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PROMOTING HEALTH: The
Primary Health Care Approach

SEVENTH EDITION

JANE TAYLOR, PhD (Pub Hlth), M Hlth

Prom, Grad Cert Int Hlth, BEd
Associate Professor and Discipline Lead Health Promotion & Public
Health, School of Health and Sports Sciences, University of Sunshine
Coast, QLD

LILY O’HARA, PhD (Pub Hlth), MPH,

Postgrad Dip Hlth Prom, BSc
Associate Professor of Public Health (Health Promotion) Department of
Public Health, College of Health Sciences, QU Health, Qatar University,
Doha

LYN TALBOT, Dr Pub Hlth, M Hlth Sc,

Grad Dip Hlth Sc, Grad Cert Higher Ed, RN
Corporate and Community Planner—Strategy, City of Greater Bendigo,
VIC

GLENDA VERRINDER, PhD, M Hlth Sc,

Grad Dip Hlth Sc, Grad Cert Higher Ed,
Cert CHN, RN, RM
Senior Lecturer, La Trobe Rural Health School, School of Science, Health
and Engineering, La Trobe University, VIC
Table of Contents

Cover image

Title page

Copyright

PREFACE

INTRODUCTION

ACKNOWLEDGEMENTS

ABOUT THE AUTHORS

GLOSSARY

PART 1: Health promotion development and

concepts
Introduction to PART 1: HEALTH PROMOTION DEVELOPMENT
AND CONCEPTS

Chapter 1: Health promotion in context

INTRODUCTION

HEALTH STATUS AND HEALTH INEQUALITIES

SOCIO-ECOLOGICAL DETERMINANTS OF HEALTH AND

WELLBEING

WHO GLOBAL RESPONSES TO HEALTH AND WELLBEING

HEALTH PROMOTION

A FRAMEWORK FOR HEALTH PROMOTION PRACTICE

WITHIN A CPHC CONTEXT

COMPREHENSIVE PRIMARY HEALTH CARE INTO THE

FUTURE

CONCLUSION

Chapter 2: Core concepts informing health promotion practice

INTRODUCTION

HEALTH, WELLBEING, QUALITY OF LIFE AND

SALUTOGENESIS

CONCEPTS RELATED TO INDIVIDUAL-LEVEL SOCIO-

ECOLOGICAL DETERMINANTS OF HEALTH AND
WELLBEING
 CONCEPTS RELATED TO POPULATION-LEVEL SOCIO-
ECOLOGICAL DETERMINANTS OF HEALTH AND
WELLBEING

