The "social determinants" of practice? A critical analysis of the discourse of health promotion.

Developments in the practice of health promotion have centred on considerations of what clients bring to their encounters with professionals. This changes in the provider-client relationship marks a significant departure from practice models that relied on the professional giving the client expert health instructions. The literature that seeks to illuminate these more contemporary relationships with clients tends to ignore what practitioners bring to the health promotion encounter and, significantly, the social conditions that underlie the encounter. This paper, drawing on research gathered during an ethnographic study of practice in a public health clinic, critically analyzes health promotion with a view to challenging researchers, educators, and practitioners concerning the health-promoting possibilities in existing practice settings.