Health promotion

Health promotion is, as stated in the

1986 World Health Organization
(WHO) Ottawa Charter for Health
Promotion, "the process of enabling
people to increase control over, and
to improve, their health. To reach a
state of complete physical, mental
and social well-being, an individual or
group must be able to identify and to
realize aspirations, to satisfy needs,
and to change or cope with the
environment. Health is, therefore,
seen as a resource for everyday life,
not the objective of living. Health is a
positive concept emphasizing social
and personal resources, as well as
physical capacities. Therefore, health
promotion is not just the
responsibility of the health sector,
but goes beyond healthy life-styles to
well-being".

Scope
The WHO's 2005 Bangkok Charter for
Health Promotion in a Globalized
World defines health promotion as
"the process of enabling people to
increase control over their health
and its determinants, and thereby
improve their health".[1]

Health promotion involves public

policy that addresses health
determinants such as income,
housing, food security, employment,
and quality working conditions. More
recent work has used the term
Health in All Policies to refer to the
actions that incorporate health into
all public policies. Health promotion is
aligned with health equity and can be
a focus of non-governmental
organizations (NGOs) dedicated to
social justice or human rights. Health
literacy can be developed in schools,
while aspects of health promotion
such as breastfeeding promotion can
depend on laws and rules of public
spaces. One of the Ottawa Charter
Health Promotion Action items is
infusing prevention into all sectors of
society, to that end, it is seen in
preventative healthcare rather than
a treatment and curative care
focused medical model.
There is a tendency among some
public health officials, governments,
and the medical industrial complex to
reduce health promotion to just
developing personal skill also known
as health education and social
marketing focused on changing
behavioral risk factors.[2]

History
This first publication of health
promotion is from the 1974 Lalonde
report from the Government of
Canada,[3] which contained a health
promotion strategy "aimed at
informing, influencing and assisting
both individuals and organizations so
that they will accept more
responsibility and be more active in
matters affecting mental and
physical health".[4] Another
predecessor of the definition was the
1979 Healthy People report of the
Surgeon General of the United
States,[3] which noted that health
promotion "seeks the development of
community and individual measures
which can help... [people] to develop
lifestyles that can maintain and
enhance the state of well-being".[5]
At least two publications led to a
"broad
empowerment/environmental"
definition of health promotion in the
mid-1980s:[3]

In year 1984 the WHO Regional

Office for Europe defined health
promotion as "the process of
enabling people to increase control
over, and to improve, their
health".[6] In addition to methods to
change lifestyles, the WHO Regional
Office advocated "legislation, fiscal
measures, organisational change,
community development and
spontaneous local activities
against health hazards" as health
promotion methods.[6]
In 1986, Jake Epp, Canadian Minister
of National Health and Welfare,
released Achieving health for all: a
framework for health promotion
which also came to be known as
the "Epp report".[3][7] This report
defined the three "mechanisms" of
health promotion as "self-care";
"mutual aid, or the actions people
take to help each other cope"; and
"healthy environments".[7]
1st International Conference on
Health Promotion, Ottawa, 1986,
which resulted in the "Ottawa
Charter for Health Promotion".[8]
According to the Ottawa Charter,
health promotion:[8]
"is not just the responsibility of
the health sector, but goes
beyond healthy life-styles to
well-being"
"aims at making... [political,
economic, social, cultural,
environmental, behavioural
and biological factors]
favourable through advocacy
for health"
 "focuses on achieving equity in
health"
"demands coordinated action
by all concerned: by
governments, by health and
other social organizations."

The "American" definition of health

promotion, first promulgated by the
American Journal of Health
Promotion in the late 1980s, focuses
more on the delivery of services with
a bio-behavioral approach rather
than environmental support using a
settings approach. Later the power
on the environment over behavior
was incorporated.

The WHO, in collaboration with other

organizations, has subsequently co-
sponsored international conferences
including the 2015 Okanagan Charter
on Health Promotion Universities and
Colleges.