COMMUNITY AS A FOCUS OF HEALTH PROMOTION

PRACTICE

CONCLUSION

Chapter 3: Ecological sustainability and human health and wellbeing

INTRODUCTION

ECOLOGICAL SUSTAINABILITY CONCEPTS

IMPACT OF ECOLOGICAL SUSTAINABILITY ON HEALTH

AND WELLBEING

ECOLOGICAL SUSTAINABILITY AND AUSTRALIA

ECOLOGICAL SUSTAINABILITY AND NEW ZEALAND

LOCAL-LEVEL HEALTH PROMOTION ACTION FOR

SUSTAINABILITY

CONCLUSION

PART 2: Health promotion practice

Introduction to PART 2: HEALTH PROMOTION PRACTICE

Chapter 4: Health promotion practice

INTRODUCTION
 HEALTH PROMOTION MODELS

HEALTH PROMOTION PRACTICE CYCLE

RESEARCH AND PRACTICE

STAGE 1: COMMUNITY ASSESSMENT

STAGE 2: PLANNING THE HEALTH PROMOTION PROGRAM

STAGE 3: IMPLEMENTING THE HEALTH PROMOTION

PROGRAM

STAGE 4: EVALUATING THE HEALTH PROMOTION

PROGRAM

CONCLUSION

Chapter 5: Healthy public policy to create environments and settings

that support health and wellbeing

INTRODUCTION

BUILDING HEALTHY PUBLIC POLICY

HEALTH IN ALL POLICIES

PUBLIC POLICYMAKING PROCESS

HEALTHY PUBLIC POLICY AT ALL LEVELS: TOBACCO

CONTROL CASE EXAMPLE

HEALTH PROMOTING SETTINGS

ADVOCATING FOR HEALTHY PUBLIC POLICY

INTERSECTORAL COLLABORATION AND PARTNERSHIPS

 CONCLUSION

Chapter 6: Community development action for social and

environmental change

INTRODUCTION

PHILOSOPHY OF COMMUNITY DEVELOPMENT

COMMUNITY DEVELOPMENT PRACTICE

COMMUNITY DEVELOPMENT PRACTICE ROLES, SKILLS

AND ATTRIBUTES

SOCIAL ENTERPRISE AND SOCIAL ENTREPRENEURSHIP

CHALLENGES FOR COMMUNITY DEVELOPMENT

PRACTICE

EVALUATING COMMUNITY DEVELOPMENT PRACTICE

CONCLUSION

Chapter 7: Health education and health literacy to develop

knowledge and skills for health and wellbeing action

INTRODUCTION

HEALTH EDUCATION AND HEALTH LITERACY

PLANNING HEALTH EDUCATION STRATEGIES

SKILLS FOR EDUCATING GROUPS AND COMMUNITIES

WORKING WITH GROUPS

CONCLUSION
Chapter 8: Health information and social marketing to raise
awareness about health and wellbeing priorities

INTRODUCTION

SOCIAL MARKETING

STEPS OF SOCIAL MARKETING

INTEGRATING SOCIAL MEDIA AND SOCIAL MARKETING

SOCIAL MARKETING SKILLS

CONCLUSION

Chapter 9: Vaccination, screening, risk assessment and surveillance

INTRODUCTION

VACCINATION

POPULATION SCREENING

INDIVIDUAL RISK FACTOR ASSESSMENT

RISK ASSESSMENT OF LOCAL ENVIRONMENTS

SURVEILLANCE

CONCLUSION

Declaration of Alma-Ata

The Ottawa Charter for Health Promotion

Shanghai Declaration on Promoting Health in the 2030 Agenda for
Sustainable Development

Declaration of Astana on Primary Health Care

Universal Declaration of Human Rights

The Earth Charter Preamble

INDEX
Copyright

Elsevier Australia. ACN 001 002 357

(a division of Reed International Books Australia Pty Ltd)
Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067

Copyright © 2021 Elsevier Australia. 1st edition © 1994, 2nd edition ©

2000, 3rd edition © 2005, 4th edition © 2010, 5th edition © 2014, 6th
edition © 2018 Elsevier Australia

All rights reserved. No part of this publication may be reproduced or

transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and
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organizations such as the Copyright Clearance Center and the
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This book and the individual contributions contained in it are

protected under copyright by the Publisher (other than as may be
noted herein).
ISBN: 978-0-7295-4353-8

