HEALTH PROMOTION COMMUNITY-DEVELOPMENT AND THE TYRANNY OF INDIVIDUALISM

Economic evaluation of health promotion poses few major difficulties w hen the theoretical approach of the programme and the evaluation of co st and benefits are confined within the context of the individual. Met hodological individualism has a long history in economics and the tech niques of microeconomics are well suited to the examination of individ ually focused behaviour change programmes. However, new developments i n community health promotion pose special challenges. These programmes have the community, not the individual, as the focus of programme the ory and 'community' means something completely different from the sum of individuals. Community empowerment and promotion of the community's capacity to deal with health issues are the goals of such programmes. To reflect these notions, sense of community and community competence should be considered as 'functionings', an extra-welfarist constituen t of well-being. Their inclusion as outcomes of community health promo tion requires a shift from individualist utilitarian economics into a communitarian framework which respects the programme's notion of commu nity. If health economics fails to develop new constructs to deal with these new approaches in health promotion, the application of existing techniques to community programmes will mislead health decision maker s about their value and potential.