Workplace Setting
The process of health promotion
works in all settings and sectors
where people live, work, play and
love. A common setting is the
workplace. The focus of health on the
work site is that of prevention and
the intervention that reduces the
health risks of the employee. The U.S.
Public Health Service recently issued
a report titled "Physical Activity and
Health: A Report of the Surgeon
General" which provides a
comprehensive review of the
available scientific evidence about
the relationship between physical
activity and an individual's health
status. The report shows that over
60% of Americans are not regularly
active and that 25% are not active at
all. There is very strong evidence
linking physical activity to numerous
health improvements. Health
promotion can be performed in
various locations. Among the
settings that have received special
attention are the community, health
care facilities, schools, and
worksites.[9] Worksite health
promotion, also known by terms
such as "workplace health
promotion," has been defined as "the
combined efforts of employers,
employees and society to improve
the health and well-being of people at
work".[10][11] WHO states that the
workplace "has been established as
one of the priority settings for health
promotion into the 21st century"
because it influences "physical,
mental, economic and social well-
being" and "offers an ideal setting and
infrastructure to support the
promotion of health of a large
audience".[12]

Worksite health promotion

programs (also called "workplace
health promotion programs,"
"worksite wellness programs," or
"workplace wellness programs")
include exercise, nutrition, smoking
cessation and stress management.
According to the Centers for Disease
Control and Prevention (CDC),
"Regular physical activity is one of
the most effective disease
prevention behaviors."[13] Physical
activity programs reduce feelings of
anxiety and depression, reduce
obesity (especially when combined
with an improved diet), reduce risk of
chronic diseases including
cardiovascular disease, high blood
pressure, and type 2 diabetes; and
finally improve stamina, strength,
and energy.
Reviews and meta-analyses
published between 2005 and 2008
that examined the scientific
literature on worksite health
promotion programs include the
following:

A review of 13 studies published

through January 2004 showed
"strong evidence... for an effect on
dietary intake, inconclusive
evidence for an effect on physical
activity, and no evidence for an
effect on health risk indicators".[14]
In the most recent of a series of
updates to a review of
"comprehensive health promotion
and disease management
programs at the worksite,"
Pelletier (2005) noted "positive
clinical and cost outcomes" but also
found declines in the number of
relevant studies and their
quality.[15]
A "meta-evaluation" of 56 studies
published 1982–2005 found that
worksite health promotion
produced on average a decrease of
26.8% in sick leave absenteeism, a
decrease of 26.1% in health costs, a
decrease of 32% in workers’
compensation costs and disability
management claims costs, and a
cost-benefit ratio of 5.81.[16]
A meta-analysis of 46 studies
published in 1970–2005 found
moderate, statistically significant
effects of work health promotion,
especially exercise, on "work
ability" and "overall well-being";
furthermore, "sickness absences
seem to be reduced by activities
promoting healthy lifestyle".[17]
A meta-analysis of 22 studies
published 1997–2007 determined
that workplace health promotion
interventions led to "small"
reductions in depression and
anxiety.[18]
A review of 119 studies suggested
that successful work site health-
promotion programs have
attributes such as: assessing
employees' health needs and
tailoring programs to meet those
needs; attaining high participation
rates; promoting self care;
targeting several health issues
simultaneously; and offering
different types of activities (e.g.,
group sessions as well as printed
materials).[19]
Entities and projects by
country
Worldwide, government agencies
(such as health departments) and
non-governmental organizations
have substantial efforts in the area of
health promotion. Some of these
entities and projects are:

International and
multinational

The WHO and its Regional Offices

such as the Pan American Health
Organization are influential in health
promotion around the world.[20] The
main eight health promotion
campaigns marked by WHO are
World Health Day, World
Tuberculosis Day, World Blood Donor
Day, World Immunization Week,
World Malaria Day, World No
Tobacco Day, World Hepatitis Day
and World AIDS Day.[21]

The International Union for Health

Promotion and Education, based in
France, holds international, regional,
and national conferences.[22][23]

The European Union is co-funding a

Joint Action on Chronic Diseases and
Healthy Ageing across the Life Cycle
(JA-CHRODIS) with a strong focus on
health promotion.[24]

Australia

The Australian Health Promotion

Association, a professional body,
was incorporated in year 1988.[25] In
November 2008, the National Health
and Hospitals Reform Commission
released a paper recommending a
national health promotion agency.[26]
ACT Health of the Australian Capital
Territory supports health promotion
with funding and information
dissemination.[27] The Victorian
Health Promotion Foundation
(VicHealth) from the state of Victoria
is "the world’s first health promotion
foundation to be funded by a tax on
tobacco." [28] The Australian
Government has come up with some
initiatives to help Australians achieve
a healthy lifestyle.[29] These
initiatives are:

Get Set 4 Life - Habits for Healthy

Kids[30]
The Stephanie Alexander Kitchen
Garden National Program[31][32]
Healthy Spaces and Places[33]
 Learning from Successful
Community Obesity Initiative
Healthy Weight information and
resources.

