[From prevention to health promotion]

There has been much talk about prevention in recent years in industrialized countries, especially in view of the problems care systems encounter. Often however, one refers particularly to secondary prevention, which is in fact the first step of a treatment process. It is essential to take into account the risk factors acting upstream, which medical professions have not done enough in the past. One has not considered enough either the inequalities which are still a frequent occurrence in our populations, and the multiples traumas of various sorts which present living environments inflict on individuals. Sometimes, excessive emphasis has been put on "negative" aspects (blame, social control) of prevention. These facts have lead to the elaboration of the concept of health promotion (and positive health), which implies an action on the environment, as well as the growth of everyone's ability to manage this environment and his own development. In this framework the creation of an adequate community oriented information system is very important; sharing of knowledge, skills and attitudes is indispensable. Health promotion, including the just mentioned sharing, includes certain risks. One may even wonder what a life fully focussed on health, where any transgression will be linked to guilt feelings, would really be. What would be its ideological underpinnings? These problems are by no means neutral, they reflect the consistencies as well as the contradictions of our society. This is one reason why research is much needed on these subjects in the future.