Notice

Practitioners and researchers must always rely on their own

experience and knowledge in evaluating and using any
information, methods, compounds or experiments described
herein. Because of rapid advances in the medical sciences, in
particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility
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Printed in Singapore by Markono Print Media Pte Ltd
PREFACE
Health and wellbeing are resources that enable people to live, learn,
play, work, flourish and thrive. Unfortunately, there are major
disparities in people’s health status around the world. There is
strong evidence that physical, mental, social and spiritual health and
wellbeing are experienced unequally, and that most of those
differences are unfair or inequitable. Addressing the factors that
contribute to such inequities is the central challenge for health
practitioners wanting to engage in critical health promotion in a
comprehensive primary health care context.
This is a time of significant change internationally. Political
instability and social uncertainty are the result of an erosion of
‘public goods’, persistent poverty, energy and food insecurity and,
most recently, the global COVID-19 pandemic. It is a time of
increasing awareness of the impact of globalised economic activities
on the health and wellbeing of people and the social, cultural,
economic, political and physical environments in which we live.
There is deep concern about global climate change, ecological
sustainability and the implications for human health and survival.
The Sustainable Development Goals have set goals and targets in 17
areas, all of which impact on the health and wellbeing of people
around the world, and while there has been good progress towards
these, many are not on track to be achieved by 2030. As such, there
has never been a greater need for critical health promotion.
Taking action on the socio-ecological determinants of health to
enhance health and reduce health inequities is the basis for critical
health promotion practice in a comprehensive primary health care
context. The concepts and skills presented in this updated edition of
Promoting Health: The Primary Health Care Approach provide an
essential resource for such practice.
This edition builds on the sound philosophical approach of the
previous six editions. The key principles of critical health promotion
and comprehensive primary health care – equity, social justice and
community empowerment – underpin both parts of the book. Part 1
addresses health promotion development and key concepts and
introduces the Framework of health promotion practice in a comprehensive
primary health care context. Each chapter in Part 2 of the book focuses
on one part of the framework. Throughout the book, current policy
and practice initiatives have been updated. The use of health
promotion theories and models has been strengthened, and new
examples from practice have been introduced in the book and on the
Evolve website.
The Ottawa Charter for Health Promotion continues to provide a
relevant and useful framework for improving health. At the start of
Chapters 3 to 9, there are questions for the health practitioner to
consider in relation to each action area of the Ottawa Charter. At the
end of each chapter, the relevant International Union for Health
Promotion and Education (IUHPE) Core Competencies for Health
Promotion are identified. Each chapter also presents reflective
questions that may be used to prompt personal reflection or to guide
group exploration.
We hope that Promoting Health: The Primary Health Care Approach
(7th ed.) engages health practitioners from a broad range of
disciplines and supports them in their critical health promotion
practice in a comprehensive primary health care context to achieve
better health and wellbeing outcomes for all.
Jane Taylor, Lily O’Hara, Lyn Talbot and Glenda Verrinder
INTRODUCTION
This seventh edition of Promoting Health affirms the use of critical
health promotion within a comprehensive primary health care
context, to address health and wellbeing priorities in all settings
from the local through to the global. The philosophy underpinning
comprehensive primary health care (CPHC) remains as relevant now
as it was when first endorsed by the World Health Organization in
1978 and expressed within the Declaration of Alma-Ata.
The term ‘comprehensive primary health care’ is used throughout
this book to reflect a comprehensive approach to primary health
care. It does not refer to primary-level services. Central to CPHC are
principles to guide all action to create health and wellbeing. These
principles tell us what is important and how we should do what we
do. They include social justice, equity, community empowerment
and ecological sustainability, and the need to work with people to
enable them to make decisions about health and wellbeing priorities
most important to them.
The socio-ecological determinants of health and wellbeing are well
established and need to be the focus of effort both within and
outside of the healthcare sector. Addressing the socio-ecological
determinants of health and wellbeing requires sound health
promotion knowledge and skills to plan, implement and evaluate
health promotion policies and programs.
The Ottawa Charter for Health Promotion (WHO, 1986)
operationalises CPHC principles set out in the Declaration of Alma-
Ata (WHO, 1978) in a framework for health promotion practice. The
Charter has been reaffirmed repeatedly by people working in health
promotion worldwide, and continues to provide a relevant guide for
professional practice in health promotion. Health promotion action
to improve health and wellbeing must primarily work to change the
environments that structure health and wellbeing opportunities, as
well as to support individuals to address the determinants of health
and wellbeing over which they have control. To undertake these
actions, health practitioners need an extensive set of skills. This book
focuses on assisting health practitioners from a broad range of
disciplines to develop the competencies essential for critical health
promotion practice within a CPHC context.
While health promotion is a discipline of its own that can lead to
professional accreditation, health promotion is also everyone’s
responsibility. Health promotion is a broad-ranging activity, which
must be embraced by as many people as possible within and outside
the health sector. Teachers, therapists road safety workers, engineers,
mediators, human rights investigators, community workers, local
government workers and many more play a role in health promotion
action. Active participation by members of the community in all
aspects of health promotion action is also essential. Community
members have a role to play in forming partnerships with
practitioners and agencies to develop environments that are
conducive to the health and wellbeing of the community.
Everyone has opportunities to promote health and wellbeing,
whether it be to lobby for changes to improve the socio-ecological
determinants of health and wellbeing, to work to make community
settings more health promoting, to assist individuals to learn about
health-enhancing behaviour, or to engage people meaningfully in
the decision-making processes that affect their health. There is a full
range of health promotion practice roles, from policy advocacy and
building health-enhancing settings, through to providing
communities with support in making changes in their communities
to improve health, conducting health education, providing health
information, and conducting screening and surveillance activities on
behalf of particular groups. Health practitioners in particular, have
roles as advocates for communities and for consideration of the
health perspective on priorities outside the health sector, which have
an impact on health and wellbeing.
 p g
By virtue of these roles, health practitioners can take a leadership
role in the creation of health and wellbeing. Professional associations
such as the International Union for Health Promotion and Education
(IUHPE), health promotion and public health associations, and the
associations of other health-specific disciplines, play an important
role in advocating for the health and wellbeing of the community
and in modelling the effectiveness of a true multidisciplinary
approach.
This book provides detailed practical guidance for students and
practitioners new to health promotion, whether their role is
specifically in health promotion or involves incorporating health
promotion into their work in another health discipline or in wider
fields of practice. In this book we encourage health practitioners to
take up the challenge to work as health activists, and promote health
and wellbeing in ways which enable communities and individuals to
flourish and thrive.
If countries continue to support a burgeoning illness-management
system, the costs to the health of the community will continue to
rise. Inequalities in health status and lack of access to appropriate
health services will become even worse. However, if a
comprehensive primary health care challenge is taken up by all
whose work impacts on health, as well as by community members
who find their health jeopardised by the circumstances in which they
live, then the positive effect could be quite profound.
Different terms are used to describe the workforce involved in
promoting health and wellbeing. The term ‘health workers’ is used
extensively in the women’s health movement, because it implies a
more equal relationship between professionals and their patients or
clients. The term ‘health promotion practitioner’ is used to describe
the workforce role where the primary purpose is to enhance health
and wellbeing. These specialist practitioners need to possess or
develop a full range of health promotion competencies. The term
‘health practitioner’ is used throughout this book in recognition that
many health promotion activities are undertaken by workers whose
primary qualification may be from a different discipline, and who is
undertaking health promotion activities within a wider field of
practice.
In this book, the terms ‘low-income’, ‘middle-income’ and ‘high-
income countries’ are used. Low-income countries are home to 9% of
the world’s population. Alternative terms for low-income countries
include ‘third world’ or ‘developing nations’ but these terms are not
used in this book as they are perjorative. They suggest that the low-
income nations are deficient, and reflect the parochialism of high-
income countries. The majority of the world’s population now live in
middle-income countries (76%). High-income countries are home to
16% of the world’s population but consume around 80% of its
collective resources. High-income countries are often referred to as
the ‘developed’ or ‘first’ world. For the same reason as described
above, these terms are not used because they imply a hierarchy of
countries based on levels of economic development.
Health promotion draws on many areas of expertise. In deciding
which skills and topics to include in this book, we gave strong
consideration to the International Union for Health Promotion and
Education Health Promotion Competencies, and to topics commonly
examined in university health science programs. In this book, we
have used real-life examples from our own professional practice
fields and often in our local geographic areas. This was a deliberate
decision in order to illustrate the diversity and wisdom in health
promotion. We encourage health practitioners to examine the health
promotion practice around them and to draw on the wisdom and
expertise of what is working locally. We hope that these examples
will encourage health practitioners to become involved in
showcasing their health promotion work, thus demonstrating that
health promotion is a meaningful part of many health workers’
practice.

