Performing health promotion: an analysis of epistemic and political technologies of accountability

The field of health promotion has developed at the interface of science and policy, resulting in programmatic tensions between the values of evidence-based and participatory approaches. This paper aims to go beyond debates between these positions, to develop an understanding of how health promotion practices are - unintendedly - performed and constructed by epistemic and political technologies of accountability. Drawing from Science and Technology Studies, the paper provides an in-depth qualitative analysis of two Dutch health promotion practices. The first presented itself primarily in epistemic terms, as an evidence-based project, while the other presented itself primarily in political terms, as a citizens' initiative. The analysis shows that while, in the first case, the specific epistemic design of health promotion as a randomized controlled trial performs robust international scientific credibility but a lack of local political credibility, the participatory approach of the second case performs robust local political credibility but meagre scientific credibility. The analysis makes clear that health promotion practices are - unintendedly - performed by situated entanglements of diverse technologies of accountability that operate on local, national and global scales, which can be aligned in diverse ways. More insights into these webs of accountability are required to improve health promotion through improving the cultures of accountability.