I lagen om etikprövning framgår det att forskning om känsliga personuppgifter kräver ett godkännande av Etikprövningsmyndigheten. Exakt vilka personuppgifter som ska betraktas som känsliga är emellertid oklart, inte minst de uppgifter som rör hälsa. Syftet med artikeln är att diskutera vilken hälsoinformation som bör betraktas som känslig.

Det är endast ohälsa lagen bör syfta på, inte positiv hälsa. Ohälsa bör då uppfattas bredare än som avsaknad av sjukdom eller skada, även om dessa bör omfattas av lagen. Vi har två möjligheter här: ohälsa som nedsatt välbefinnande samt som nedsatt funktionsförmåga. Slutligen diskuterar vi huruvida lagen bör omfatta indikatorer på ohälsa eller ohälsans bestämningsfaktorer och kommer fram till att indikatorerna som regel bör inkluderas, medan information om riskfaktorer bara bör betraktas som känsliga personuppgifter i undantagsfall.

Migration is a stressful experience and research shows that newly arrived migrants in Sweden suffer from different challenges and struggle to relate to parenting in a new culture that is different from their own. The Swedish Child Health Services (CHS) focuses on promoting health among children, as well as supporting parents in parenting. Although this is a goal, migrant parents participate at lower rates in parental support groups. This paper aims to discuss how the Swedish CHS can support these families and address the need for improvement in the parental support offered to migrant parents during transition into their host country. In addition, this paper also aims to review and discuss the advantages of using a community-based participatory research approach together with the Swedish CHS to identify and apply culturally appropriate support programs to increase health literacy among migrant parents.  

The Swedish government decided to place greater emphasis and resources on supporting parents and promoting equal health among families in Sweden, with special emphasis on migrants and other vulnerable groups. This report from the Swedish government indicates the importance of creating knowledge about new ways, methods, and actions that may be needed to increase this support. One suggestion of this paper is to provide culturally appropriate healthcare work using a community-based participatory research approach, where migrant parents themselves are actively involved in the development of support programs. This approach will not only provide migrant families knowledge and support, it will also build on their needs and the challenges they can share, and receive support to overcome.

The Swedish Act concerning the Ethical Review of Research Involving Humans (Lag 2003:460) is relatively easy to understand. However, one criterion is unclear, creating an interpretative problem, which might lead to unnecessary reviewing of research projects. The aim of this paper is to discuss this criterion to see how it could, or should, be interpreted.The criterion concerns research that “is conducted according to a method that aims to influence a research participant physically or mentally” or “that might entail an obvious risk of harm for the participant,” and, thus, includes two conditions. The question is whether the first condition is not too inclusive, since it also covers the use of methods where there is no risk of harm.The article presents some crucial distinctions and alternative interpretations, and gives examples showing that the law seems to cover research that is not in need of ethical reviewing. The authors conclude with some tentative suggestions for solving this problem.

Background: The voices of those who have grown up in a family with maternal intellectual or developmental disability (IDD) are valuable for gaining an understanding of their situation, which is essential in order to be able to support these families and avoid potentially detrimental situations.

Aim: The study aim was to describe the experience of having grown up in a family where the mother has an IDD, with a focus on everyday life and perceived health consequences in adult life.

Method: A qualitative method with retrospective narrative interviews and narrative content analysis was chosen. In-depth interviews were performed with four women who had experiences of a childhood with maternal IDD.

Findings: Four themes emerged: Living under adverse circumstances; Dealing with one’s everyday life situation; Receiving insufficient support and wishing for more; and The echo from childhood into adult life. The findings revealed a distressing childhood, characterized by neglect, abuse, anxiety, and overburdening responsibilities, and also endeavors to keep the family situation a secret, while at the same time wanting the adult world to react.

Discussion: The findings can hopefully stimulate occupational therapists and other professionals to more effectively identify the situation of these children and provide support to prevent adverse future health conditions and poor well-being.

There are great health disparities in the world today, both between countries and within them. This problem might be seen as related to the access to various kinds of capabilities. It is not fully clear, however, what the exact relation is between health and capabilities. Neither Amartya Sen nor Martha Nussbaum has explicitly formulated a theory of health to go with their theories of capabilities. This paper attempts to present a clarification of the conceptual relation between health and capabilities. Health, it is argued, should be seen as a holistic multi-dimensional phenomenon, made up of basic abilities and subjective well-being, and of fundamental states and processes. Using this theory, the paper shows how health is related to Nussbaum's ten capabilities. It is argued that health, in the senses described, is a necessary part of all ten capabilities. Moreover, some of the capabilities on Nussbaum's list, such as thinking and imagining, and practical reasoning, refer to health. Finally, it is shown that even though health is part of all capabilities, health cannot itself primarily be seen as a capability. An acceptable degree of health is required as a functioning for any theory of human flourishing to be reasonable.

