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Health promotion reflects the World Health Organization conception of health as "the extent to which an individual or group is able to realize aspirations and to satisfy needs, and to change or cope with the environment. This is a dynamic model, in which health is seen not only as a state, but as a resource for everyday life. It is a positive concept emphasizing social and personal resources as well as physical capacities". (World Health Organization. Health promotion: a discussion document on the concept and principles. Copenhagen, Regional Office for Europe, 1984)
"Health promotion includes strengthening the skills of individuals to encourage healthy behaviours and it also includes building the healthy social and physical environments to support these behaviours." (Health Canada, 2005)
"Health promotion is any combination of health education and related organizational, economic and political interventions designed to facilitate behavioral and environmental changes conducive to health." (Green L. National policy on the promotion of health. Int J Health Education 1979;22:161-168)
Green also described health promotion as “the combination of educational and environmental supports for actions and conditions of living conducive to health” (Green LW, Kreuter M. Health promotion planning: an educational and environmental approach. 3rd ed. Mountain View, CA: Mayfield Press, 1999, p14)
"Health promotion is the process of helping people to take control over their lives so that they can choose options that are health giving rather than those that are health risky." (Vetter N, Matthews I. Epidemiology and public health medicine. Churchill Livingstone, 1999: 216)
By comparison, health protection refers to "ensuring safe food and water supplies, providing advice to national food and drug safety regulators, protecting people from environmental threats, and having a regulatory framework for controlling infectious diseases in place. Ensuring proper food handling in restaurants and establishing smoke-free bylaws are examples of health protection measures." (Health Canada, 2005).
From these definitions you will see that health promotion differs from prevention or risk reduction interventions by being broader and non-specific:
The Ottawa Charter for Health Promotion.
Ottawa was the venue for an international conference on health promotion in 1987. The resulting Ottawa Charter proposed action "to achieve health for all" by the year 2000. It included the following strategies:
- Building healthy public policy. This puts health on the agenda for all policymakers, directing them to be aware of the health consequences of their decisions
- Creating supportive environments. (e.g. encouraging a family to support their relative who is trying to lose weight) This recognized the importance of environment for health, and proposed a socio-ecological approach to health
- Strengthening community action. Health promotion requires community empowerment and involvement in setting priorities, planning and implementing strategies to achieve better health
- Developing personal skills. Health promotion supports personal and social development through providing information and enhancing life skills
- Reorienting health services. Health promotion argues for shifting health resources towards a more equal distribution between health care and preventing disease. Essentially, health services should be expanded to include the four strategies above in addition to conventional medical care. Responsibility for health promotion services should be shared among individuals, community groups, health professionals, health services and governments.
Tthe Charter also identified seven prerequisites for adult health:
a stable eco-system,
and sustainable resources.
Values in Health Promotion
Health promotion is implicitly based on several values:
• equity and social justice
• a holistic definition of health
• covers the full range of health determinants
• recognizes the influence of environment on health
• empowers people and builds individual and collective capacity
• seeks to enhance people's social participation
• involves intersectorial collaboration.
Population Health Promotion
Population health and health promotion were seen as being in competition, so in 1996 Health Canada released a report that tried to reconcile the two. While the Ottawa Charter offered ideas on "how" to intervene, Health Canada proposed a population health promotion (PHP) model which applies these intervention approaches to different targets ("who"): Individuals, Families, Communities, Sectors (such as the educational system), and Society as a whole. This extends health promotion beyond the individual level and emphasizes multiple levels of involvement. Next, PHP proposes "what" the interventions should address: the nine determinants of health previously identified by Health Canada.
There are many ways to apply this model, but as an example, if the goal is to prevent the spread of AIDS, community interventions could include needle exchange programs; educational institutions can include healthy sexuality in educational curricula; the health system can make opportunities for HIV testing more accessible; social marketing campaigns can raise awareness of safe sex practices.
The PHP model offers a systematic and comprehensive way to think about strategies to influence health, many of which lie outside the health sector.
Link to Population Health
Health Risk Appraisal
A fuller discussion of recent approaches to health promotion is contained in a Health Canada report on "healthy settings". This has some good historical materials on health promotion. [HC keeps changing its web addresses. If link is broken, Google "healthy settings"]
Updated March 19, 2014