Critical Realism and Health Promotion

A key goal of health promotion is to improve health outcomes and health equity by addressing the causes of health-harming behaviors associated with non-communicable diseases, and through encouraging adoption of health-promoting behaviors. Modern health promotion approaches that derive from the Ottawa Charter and the social and economic determinants of health model highlight the interplay of individual characteristics and living and working conditions, set in broader social, economic, and cultural environments as shaping health behaviors. This chapter introduces critical realism as an underpinning approach to research which allows better understanding of health behaviors and thus provides insights that can inform the development of relevant, grounded, and effective interventions to improve health outcomes. Critical realism provides health promotion researchers with a powerful, flexible approach which provides philosophical coherence, a clear understanding of how social reality comes about, and how it is maintained and transformed. Researchers can more clearly view the multi-level factors that shape health behaviors and outcomes as integral parts of a complex system underpinned by relations of power. Within such systems, researchers and practitioners can identify vested interests that prevent people from engaging in health-promoting behaviors. Critical realism also encourages approaches that employ understandings and research methodologies and methods that are culturally safe to benefit diverse populations. Research with more diverse populations privileges other voices and allows for the development of more nuanced health promotion initiatives that are contextualized and grounded within, and structured by, people’s everyday lives and circumstances.