Abstract Background: According to ethical guidelines, healthcare professionals should be able to provide care that allows for the patients’ values, customs and beliefs, and the existential issues that are communicated through them. One widely discussed issue is existential loneliness. However, much of the debate dealing with existential loneliness concludes that both the phenomenon and the concept are quite vague. Aim: To clarify what constitutes existential loneliness, and to describe its lived experiences. A further aim was to provide a definition of existential loneliness that can function as a tool for identifying the phenomenon and for differentiating it from other kinds of loneliness. Method: A literature review including theoretical and empirical studies. Different search strategies were used to gather the articles included in the study. The analysis of the empirical studies had an interpretative approach. The articles were also analysed with the aim of providing a definition of existential loneliness. This was done by means of criteria such as language, uniqueness, theory and usefulness. This study is not empirical and does therefore not require an ethics review. Results: The analysis resulted in two main characteristics. The first one was perceiving oneself as inherently separated (disconnected) from others and from the universe. The second one brings out emotional aspects of EL, such as isolation, alienation, emptiness and a feeling of being abandoned. The empirical findings were divided into two categories: experiences of EL and circumstances in which EL arises. A definition of EL is also suggested, based on the two main characteristics identified. Conclusion: In order to meet patients’ needs, it is an ethical duty for healthcare staff to be able to recognise experiences of EL, that is, to communicate with the patients about these experiences in an appropriate manner. This in turn demands knowledge about existential issues and skills to deal with them.

‘Recovery’ is a term used in many contexts, and especially within medicine, care, and psychiatry. People can recover from a number of bad states, e.g., heartache, hunger, poverty, and indebtedness. However, given the context of this article, social psychiatry, the term appears to be about ‘getting better’, or even ‘being healed’ from a disease, disorder, illness, or similar condition. Even so, in the medical and psychiatric literature the term is used in a number of different ways, and a variety of end goals for recovery are suggested, some of which convey very different approaches to, or methods for, treating (helping, supporting, facilitating) individuals, users, clients, or patients, in order for them to recover. That the term comes with many meanings becomes even more clear when one approaches the field of social psychiatry, where the ‘recovery movement’ in psychiatry makes both a theoretical and ethical/political point in viewing recovery as a very special, and ‘valuable’, process or phenomenon. The aim of this paper, then, is to formulate a definition of the concept that might be particularly useful in the context of social psychiatry. First, the basic concept ‘recovery’ will be defined, abstractly, and second, it will be decided what, exactly, is the quality (or qualities) that the individual should regain. Several ideas about what the valued dimension should consist of will be discussed, e.g., symptom reduction, mental functioning, health, subjective well-being, happiness, quality of life, empowerment, and a meaningful life.

One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate (instrumental) goals or aims, and to morally evaluate the strengths and weaknesses of these two goal models, in relation to the ultimate goal of health promotion. The investigation shows that the behavior-change approach has several moral problems. First of all, it is overly paternalistic and often disregards the individual’s or group’s own perception of what is important—something that also increases the risk of failed interventions. Furthermore, it risks leading to ‘victim blaming’ and stigmatization, and to increased inequalities in health, and it puts focus on the ‘wrong’ problems, i.e., behavior instead of the ‘causes of the causes’. It is thereafter shown that the empowerment approach does not have any of these problems. Finally, some specific problems for the empowerment approach are discussed and resolved, such as, the idea that empowering some groups might lead to power over others, the objection that the focus is not primarily on health (which it should be), and the fact that empowered people might choose to live lives that risk reducing their health.

Aldrig i mänsklighetens historia har jordens befolkning haft det så bra som de har det nu. Världens rikedomar är större än de någonsin tidigare varit och i takt med det ökade välståndet blir världens invånare överlag allt friskare och allt äldre. Samtidigt har de generella välfärds- och hälsoökningarna inte kommit alla till del. En person som idag föds i USA förväntas tjäna 100 gånger mer under sin livstid än en samtida person i Zambia, samtidigt som en genomsnittlig japan förväntas leva 38 år längre än en sierra leonian. Ett stort problem är således att den globala hälsoförbättringen de senaste decennierna har varit djupt ojämlik. Syftet med denna bok är att redogöra för de globala folkhälsoproblem som idag utgör den största bördan för mänskligheten, liksom för de övergripande globala faktorer som har en påverkan på olika befolkningars hälsa. Boken syftar även till att presentera en begreppslig ram för folkhälsoområdet, och den diskuterar ett antal etiska aspekter rörande den globala hälsosituationen och dess olika orsaker. Den argumenterar slutligen för att det globala samfundet bör ta ett större ansvar för att åtgärda nuvarande problem och skapa en hållbar förändring.

BackgroundThere might be a need for support for families where the mother has an intellectual disability, in order to counteract the effects of potential parental inadequacy and other detrimental aspects of the family situation. The purpose of this study was to describe how professionals characterized such support and the collaboration required. Materials and methodsFocus group interviews involving 29 professionals were conducted and analysed using content analysis ResultsFive themes were identified: The roles and activities of the professionals involved; ways in which needs of support are identified; problems in identifying mothers with an intellectual disability; how professionals coordinate their support and work together; and the dilemma concerning legislative actions ConclusionsBy identifying both fruitful and problematic aspects of professional support, the findings may be used to enhance future support. More efficient chains of information and improved inter-sector collaboration between professions may further enhance the support practices

The discussion about theories of health has recently had an important new input through the work of Sridhar Venkatapuram. He proposes a combination of Lennart Nordenfelt's holistic theory of health and Martha Nussbaum's version of the capability approach. The aim of the present article is to discuss and evaluate this proposal. The article starts with a discussion of Nordenfelt's theory and evaluates Venkatapuram’ critique of it, that is, of its relativism, both regarding goals and environment, and of the subjectivist theory of happiness used. Then the article explains why Nordenfelt's idea of a reasonable environment is not a problem for the theory, and it critiques Venkatapuram's own incorporation of the environment into the concept of health, suggesting that this makes the concept too wide. It contends, moreover, that Venkatapuram's alternative theory retains a problem inherent in Nordenfelt's theory, namely, that health is conceived of as a second-order ability. It is argued that health should, instead, be defined as first-order abilities. This means that health cannot be seen as a capability, and also that health cannot be seen as a meta-capability of the kind envisioned by Venkatapuram. It is, furthermore, argued that the theory lacks one crucial aspect of health, namely, subjective wellbeing. Finally, the article tries to illustrate how health, in the suggested alternative sense, as first-order abilities, fits into Nussbaum's capability theory, since health as an ‘actuality’ is part of all the ‘combined capabilities’ suggested by Nussbaum.

