it has struck me over the last few days that many of the points under discussion are about styles of health promotion. This is an area where I have absolutely no knowledge, and it would probably be true to say that what is successful in one area is unsuccessful in another. There are threee aspects to health promotion in general, and how it applies to breastfeeding in particular that I would love to see discussed:

 - Does it make a difference which outcomes are focused on for the sake of promoting a public good? Or if the prevalence of negative outcomes may seem to be exaggerated. As far as I know, research in road safety awareness around here suggests that focusing on nasty accidents switches people off and they no longer pay attention. Is that true of health promotion? In any country? 

I recently took part in a health quiz from the UK (I live in Ireland, not in the UK), where among other things I was asked about my drinking habits. I pu tdown, accurately, that I took a glass of wine a week. Unfortunately in my culture that almost labels me as abstemious, as there is way too much consumed. I was outraged when the report on my drinking showed an orange colour, saying "No amount of drinking is safe". I completely disregarded that health promotion after that, as they seem to be living on a different planet.

 - Does the tone of health promotion make a difference? Is it warm and fuzzy, or is it more directive in approach? The only research I am aware of that looks at styles of communication wasdone in Tower Hamlets, an underprivileged part of London. The booking midwives asked the question "What do you know about breastfeeding?" and were trained to respond to the mothers supportively and non-judgementally. This group had an increased rate of breastfeeding, but unfortunately I can't find a reference to the study. Tina Miller, in her book "Making Sense of Motherhood", speaks of moral discourses around the responsibilities of mothering, something that Glenda Wall has also written about. Do they have a point, or is it just tiresome?

 - What is the best way for public health promotion to deal with resistance? And that is probably the most crucial question of all, because resistance appears to have set in among mothers. Has resistance to lifestyle advice being dealt with successfully in any other health arena? Resistance to change is also part of the change management model, and ways to counter it include education and communication; participation and involvement; and facilitation and support. Is this relevant to public health promotion? Have they been used? Could they be used to promote breastfeeding? How relevant is it that the greatest amount of resistance (just an opinion here, not evidence based) appears to have come from mothers who have started breastfeeding and for whom it didn't work for whatever reason?

Just a few thoughts and questions,

Eithne Murray
Carlow, Ireland

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