Conceptualizing structural change in health promotion: why we still need to know more about theory

As recently discussed in the public health literature, many questions concerning 'structural' approaches in health promotion seem to remain unanswered. We argue that, before attempting to provide answers, it is essential to clarify the underlying theoretical assumptions in order to arrive at the right questions one should ask. To this end, we introduce into the current debate an existing theoretical framework that helps conceptualize structural and individual aspects of health promotion interventions at different levels of action. Using an example from the field of physical activity promotion, we illustrate how an integrated framework can help researchers and health promoters rethink important issues and design better interventions. In particular, such an approach may help overcome perceived distinctions between different types of approaches, re-conceptualize ideas about the effectiveness of interventions, and appropriately address issues of health disparities.