It is an imperative within health care, medicine, and public health to restore, preserve, and enhance health. Therefore, it is important to determine what kinds of enhancement are increases in health and what kinds are not. Taking as its point of departure two conceptions of health, namely, “manifest health” and “fundamental health,” the paper discusses various means used to enhance ability and well-being, and if those means, such as wheelchairs, implants, medicines, stimulants, or narcotics, enhance health. The fact that some means that enhance ability or well-being are not usually considered health enhancing, for example, narcotics, constitutes a problem. The paper ends with a discussion of some suggestions about how to distinguish between those enhancements that are health related and those that are not. One plausible idea holds that an enhancement is health related when the substance, or aid, increases ability or well-being, is integrated into the body, and does not harm the individual’s fundamental health.

This paper distinguishes between the uses of empowerment across different contexts in healthcare policy and health promotion, providing a model for the ethical and political scrutiny of those uses. We argue that the controversies currently engendered by empowerment are better understood by means of a historical distinction between two concepts of empowerment, namely, what we call the radical empowerment approach and the new wave of empowerment. Building on this distinction, we present a research agenda for ethicists and policy makers, highlighting three domains of controversy raised by the new wave of empowerment, namely: (1) the relationship between empowerment and paternalistic interferences on the part of professionals; (2) the evaluative commitment of empowerment strategies to the achievement of health-related goals; and (3) the problems arising from the emphasis on responsibility for health in recent uses of empowerment. Finally, we encourage the explicit theorisation of these moral controversies as a necessary step for the development and implementation of ethically legitimate empowerment processes.

The discussion about theories of health has recently had an important new input, namely, through the work of Sridhar Venkatapuram. His intention is to combine Lennart Nordenfelt’s holistic theory of health with Martha Nussbaum’s version of the capability approach. The aim of the present paper is to discuss and evaluate this proposal. For this purpose I will first compare Venkatapuram’s theory with a few others, starting with that of Nordenfelt, in order to show some of its weaknesses. Taking an alternative, two-dimensional, theory of health as a starting point, the paper will then discuss a number of issues in relation to the capabilities approach. Several points are made, and discussed: Venkatapuram does not give an account of well-being and its relation to health; he does not explicitly relate health conceptually to an environment; the second order-nature of health is not fully taken into account or explained; health is an “actuality” (or functioning), not (only) a capability; several of the capabilities listed by Nussbaum are health-related and, thus, cannot be (only) conceived of as potentialities; and, Venkatapuram does not fully, or in detail, explain in what sense health is a meta-capability in relation to Nussbaum’s ten capabilities. The paper will end with an explanation of these relations, utilizing the two-dimensional theory, and finally, it will also briefly, relate health to a theory of empowerment.

Kapitlet utgår från några problem som många kvantitativa instrument lider av, nämligen bristande validitet samt att de är onödigt omfattande, vilket även illustrerades i föregående kapitel. Huvudsyftet med kapitlet är att visa hur man utifrån en noggrant konstruerad definition av begreppet “arbetsförmåga” kan skapa ett kvalitativt frågeformulär ämnat att utvärdera en individs specifika arbetsförmåga och samtidigt erhålla information relevant för att kunna lösa, minska, eller kompensera för, problemet ifråga. Lärdomar: De flesta kvantitativa instrument har problem med validiteten, då den begreppsliga grunden för dem är svag. Många instrument är även omständliga eftersom de innehåller många irrelevanta frågor. Validiteten kan öka om man skapa instrumentet utifrån en noggrant konstruerad definition som avser fånga fenomenet man är intresserad av, t.ex. arbetsförmåga. Det bästa sättet att försöka fånga det komplexa fenomenet arbetsförmåga är genom en kvalitativ intervjuundersökning som utgår ifrån den framtagna definitionen. En individs arbetsförmåga kan endast utvärderas i relation till ett konkret arbete, inte till en abstrakt arbetsmarknad.

Detta kapitel går igenom några vanliga instrument som avser att mäta eller utvärdera arbetsförmåga, eller motsvarande förmåga under annan beteckning. Syftet är att granska i vilken grad de faktiskt mäter eller utvärderar arbetsförmågan hos individer, och hur väl de gör det. Av utrymmesskäl kommer endast ett mindre antal instrument att granskas. Instrumenten är hämtade från några Europeiska länder och är exempel på hur instrument ofta utformas. Granskningen utgår ifrån en specifik definition av begreppet ”arbetsförmåga”, som fungerar som en ”validitestkontroll”. Resultat: De flesta instrument som avser att mäta arbetsförmåga och som diskuteras i kapitlet lider av bristande validitet. De fångar ofta hälsan samt en hel del mer komplexa förmågor och kompetenser. De fångar ibland även individens tolerans, styrka och motivation. Men det är sämre på att utvärdera individens yrkesrelaterade karaktärsegenskaper och kompetenser. Dessutom misslyckas alla instrumenten i stort sett med att kontextualisera arbetsförmågan, då de saknar möjlighet att undersöka individens förmåga eller kompetens i relation till konkreta arbetsuppgifter och till en konkret arbetsmiljö.