HOW TO USE THIS BOOK

The book is structured into two distinct but interrelated parts
covering nine chapters.
Another random document with
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 Larry is a fine strapping doughboy in his uniform, on
which are two gold service stripes and several decorations
for bravery. His hand is bandaged. They come down.
As Livingston gives no indication of leaving, Bess still
sits there while Hood keeps his eyes on her husband’s
back. His silence holds them there.)

Professor
But I was expecting at least two hundred.

Larry
They got lost on the way.

Professor
Lost?

Larry
Yes. I left them at the Follies. But I’d heard my uncle speak of this
place.

Professor
(Brightens)
Is your uncle interested in fossils?

Larry
Yes. He’s a queer bug. He told me to be sure and not miss the
Chamber of Horrors. You know, where all the Kings and Queens and
statesmen are embalmed in wax?

Professor
 But, my dear friend, they tore down the Eden Musée several years
ago.

Larry
They did? Why didn’t they wait till I got back? Haven’t you any
Chamber of Horrors here?

Professor
No; this is the Paleontological section.

Larry
(Looking about)
Well, now that I’m here maybe this will do as well.
(Livingston now turns, leaning against the case, much
interested in the two men. As he shows no intention of
moving, Bess sits there, twisting her handkerchief
nervously in her hand. Hood is embarrassed and
undecided.)
Trot ’em out, so I can tell uncle I’ve seen ’em.

Professor
(Pointing to Brontosaurus)
This is a major Dinosaur.

Larry
Major what?

Professor
The more popular name is the Brontosaurus.

Larry
 Is that so? (Looking at it.) Some bird!

Professor
It’s a reptile: its name means Thunder Lizard because its mighty
tread shook the earth.

