A Hope for Hope: Refocusing Health Promotion on Hopefulness to Reduce Alcohol Consumption and Breast Cancer.

Our perspective paper focuses on the sociology of hope and is a call to action for health promotion policy makers to create the conditions for hopefulness in alcohol reduction policy, advocacy and programs for/with midlife women. Alcohol is a major risk factor for breast cancer, and high proportions of midlife women in most high-income countries drink at "risky" levels, increasing the chances of breast cancer (due to both age and alcohol consumption). At present, alcohol reduction approaches convey mostly individualised risk messages and imply personal responsibility for behaviour change, stripped from contexts, and heavy drinking persists among groups. New approaches that address the social norms, identities and practices that operate to sustain heavy drinking are necessary considering alcohol harms. We argue that focusing on changing these factors to support hopeful futures may create hope for midlife women to reduce alcohol consumption. We synthesise contemporary theories on the sociology of hope and analyse how these might help to refocus health promotion policy on hopefulness in the context of alcohol reduction and breast cancer prevention. We will draw on Freire's notions of a Pedagogy of Oppression and a Pedagogy of Hope to show how enabling people to recognise and respond to the "oppressive forces" shaping their alcohol consumption might lead to more hopeful futures with reduced alcohol consumption for priority populations. Our focus on building hope into health-promoting alcohol reduction approaches intends to shift policy focus from the individual as the "problem" towards hope being a "solution".