Families where the mother has an intellectual disability need support to counteract possible detrimental life circumstances for the children involved. The aim of this study was to describe social and healthcare professionals' experiences of providing support for families with maternal intellectual disability and specifically focused on if and how they believed the support practices benefited the children. Seven focus group interviews were performed with 29 professional informants. The transcripts were analyzed with qualitative content analysis. Three themes were identified: “support practices,” “pedagogical strategies when supporting families with maternal intellectual disability,” and “maintaining the child perspective.” The support practices mainly dealt with parenting skills, which were addressed by a variety of teaching methods and practices, while the children were at risk of not being seen or heard.

Power relations seem to exist everywhere: between men and women, teachers and students, doctors and patients, employers and employees, authorities and refugees, and between the state and its citizens. These relations can take many forms, from violence and coercion to more subtle influences in the shape of rewards, persuasion, authority, and manipulation. Power can be visible, as well as invisible, as is the case of some structural forms of power. Certain norms and values appear to be important forms of power, not least those that are ideological and political. Even scientifically produced knowledge can be seen as a kind of power, in that it creates new “forms of life” that categorize the world in ways that make people behave and see themselves in new ways. Some of these forms of power appear legitimate, as when a democratically elected government creates new laws, whereas others seem to be illegitimate and immoral, as when minorities are prevented from practicing their religions. Biopower seems to be a particular form of power, one that concerns the whole population and that emanates from the government and its civil servants. It is not completely clear, however, how this kind of power relates to other kinds of power, or even if it should count as a kind of power. The aim of the paper is, thus, to try to disentangle this issue by, first, specifying what biopower is usually taken to mean, and then comparing it to other conceptions of power, such as “power to”, “power over”, “social power”, “structural power”, and “discursive power”, and investigating in what forms it might manifest itself, that is, if it is “exercised”, as, for example, influence, coercion, manipulation, incentive, or persuasion. Finally, since biopower is claimed to be related to the health of populations, a few cases from public health practice and health promotion interventions will be discussed in order to try to determine if, and how, they might be examples of biopower, as “defined” in the text. This will give us a possibility to evaluate the normative utility of the idea of biopower, and to determine if it adds anything valuable to the critical discussions of these kinds of interventions.

Abstract. Problem: We often need to be able to assess the extent to which individuals have or lack work ability. For this we need instruments. Most of the instruments available have flaws. They either lack validity or they use roundabout methods when collecting information about the individual’s work ability. Objectives: The aim of this paper is to present a conceptual model for constructing a questionnaire that can be used for assessing work ability. Methods: The methods used are philosophical, i.e. analytical and deductive. A conceptual theory is provided, and based on the resulting definition of the concept of “work ability” conclusions are drawn regarding how to assess work ability. Results: When constructing quantitative instruments, we can increase validity through using a more strict definition of work ability. However, such an approach will only solve some of the problems noted above. The proposal is, instead, to create a qualitative questionnaire, founded on a definition of “work ability”, which focuses on the concrete problems concerning the work ability of the individual. Finally, a sketch of such an instrument is provided, with questions covering all the relevant aspects of work ability. Conclusion: The qualitative questionnaire proposed is believed to be superior to more traditional (quantitative) instruments for assessing a person’s work ability, as well as for finding solutions to her problems concerning work ability.

One important ethical issue for public health work and health promotion is to try to determine what the goals for these practices should be. This paper will, therefore, try to clarify some of the issues concerning what these goals are thought to be, and what they ought to be. It will primarily discuss two common approaches in health promotion, namely behavior change and empowerment. For this purpose two “ideal types” will be created of these approaches, making them clear alternatives. For empowerment I will use my own previous analysis. For the behavior approach I will construct a conception that focuses on central, common features found in the literature on the topic. The general aim of this paper is to investigate what the similarities and differences are between the behavior change approach and the empowerment approach, concerning their immediate (instrumental) goals or aims, and relate them to the ultimate goal of health promotion and public health work, which is taken to be quality-of life-related health (and longevity). The paper ends with an ethical evaluation of the strengths and weaknesses of these two goal models, and, it argues that we should prefer empowerment to behavior change. Behavior change has relatively narrow targets, normally “life-style” changes, such as smoking cessation, weight loss, increased condom use, or increased exercise, whereas empowerment strengthens the “whole” individual – her autonomy, self-confidence, skills and general control – in achieving better health, and therefore creates a more solid foundation for future health and longevity.

There are several strategies to promote health in individuals and populations. Two general approaches to health promotion are behavior change and empowerment. The aim of this article is to present those two kinds of strategies, and show that the behavior change approach has some moral problems, problems that the empowerment approach (on the whole) is better at handling. Two distinct “ideal types” of these practices are presented and scrutinized. Behavior-change interventions use various kinds of theory to target people’s behavior, which they do through information, persuasion, coercion and manipulation. Empowerment is a collaborative method where those “facilitated” participate in the change process. Some ethical problems with the behavior change model are that it does not sufficiently respect the right to autonomy of the individuals involved, and that it risks reducing their ability for autonomy of the individuals involved and risks increasing health inequalities. Empowerment, on the other hand, respects the participant’s right to autonomy, tends to increase the ability for autonomy, as well as increasing other coping skills, and is likely to reduce inequalities. A drawback with the method is that it often takes longer to realize.