Larry
Where did it grow?

Professor
From other bones we have found I should say it roamed all over
the world. This specimen was dug up in Wyoming.

Larry
What was it doing in Wyoming?

Professor
(On his dignity)
It was possibly overtaken there by an earthquake.

Larry
Must have been some earthquake.

Professor
Since it was thus buried in silica away from the decomposing air
and moisture, it was preserved for centuries—till we happened to
discover it with a pick.

Larry
You don’t say so! (He looks at it a bit awed.) When we were
digging trenches in No Man’s Land we used to find....
 Professor
What?

Larry
Not that sort of bones.

Professor
This was in an excellent state of preservation. It is sixty feet long
and must have weighed when alive forty tons. It took seven years to
dig it out and mount it. We had to be very careful not to break its
marvelous tail. If you’ll walk to the other end you’ll get an idea of its
length. We found ninety-seven perfect vertebræ.

Larry
Ninety-seven? You don’t say so?

Professor
You can count them and see.

Larry
Ninety-seven what you call ’ems! Think of that. (As he goes up.)
And you say it came from Wyoming?

Professor
Yes.

Larry
(Proudly)
That’s my state, too.
(Larry wanders off out of sight looking at the fossil. As
the Professor starts to follow, Livingston, who has
 been watching his wife and Hood, stops him.)

Livingston
I beg your pardon. I hope you won’t mind our being interested in
what you were saying; but we were wondering about the animal
ourselves.
(Hood looks at Bess quickly not knowing what
Livingston is driving at.)

Professor
(Brightening)
Indeed? I’m afraid our young friend is a bit irreverent.

Livingston
May I ask what is known of its domestic habits?

Professor
It was hardly a domestic animal. Its family life probably extended
only during the infancy of its young.

Livingston
Was this a female, by chance?

Professor
Yes: the large pelvic development....

Livingston
This one undoubtedly had young, too?

Professor
 Of course. But we have never found any of its eggs. It was a
reptile, you know.

Livingston
But while they were dependent it undoubtedly fought to protect its
young—like other animals?

Professor
With very few exceptions all the female animals at least do that;
even those of low intelligence.

Livingston
This one couldn’t by any chance have been wooed away from that
obligation by romantic notions?

Professor
(Suspiciously)
This—romantic?

Livingston
But you said it roamed in search of adventure?

Professor
(A bit on his dignity)
Romance lies in the field of the emotions: I am a scientist.

Livingston
What I mean is: was she faithful to one or promiscuous?

Professor
 (Embarrassed)
Undoubtedly promiscuous.

Livingston
Of course.—You see, Bess, the lady existed before man made his
conventions.

Professor
Yes. She could follow all her natural instincts.

Livingston
Which were?

Professor
Food and fighting. You will observe her large maw and small brain.
Her main weapon of defense was her long powerfully muscled tail.
From the teeth, we deduce she was mainly herbivorous.

Livingston
What did she feed on?

Professor
Everything she could pick up.

Livingston
(Significantly)
Think of that, Hood—“everything she could pick up.”

Professor
Young weeds, tender grass and the like.
 Livingston
Young weeds—ah, yes, of course. Yet in spite of her diet, there is
something quite impressive about dead things, isn’t there?

Professor
(Eyeing it)
They have a dynamic power.

Livingston
Exactly. You see, Mr. Hood, a dead tree, that has in its time given
shelter and substance, fights to be left standing. It resists the alien
ax. Its roots go as deep as when they flowed with sap. They also
fight to prevent themselves from being torn up. They don’t like to be
disturbed—any more than this animal did in its cold clayey comfort.
(To Professor) You say it took seven years?

Professor
(Not understanding)
Yes. We were afraid of hurting it if we were careless.

Livingston
You were right to be careful: one shouldn’t hurt the dead. What is
its scientific significance?

Professor
Nothing but a further proof of the slow processes of evolution.

Livingston
(With a smile)
I am a utilitarian. I see another significance. Possibly she was dug
up, a thousand centuries after she died, just to give you an
occupation.

Professor
I can’t accept that as a working hypothesis.

Livingston
Just think, Hood. Several million years dead! There it stands for
man to look upon! Possibly that was why it existed, after all: for us
three to look upon. (He glances pointedly at them.) Mr. Hood is
thinking of introducing a bill in the Legislature to increase the wings
of the Museum.