Health Promotion is strong and well-

established in Australia. Since 2008
there has been a number of graduate
courses people can take to be
involved within Health Promotion in
Australia. The government since
2008 has included an initiative that
involves the Aboriginal and Torres
Strait Island citizens in the
preventive health sector.[34]

Health Promotion In
Australian Schools

School programs are based on

curriculum documents from state
and territorial councils. Schools
mainly focus on health issues that
are being supported by funding and
special events. Funding for many
health issues are the main basis for
the school curriculum's subject of
health.[35]

Health Promotion for

Aboriginal and Torres Strait
Islander Citizens
Aboriginal and Torres Strait Island
citizens in Australia in the last couple
of centuries have had poor health.
The reason behind the poor health
conditions is due to major events in
the history of Australia. There is an
increasing advancement in the
promotion of health for Torres Strait
Islander and Aboriginal citizens, but
this cannot be achieved without the
co-operation of non-indigenous
Australians. For this health
promotion to be a success, the
citizens of Australia need to put the
history between non-indigenous and
indigenous citizens behind them and
co-operate as equals.[36]

Canada

The province of Ontario appointed a

health promotion minister to lead its
Ministry of Health Promotion in the
year of 2005.[37]

The Ministry’s vision is to enable

Ontarians to lead healthy, active lives
and make the province a healthy,
prosperous place to live, work, play,
learn and visit. Ministry of Health
Promotion sees that its fundamental
goals are to promote and encourage
Ontarians to make healthier choices
at all ages and stages of life, to create
healthy and supportive
environments, lead the development
of healthy public policy, and assist
with embedding behaviours that
promote health.[38]

The Canadian Health Network was a

"reliable, non-commercial source of
online information about how to stay
healthy and prevent disease" that
was discontinued in 2007.[39]
The BC Coalition for Health
Promotion is "a grassroots,
voluntary non-profit society
dedicated to the advancement of
health promotion in British
Columbia".[40]

Ireland

Health Promotion Research in

Ireland

The Health Promotion Research

Centre (HPRC) at the National
University of Ireland Galway was
established in 1990 with support from
the Department of Health to conduct
health promotion related research
on issues relevant to health
promotion in an Irish context. The
Centre is unique in that it is the only
designated research centre in
Ireland dedicated to health
promotion. It produces high quality
research of national and
international significance that
supports the development of best
practice and policy in the promotion
of health. The Centre is a World
Health Organization (WHO)
Collaborating Centre for Health
Promotion Research, has an active
multidisciplinary research
programme, and collaborates with
regional, national and international
agencies on the development and
evaluation of health promotion
interventions and strategies.

Objectives of the HPRC include:

The generation and dissemination

of health promotion research that
is of national and international
relevance.
The translation of research that
will lead to the development of
 healthy public policy and evidence-
informed practice.

New Zealand

The Health Promotion Forum (HPF) of

New Zealand is the national umbrella
organization of over 150
organisations committed to
improving health.[41][42] HPF has
worked with The Cancer Society in
order to produce a personal
development plan for health
promoters, which may be helpful to
perform personal development
reviews, to identify the
competencies of individuals and to
provide ideas for future
development.[43]

The Health Promotion Agency (HPA),

formed July 1, 2012, is a Crown
institution that has been established
under the New Zealand Public Health
and Disability Amendment Act
2012.[44] Its board has been appointed
by the Minister of Health.[45] The work
of HPA is divided into three main
areas:

Promoting the wellbeing and health

of the community
 Enabling health promoting
initiatives and environments
Informing the public on health
promoting policies and
practices[46]

HPA has a variety of programs

based around many areas of work,
including alcohol, immunisation,
mental health, and skin cancer
prevention. The agency aims to
promote the wellbeing of individuals
and encourage healthy lifestyles,
prevent disease, illness and injury,
enable environments that support
health and wellbeing, and to reduce
personal, economic and social
harm.[47]