When seeing immoral actions, criminal or not, we sometimes deem the people who perform them unhealthy. This is especially so if the actions are of a serious nature, e.g. involving murder, assault, or rape. We turn our moral evaluation into an evaluation about health and illness. This tendency is partly supported by some diagnoses found in the DMS-IV, such as Antisocial personality disorder, and the ICD-10, such as Dissocial personality disorder. The aim of the paper is to answer the question: How analytically sound is the inclusion of morality into a theory of health? The holistic theory of Lennart Nordenfelt is used as a starting point, and it is used as an example of a theory where morality and health are conceptually distinct categories. Several versions of a pluralistic holistic theory are then discussed in order to see if, and if so, how, morality can be conceptually related to health. It is concluded that moral abilities (and dispositions) can be seen as being part of the individual’s health. It is harder to incorporate moral virtues and moral actions into such a theory. However, if immoral actions ‘‘cluster’’ in an individual, and are of a severe kind, causing serious harm to other people, it is more likely that the person, for those reasons only, be deemed unhealthy.

Empowerment has been on the agenda for many years, in a number of professional fields. It has been a primary goal for health promotion and public health. An ethical reason for discussing power and empowerment is that one way of evaluating how just a society is, is to look at inequalities in empowerment. But what kind of power is empowerment, and what is its relation to health? The paper discusses various kinds of power: ‘power to’, ‘power over’, ‘power with’ and ‘power within’. One conclusion is that ‘empowerment as a goal’ is a version of ‘power to’, i.e. the ability to produce intended effects – in the case of empowerment on one’s own “good” life. There are also connections to the other kinds of power. ‘Power with’ can be seen as the collective ability to control effects, and ‘power within’, e.g. self-confidence, can be seen as part of ‘power to’. Empowerment is to a much lesser extent a form of ‘power over’. Finally, health is defined in terms of ability and well-being. Health, it turns out, is a form of power, since (health-related) ability is necessary for having both ‘power to’, i.e. the (general) ability to produce intended effects, and empowerment, i.e. the (general) ability to control one’s ‘good’ life. A final ethical conclusion is that inequalities in health also constitute inequalities in empowerment, and they should, thus, be eliminated for a society to be just.

Background: Families with parental intellectual disabilities are likely to need support in achieving a decent family life. In order to accurately plan for such support services, society needs data regarding the occurrence of those parents and their children. The aim of this study was to investigate the five-year incidence of children born to women with intellectual disabilities in a county in Sweden. Methods: Women born between 1975 and 1989 were identified from school registers for children and adolescents with intellectual disabilities in the county of Blekinge. The women’s personal identification numbers were, in 2010, linked and matched with the Swedish Medical Birth Register. Results: In total, 98 women with intellectual disabilities were identified. Nine of these had given birth to children; one woman to two children and eight women to one child each. The ten children were born between 2004 and 2008. Conclusion: The incidence rate calculated as a result of the present study indicates that approximately 2.12 per thousand children are born per year to women with intellectual disabilities. For the whole of Sweden that rate indicates an incidence of approximately 225 children each year. On the basis of this, the prevalence of children (aged 0-18 years) being born to women with intellectual disabilities is estimated at about 4,050.

Trots att vi lever i ett välfärdssamhälle, där kunskap och resurser inte borde vara något problem, ser vi en bestående ojämlikhet i hälsa och en ökande psykosocial ohälsa bland ungdomar. Hur är detta möjligt och vad kan man göra åt det? Genom vilka sociala interventioner och andra insatser kan unga människors reella delaktighet, egenmakt, välfärd, livskvalitet och hälsa främjas på ett hållbart sätt? Denna rapport från en pilotstudie genomförd i Simrishamn presenterar de teoretiska och empiriska bevekelsegrunderna för hur och varför en deltagarbaserad aktionsforskningsansats skulle kunna vara ett bra sätt att arbeta för att förbättra villkoren för ungdomars hälsa. Rapporten förespråkar dels ett ökat tvärvetenskapligt och professionsöverskridande samarbete mellan forskare och beslutsfattare, dels ett nära samarbete med ungdomarna själva. Det handlar om att få till stånd ett mer jämlikt utbyte av kunskap målgrupper och makthavare emellan – och därmed förhoppningsvis ett i längden mer jämlikt inflytande över användningen av samhällets resurser.

It seems that we all have a moral obligation to restore, preserve and enhance health, our own and that of others, e.g. that of our children or parents. It is also an imperative within health care, medicine and public health, to support and enhance people’s health. Health is, furthermore, thought to be a human right. In its most ambitious formulation health is not only "a fundamental human right”, but “the attainment of the highest possible level of health” is “a most important worldwide social goal” (WHO 1986). These ethical imperatives make it important to discuss what health is, and what kinds of enhancement are increases in health and what kinds are not. This paper presents different attempts to draw a demarcation line between processes and states that we believe should belong to the concept of health, and processes and states which we believe should not belong to it. Since all we can expect to produce is a nominal definition, some initial criteria for the explication of health are presented. On the basis of these criteria, a holistic, pluralistic theory is suggested. The theory defines health in terms of basic abilities and well-being. A distinction is also made between manifest health, i.e. the ability and well-being here and now, and basic or fundamental health, i.e. the internal foundations for manifest health. Given these conceptual starting points, the remainder of the paper discusses various ways of trying to differentiate between enhancement that is an increase in (the various aspects of) health, and enhancement that is not, e.g. if there is a distinction between reducing ill health, and promoting positive health, or between “normal” and “supernormal” enhancement. It also discusses if the means used matter, e.g. if wheel-chairs, implants, medicine, narcotics, or genetic manipulation enhance health, if they only compensate for the lack of it, or if they enhance something else, such as non-health-related abilities, capacities or competences. Finally, the paper makes some suggestions towards distinguishing substances that are health-enhancing and those that are non-health-enhancing, e.g. those that are normal to humans, or normal in the culture, those which individuals need in order to live and to flourish, and those that can be tolerated in the long run by the human body and mind.