Professor
That’s very kind of him. We have many boxes still unpacked in the
cellar for lack of room. But, unfortunately, this museum is under the
control of the city, not the state.

Livingston
(Smiling at Hood)
Indeed?

Bess
(Rising impatiently)
It’s getting late.

Larry
(Re-entering)
I only counted sixty-three.

Professor
(Emphatically)
 But there are ninety-seven.

Larry
All right. I won’t argue it.

Professor
If you’ll come with me, I’ll show you the Tyrannosaurus. They were
carnivorous and the greatest fighters of them all.

Larry
Say, this is a fine place to be showing a fellow who’s just back
from France.

Bess
(Sweetly)
Young man, I’d like to shake your hand. I see you have all sorts of
lovely decorations. May I ask how you got them?

Larry
(Embarrassed)
Oh, I was careless and they pinned a rose on me by mistake.

Bess
You must be very proud of them?

Larry
Sure I am. (Looking at the Brontosaurus.) But that lizard kinder
takes the pride out of a fellow.

Bess
 But I admire bravery—whenever I see it. I’d like to hear about how
you really got those decorations.

Larry
Would you?
(The gong in the distance rings.)

Professor
(In back)
If you want to see the Tyrannosaurus before we close....

Larry
Oh, all right. (To others) Gee, I’ll be glad to get out among the live
ones.

Bess
(Smiling at him)
So will I.

Livingston
(Coldly)
You should have gone to the Follies, young man.

Larry
Oh, I might have sprained an ankle going to my seat.
(He goes out after the Professor as Bess looks after
him. Sarah comes in back and then goes off. The rear of
room darkens, indicating she has pulled the curtain up.
Livingston glances at Hood who is gazing at Bess with a
strange enlightenment.)
 Livingston
I think you’re right, Bess: we’d better be going. We might stop and
take the children for a spin before it’s dark.

Bess
Yes.

Livingston
(To Hood)
Are you going our way?

Hood
No.

Bess
You’re sure we can’t drop you somewhere?

Hood
No. Thank you.

Livingston
I’m delighted to have met you, Mr. Hood. (Shaking hands.) I shall
follow your work in the Legislature with great interest.

Hood
Perhaps I may be able to help you with your museum.

Livingston
Just talking to you has encouraged me greatly. Good-bye. There is
a big political future waiting a young man these days—if he keeps
his head.

Bess
(Shaking his hand)
I’m sure my husband is right.

Hood
(Looking at her)
So am I. Quite sure.
(She turns away, as she sees what his tone of finality
implies, and looks up at the Brontosaurus with a start.)

Livingston
What is it, dear?

Bess
Nothing. Only it seems to be smiling at us.

Livingston
All skulls grin: it’s the eternal laughter of the dead.

Bess
Come. (As she starts.) Dear, don’t you think it might be a good
idea to rescue that fine strong good-looking young soldier? He must
be so lonely and we might take him for a drive.

Livingston
(A bit wearily at what he sees ahead)
Oh, yes; if you wish. But I’m sure he should have gone to the
Follies.
 (He offers her his arm—she takes it. Hood watches them
as they walk out without turning back. He stands there a
moment, with a cynical smile creeping over his lips. He
throws the catalogue on the seat. Then he goes to the
sign before the Brontosaurus.)

Hood
(Reading and thinking)
“Mainly Herbivorous.” “Anything she can pick up.” “Several million
years”....
(As he gazes there, Sarah enters and goes out to pull up
the other curtain. She apparently does so for some red
rays slowly gather about the fossil. The room is darker.
She re-enters and stands there looking at him. Hood
gives a sigh of relief, and determination: he puts on his
hat, and, with hands in his pockets, goes off whistling.
Sarah stands there as the room darkens. Then she
goes over near the seat and begins to mop.)

Sarah
Moppin’ and scrubbin’ ... moppin’....
(She pauses and gives a glance at the Brontosaurus on
whose skull are now centered the rays of the setting sun.)
Holy Mother of Saints! What are you grinnin’ at, ye dirty heathen?
(She lifts her arm again in revolt as though to throw the
mop at it. Then she puts it down with a sense of futility.
She picks up her things and goes off slowly.
The place is now dark save for the faint light on the
skull; and even that fades after a little while.)

[Curtain]
 FOOTNOTES:
[B] Copyright by George Middleton. See back of title
page.
 TIDES
THE PEOPLE
William White, a famous Internationalist.
Hilda, his wife.
Wallace, their son.

