent within community settings, atleast for health promotion initiatives, and onemight assume that the same is so for complemen-tary practices. This being the case, it might beuseful to develop strategies that promote furthercollaboration, where complementary therapies arepractised within institutional settings or not,whilst maintaining and enhancing those withincommunity settings.

CONCLUSION

If, as Benson and Latter (1998) suggest, nursingand health promotion are deemed to be synony-

mous with each other, it is suggested that so tooshould complementary therapies be included inthe equation. Despite the obvious similaritiesbetween the two disciplines of health promotionand complementary therapies, however, it is clearthat much will have to change, both within eachdiscipline and between the two disciplines. It isenvisaged, or at least hoped, that once aconstructive dialogue is actively commenced andpersued, around the benefits to be drawn from aconcerted effort to bring the two disciplinestogether, then the 'flood-gates' will open andprogress will be made to bring about such change.

Wright (1995) asserts that, as we head towardsa new millennium, a 'paradigm shift' is in effecttaking place, which sees nursing, as part of a'post-modern era', moving away from traditionalhealth-related practices towards a more enligh-tened era. He goes on to state that the shift wiIIbe an insidious process and wiII not manifestitself as a complete overhaul of the system, butrather, as a gradual and evolutionary change.This account argues, on the other hand, that wemaybe cannot afford the luxury of time and mustbe seen to be quick and proactive in facilitatingsuch a shift before changes are imposed upon usor before we fall far behind other health-careprofessions. Either way, it is suggested that oncof the most constructive ways that such a changecan be incorporated into our profession, is to seethe joining of forces of health promotion andcomplementary practices, in providing a power-ful force for change in order to 'humanize' thecurrent system. Complementary therapists wouldbe iII-advised to disregard the influence of healthpromotion in, as Kickbusch (1996) states,significantly moving the health debate forwardtowards a paradigm based on the creation andproduction of health . Likewize, advocates ofhealth promotion should recognize the contribu-tion that has been made and wiII continue to bemade, by complementary practices, in movingthis debate forward.

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