Introduction: The concept of ” work ability” is central for many sciences, especially for those related to working life and to rehabilitation. It is one of the important concepts in legislation regulating sickness insurance. How the concept is defined therefore has important normative implications. The concept is, however, often not sufficiently well defined. Aim and Method: The objective of this paper is to clarify, through conceptual analysis, what the concept can and should mean, and to propose a useful definition for scientific and practical work. Results: Several of the defining characteristics found in the literature are critically scrutinized and discussed, namely health, basic standard competence, occupational competence, occupational virtues, and motivation. These characteristics are related to the work tasks and the work environment. One conclusion is that we need two definitions of work ability, one for specific jobs that require special training or education, and one for jobs that most people can manage given a short period of practice. Having work ability, in the first sense, means having the occupational competence, the health required for the competence, and the occupational virtues that are required for managing the work tasks, assuming that the tasks are reasonable and that the work environment is acceptable. In the second sense, having work ability is having the health, the basic standard competence and the relevant occupational virtues required for managing some kind of job, assuming that the work tasks are reasonable and that the work environment is acceptable. Conclusion: These definitions give us tools for understanding and discussing the complex, holistic and dynamic aspects of work ability, and they can lay the foundations for the creation of instruments for evaluating work ability, as well as help formulate strategies for rehabilitation.

Problem: It is claimed that there are more than 400 kinds of psychotherapy. Is this true? What are the common characteristics that make these the same kind of practice? How does one differentiate between what is psychotherapy and what is not (e.g. psychiatry, coaching, education, philosophical counseling, meditation)? A clear definition would help us answer these questions. Aim: This is an attempt to define the concept of “psychotherapy”. I start by critically scrutinizing several definitions suggested by other writers and then present and argue for my own suggestion. Method: The method used is philosophical, or conceptual. This means that I try to state the necessary and jointly sufficient characteristics of the term in question. The starting point is that all kinds of psychotherapy share some characteristics, without which they would not qualify as psychotherapy, and that it is these core characteristics that constitute the practice. Result: Psychotherapy is the interaction between two or more persons, a client and a therapist, where the latter is trained (at least to some degree), based on some kind of general theory of therapy and personality change, where the aim is to create significant and lasting positive quality-of-life-related mental changes, involving several aspects of the person’s mental “faculties” (cognition, emotion, perception, volition, attitudes, or values), where the means to reach these goals are mainly verbal (but sometimes also non-verbal), and this interacting is primarily what leads to the positive change. A practice that does not fulfill these “minimal” requirements will not count as psychotherapy.

It appears that there are two distinct practices within public health, namely health promotion and disease prevention, leading to different goals. But does the distinction hold? Can we promote health without preventing disease, and vice versa? The aim of the paper is to answer these questions. First, the central concepts are defined and the logical relations between them are spelt out. A preliminary conclusion is that there is a logical difference between health and disease, which makes health promotion and disease prevention two distinct endeavours. However, since disease is defined in relation to health, as those kinds of internal processes and states that typically lead to ill health, the difference is smaller than it might appear. Second, in order to answer the practical question whether it is possible to promote health without preventing disease, and vice versa, several kinds of public health interventions are discussed. The conclusion is that while health promotion and disease prevention can be distinguished conceptually, they can hardly be distinguished in practice. Most general measures do both at the same time.

The terms “health promotion” and “disease prevention” refer to professional activities. But a “health promoter” has also come to denote a profession, with an alternative agenda compared to that of traditional public health work, work that by some is seen to be too medically oriented, too reliant upon prevention, risk-elimination and health-care. But is there really a sharp distinction between these activities and professions? The main aim of the paper is to investigate if these concepts are logically different, or if they are just two extremes of one dimension. The central concepts, health promotion and disease prevention, are defined, and it is concluded that health promotion and disease prevention are logically distinct concepts, although they are conceptually related through a causal connection. Thus, logically, it is possible to promote health without preventing disease, even if this is not so common, in practice, but it is not possible to prevent disease without promoting health. Finally, most health promoting interventions target basic health, not manifest health, and often also thereby reduce future disease.