SCENE
At the Whites; spring, 1917.
 TIDES[C]
A simply furnished study. The walls are lined with bookshelves,
indicating, by their improvised quality, that they have been increased
as occasion demanded. On these are stacked, in addition to the
books themselves, many files of papers, magazines and “reports.”
The large work-table, upon which rests a double student lamp and a
telephone, is conspicuous. A leather couch with pillows is opposite,
pointing towards a doorway which leads into the living-room. There
is also a doorway in back, which apparently opens on the hallway
beyond. The room is comfortable in spite of its general disorder: it is
essentially the work-shop of a busy man of public affairs. The strong
sunlight of a spring day comes in through the window, flooding the
table.
William White is standing by the window, smoking a pipe. He is
about fifty, of striking appearance: the visual incarnation of the
popular conception of a leader of men. There is authority and
strength in the lines of his face; his whole personality is
commanding; his voice has all the modulations of a well-trained
orator; his gestures are sweeping—for, even in private conversation,
he is habitually conscious of an audience. Otherwise, he is simple
and engaging, with some indication of his humble origin.
On the sofa opposite, with a letter in her hand, Hilda White, his
wife, is seated. She is somewhat younger in fact, though in
appearance she is as one who has been worn a bit by the struggle of
many years. Her manner contrasts with her husband’s: her
inheritance of delicate refinement is ever present in her soft voice
and gentle gesture. Yet she, too, suggests strength—the sort which
will endure all for a fixed intention.
It is obvious throughout that she and her husband have been
happy comrades in their life together and that a deep fundamental
bond has united them in spite of the different social spheres from
which each has sprung.

White
(Seeing she has paused)
Go on, dear; go on. Let’s hear all of it.

Hilda
Oh, what’s the use, Will? You know how differently he feels about
the war.

White
(With quiet sarcasm)
But it’s been so many years since your respectable brother has
honored me even with the slightest allusion....

Hilda
If you care for what he says—(Continuing to read the letter)
—“Remember, Hilda, you are an American. I don’t suppose your
husband considers that an honor; but I do.”

White
(Interrupting)
And what kind of an American has he been in times of peace?
He’s wrung forty per cent profit out of his factory and fought every
effort of the workers to organize. Ah, these smug hypocrites!
 Hilda
(Reading)
“His violent opposition to America going in has been disgrace
enough——”

White
But his war profits were all right. Oh, yes.

Hilda
Let me finish, dear, since you want it. (Reading) “—been disgrace
enough. But now that we’re in, I’m writing in the faint hope, if you are
not too much under his influence, that you will persuade him to keep
his mouth shut. This country will tolerate no difference of opinion
now. You radicals had better get on board the band wagon. It’s
prison or acceptance.” (She stops reading.) He’s right, dear. There
will be nothing more intolerant than a so-called democracy at war.

White
By God! It’s superb! Silence for twenty years and now he writes
his poor misguided sister for fear she will be further disgraced by her
radical husband.

Hilda
We mustn’t descend to his bitterness.

White
No: I suppose I should resuscitate the forgotten doctrine of
forgiving my enemies.

Hilda
He’s not your enemy; he merely looks at it all differently.
 White
I was thinking of his calm contempt for me these twenty years—
ever since you married me—“out of your class,” as he called it.

Hilda
Oh, hush, Will. I’ve been so happy with you I can bear him no ill
will. Besides, doesn’t his attitude seem natural? You mustn’t forget
that no man in this country has fought his class more than you. That
hurts—especially coming from an acquired relative.

White
Yes; that aggravates the offense. And I’ll tell you something you
may not know: (Bitterly) Whenever I’ve spoken against privilege and
wealth it’s been his pudgy, comfortable face I’ve shaken my fist at.
He’s been so damned comfortable all his life.

Hilda
(She looks at him in surprise)
Why, Will, you surely don’t envy him his comfort, do you? I can’t
make you out. What’s come over you these last weeks? You’ve
always been above such personal bitterness; even when you were
most condemned and ridiculed. If it were anybody but you I’d think
you had done something you were ashamed of.

White
What do you mean?

Hilda
Haven’t you sometimes noticed that is what bitterness to another
means: a failure within oneself? (He goes over to chair and sits
without answering.) I can think of you beaten by outside things—that
sort of failure we all meet; but somehow I can never think of you