Background: Being empowered has to do with having control over the determinants of one’s quality of life (including health) (Tengland 2007). Many things can be changed, on many levels, to increase empowerment in this sense and increasing the empowerment of individuals and groups can be seen as a goal for many kinds of social interventions, e.g. health promotion (WHO 1986). Empowerment can also be seen as the process of facilitating increased control. This process involves fully engaging the person or group concerned in the change process, so that they controls as much of this process as possible. The professional supports this process, and has no agenda of her own other than to facilitate the individual or group in achieving their aims (Tengland 2007). Empowerment has a positive ethical ring to it. It is supposedly superior to other ways of working towards health and social change – better than top-down interventions and behavior change projects. But is this so? Objectives: The aim of the paper is to critically discuss the ethical pros and cons of empowerment and relate it to other kinds of goals and interventions within health promotion and public health. Underlying values and principles: Ethical principles and theories, such as utilitarianism, deontology, principalism, virtue ethics and theories of justice are used throughout the discussion. Knowledge base/ Evidence base: The ethical analysis starts from a conceptual theory of empowerment (Tengland 2008) in relation to health promotion (Tengland 2007). Context of intervention/project/work: The general context of the project are the ethical aspects of health promotion and public health (Holland 2007). Methods: Ethical analysis (ethical theories and principles) is used when discussing and evaluating the goals and means of the empowerment approach, and relating it to other approaches (see underlying values and principles). Results and Conclusions: A first conclusion is that empowerment as a process is superior to many behavior change projects, since a) it reduces persuasion, manipulation and coercion of the subjects involved, something that is common in other approaches, b) it (thus) enhances autonomy, rather than reducing it, and c) it is founded on a more accurate theory of human nature, humanistic theory, rather than cognitive theory. Another conclusion is that many top-down projects are ethically compatible with most empowerment goals (i.e. increased control), e.g. literacy projects in poor countries, although not with all such goals, e.g. requiring drivers to wear seat-belts. However, other ethical concerns are also important, e.g. social justice, equal opportunity, and positive freedom, some of which might not necessarily lead to empowerment of individuals or groups. References: Holland, S 2007. Public Health Ethics. London: Polity. Tengland, Per-Anders 2007. Empowerment: A Goal or a Means for Health Promotion? Medicine, Health Care and Philosophy, Vol. 10, No 2 (2007), 197-207. Tengland, Per-Anders 2008. Empowerment: A Conceptual Discussion. Health Care Analysis vol 16, no 2, 77-96. WHO (1986) Ottawa Charter for Health Promotion. WHO: Geneva.

When seeing immoral actions, criminal or not, we often deem the people who perform them (mentally) unhealthy or disordered. This is especially so if the actions are of a serious nature, e.g., involving murder, rape, or other kinds of violence. That is, we translate our moral evaluation into an evaluation about (mental) health and illness. The question is, how analytically sound is such a move? In this paper I will scrutinize the most common theories of health (and illness) in order to see if they, or any one of them, support the claim that immoral acts are by definition unhealthy? When seeing immoral actions, criminal or not, we often deem the people who perform them (mentally) unhealthy or disordered. This is especially so if the actions are of a serious nature, e.g., involving murder, rape, or other kinds of violence. That is, we translate our moral evaluation into an evaluation about (mental) health and illness. The question is, how analytically sound is such a move? In this paper I will scrutinize the most common theories of health (and illness) in order to see if they, or any one of them, support the claim that immoral acts are by definition unhealthy? The psychological theory of Carl Rogers and the holistic theory of Lennart Nordenfelt are used to frame the issue and show how morality can, in Roger’s case, and cannot, in Nordenfelt’s case, be seen as conceptually related to health. Several versions of a pluralistic holistic theory then are discussed in order to see if, and if so, how, morality can be conceptually related to health. It is concluded that moral abilities and, perhaps also, moral virtues can be seen as being part of the individuals health. It is harder to incorporate moral actions into such a theory. If immoral actions are typical, or cluster, in the individual, or/and if they are of a severe kind, causing serious harm, it is more likely that the person can be deemed unhealthy.

“Empowerment” is a central concept in health promotion and public health, but also for “medical” disciplines like nursing and physiotherapy. Sometimes empowerment and health promotion are even seen as being synonymous. The concept is, however, also used in various other areas, such as social work and education, so empowerment appears to denote something more than working towards promoting health. An analysis of the concept supports this claim. Empowerment can be seen both as a goal, i.e. having control over the determinants of one’s quality of life, and as a means, i.e. working with people (individuals, groups, communities) in such a way as to support them in taking control over positive change processes. The aim of this paper is first to see in what sense empowerment is a form of power, and second, to see in what sense empowerment is a goal for health promotion, i.e. what empowerment has to do with health. Several aspects of power are discussed, such as “power to”, “power over”, and “power with”, and these different aspects of power are related to health (seen as a combination of ability and well-being). The main connection, it will argued, is that health as ability has to do with power in the sense of being able to influence and change the world. Health, then, is a major determinant of future health, but also a determinant of quality of life. So health, in this sense, can be seen as one aspect of empowerment (as a goal).

Psychotherapy appears to be one kind of practice and one kind of science. Despite this different schools of psychotherapy suggest different goals for their practices. The aim of the paper is to scrutinize some of the goals suggested and to formulate a normative theory of what goals psychotherapy in general ought to pursue. Various kinds of goals are identified, for example, personal goals, theoretical goals, and ultimate goals. Some theoretical goals, like cognitive change, symptom reduction, and self-knowledge, are found wanting as ultimate goals for psychotherapy, as are some broader goals, like health, well-being and empowerment. Quality of life is found to be the most reasonable ultimate goal for psychotherapy, if it is achieved through some internal, mental change. This overarching goal is shown to encompass many of the other suggestions, including person-centered goals like congruence. Finally, the value of the study is primarily the formulation of goals which can help us construct better outcome instruments, and make it easier to compare the effects of different kinds of psychotherapy.

The concept of ‘empowerment’ is used frequently in a number of professional areas, from psychotherapy to social work. But even if the same term is used, it is not always clear if the concept denotes the same goals or the same practice in these various fields. The purpose of this paper is to clarify the discussion and to find a plausible and useful definition of the concept that is suitable for work in various professions. Several suggestions are discussed in the paper, for example control over life or health, autonomy, ability, self-efficacy, self-esteem, and freedom, and it is concluded that there are two plausible complementary uses, one as a goal and one as a process or approach. Empowerment as a goal is to have control over the determinants of one’s quality of life, and empowerment as a process is to create a professional relation where the client or community takes control over the change process, determining both the goals of this process and the means to use.

The starting point for the contemporary debate about theories of health should be the holistic theory of Lennart Nordenfelt, claims George Khushf, not the refuted theory of Christopher Boorse. The present paper is an attempt to challenge Nordenfelt and to present an alternative theory to his and other theories, including Boorse’s. The main problems with Nordenfelt’s theory are that it is relativistic, that it leads to counter-intuitive results as to what goals can count as healthy, that it focuses on the wrong kind of abilities, that it makes measuring health extra difficult, and that it does not give us a sufficient account of health, at most a necessary one. The alternative theory proposed is two-dimensional. First, health is to have developed the abilities and dispositions that members of one’s culture typically develop, and be able to use them, in acceptable circumstances; and second, health is to experience positive moods and sensations, the kinds that have internal causes. The theory solves the problems attached to Nordenfelt’s theory by not being individual relativistic, by eliminating the goals in the definition, by giving an alternative interpretation of “ability,” by making health easier to measure, and by adding the dimension of well-being that, together with health as ability, not only gives us a necessary, but also a sufficient, account of health.

Empowerment is a concept that has been much used and discussed for a number of years. However, it is not always explicitly clarified what its central meaning is. The present paper intends to clarify what empowerment means, and relate it to the goals of health promotion. The paper starts with the claim that health-related quality of life is the ultimate general goal for health promotion, and continues by briefly presenting definitions of some central concepts: “welfare”, “health” and “quality of life”. Several suggestions as to what empowerment is are then discussed: autonomy, freedom, knowledge, self-esteem, self-confidence, and control over health or life. One conclusion of this discussion is that empowerment can be seen as a complex goal which includes aspects of the three central concepts welfare, health and quality of life. To the extent that the empowerment goals aimed at are health-related, it is concluded that empowerment is a legitimate goal for health promotion. But empowerment is not only a goal, it can also be described as a process or as an approach. This process, or approach, in a fundamental way involves the participants in problem formulation, decision making and action, which means that the experts have to relinquish some of their control and power.

“Empowerment” is a central concept in health promotion. Sometimes empowerment and health promotion are even seen as being synonymous. The concept is, however, also used in various other areas, like social work and education, so “empowerment” appears to denote something more than working towards promoting health. This calls for a clarification of the concept. The intention of this paper is to find a plausible and useful definition of “empowerment” that is suitable for work in various professions, including health promotion, health education and public health. Several suggestions are discussed in the paper, for example control over life or health, autonomy, knowledge, health, self-efficacy, self-esteem, and freedom. It is concluded that there are two plausible complementary uses, one where empowerment is seen as a goal and one where it is seen as a process or approach. Empowerment as a goal is to have control over the determinants of one’s quality of life (which includes health), and empowerment as a process is to create a professional relation where the client, group or community takes control over the change process, determining both the goals of this process and the means to use. Finally, the practical and ethical consequences for health promotion of this definition of “empowerment” are presented. In order to be consistent with the definition, the empowerment goals should only involve (direct and indirect) health changes that contribute to quality of life, and the “approach” used has to start from the wishes of the group or community in question.

There appears to be a practical, but also an ideological, difference between the professional activities of disease prevention and health promotion. Whether or not this distinction holds has to do with at least two things. First, it has to do with the concept of health and the concept of disease. Are they logically different (and only causally related), or are they just two extremes on one dimension? Second, it has to do with the practices of professionals. Are the methods and strategies used in health promotion different from those used in disease prevention, and are the targets, e.g. the whole population, sub-populations, communities, risk groups, of these methods and strategies different? In the paper it is argued that the difference is much smaller than is sometimes assumed. First a conceptual framework is suggested, where the concepts of health, illness and disease are defined, and it is shown that it does not follow logically from these definitions that disease prevention and health promotion require different methods and strategies. Then it is shown that differences in choice of target for interventions have other reasons, e.g. professional affiliation and ethical assumptions.

Health-related quality of life is the ultimate general goal for medicine, health care and public health, including health promotion and health education. The other important general goal is health-related welfare. The aim of the paper is to explain what this means and what the consequences of these assumptions are for health work. This involves defining the central terms “health”, “quality of life” and “welfare” and showing what their conceptual relations are. Health-related quality of life has two central meanings: health-related well-being, which constitutes quality of life, and health as ability, which contributes causally to quality of life. Four meanings of health-related welfare are put forward: general well-being, health as ability, other inner properties of the individual, and external factors. States and processes covered by these categories contribute causally to health-related quality of life. Finally, using these distinctions, some more specific goals for medicine and health care, on the one hand, and for public health and health promotion, on the other, are outlined. In the former fields work is primarily directed towards changing the health-related quality of life of the individual through direct measures, “manipulating” the individual, whereas public health work and health promotion primarily use indirect measures and further health through various sorts of health-related welfare changes, e.g. through changing the environment.

Mental health issues are a growing concern in our modern Western society. This is part of an increasing interest in questions about health, quality of life, personal development, and self-fulfilment. However, most of what has been written so far has had its focus on mental illness or disease, the negative side of the coin, and few attempts have been made to discuss more thoroughly, from a philosophical perspective, what it is to be mentally healthy. The present book is such an attempt.The author's aim is to analyze, philosophically, the notion of `positive mental health'. In so doing a number of ideas found in the literature are presented and discussed. The author also raises some important methodological questions. The final result of the analysis is a formal and a material reconstruction of the concept of "positive mental health".The book will be of value to all professionals within the health care sector, in particular to psychiatrists, clinical psychologists, and psychotherapists. It will also be of interest to philosophers and social scientists working with health questions.