Health Workforce New Zealand

(HWNZ) is an organisation that is
part of the National Health Board
which provides national leadership
on the development of the health
workforce.[48] Some health
promotional programs supported by
HWNZ include education and training
initiatives, and the Voluntary Bonding
Scheme, which rewards medical,
midwifery and nursing graduates
who agree to work in hard-to-staff
communities, and sonography,
medical physicist and radiation
therapy graduates who stay in New
Zealand.[49]

Health promotion in New Zealand has

become an established approach in
addressing public problems since the
1980s, through increasing use of
intersectoral action, the use of public
policy and mass media as
promotional strategies, and the
increasing control Maori have taken
over the provision and purchase of
health promotion services.[50] An
example of health promotional
initiatives is the action put in place to
reduce childhood obesity in primary
schools. Research was completed to
identify the barriers to improving
school food environments and
promoting healthy nutrition in
primary schools in New Zealand.[51]

Considerable progress has also been

made in the health impact
assessment (HIA) research on the
impact of policies on health in New
Zealand. The approach has an
important contribution to make in the
strengthening of health and wellbeing
in policymaking in New Zealand.[52]
Sri Lanka

In 2015, the life expectancy of Sri

Lankan people was 72 for male and
78 for female. [53] The disease burden
has started to shift towards non-
communicable diseases related to
lifestyle and environmental
factors.[54] The 2012 estimated
“healthy life expectancy” at birth of
all Sri Lanka's population is 68 for
females, 63 for males, and 65 overall.
[55]

The development of the Sri Lankan

National Health Promotion Policy is
related to the State Policy and
Strategy for Health and the Health
Master Plan 2007–2016. It
emphasises advocacy and
empowerment to enable individuals
and communities to take control of
their own health, as well as
improving the management of health
promotion interventions across
sectors.[56]

Sweden

In Sweden, on a national level, health

promotion is primarily the
responsibility of the Public Health
Agency of Sweden[57]. However,
many regional initiatives exist, for
example, within clinical health
promotion programs in certain
geographical areas [58]. Health
promotion is also highlighted by the
Swedish National Board of Health
and Welfare as the agency suggests
this to be a component in health
professionals' curriculum and
training, which concerns, for
example, Registered Nurses and
Physicians [59].

Many health promotion initiatives in

Sweden focus on health equity and
thus focus on groups in society that
have seen to be experiencing poorer
health status. For example, a
Swedish study suggest that health
promotion interventions aiming at
empowering adolescents in
disadvantaged communities, should
enable active learning activities, use
visualizing tools to facilitate self-
reflection, and allow the adolescents
to influence the intervention
activities [60].

United Kingdom

The Royal Society for Public Health

was formed in October 2008 by the
merger of the Royal Society for the
Promotion of Health (also known as
the Royal Society of Health or RSH)
and the Royal Institute of Public
Health (RIPH).[61] Earlier, July 2005
saw the publication by the
Department of Health and Welsh
Assembly Government of Shaping
the Future of Public Health:
Promoting Health in the NHS.
Following discussions with the
Department of Health and Welsh
Assembly Government officials, the
Royal Society for Public Health and
three national public health bodies
agreed, in 2006, to work together to
take forward the report's
recommendations, working in
partnership with other
organisations.[62] Accordingly:

1. The Royal Society for Public

Health (RSPH) leads and hosts
the collaboration, and focuses on
advocacy for health promotion
and its workforce;
2. The Institute of Health Promotion
and Education (IHPE) works with
the RSPH Royal Society for
Public Health to give a voice to
the workforce;
 3. The Faculty of Public Health
(FPH) focuses on professional
standards, education and
training; and
4. The UK Public Health Register
(UKPHR) is responsible for
regulation of the workforce.

In Northern Ireland, the

government's Health Promotion
Agency for Northern Ireland was set
up to "provide leadership, strategic
direction and support, where
possible, to all those involved in
promoting health in Northern
Ireland". The Health Promotion
Agency for Northern Ireland was
incorporated into the Public Health
Agency for Northern Ireland in April
2009.[63]

Recent work in the UK (Delphi

consultation exercise due to be
published late 2009 by Royal Society
of Public Health and the National
Social Marketing Centre) on the
relationship between health
promotion and social marketing has
highlighted and reinforced the
potential integrative nature of the
approaches. While an independent
review (NCC 'It's Our Health!' 2006)
identified that some social marketing
has in the past adopted a narrow or
limited approach, the UK has
increasingly taken a lead in the
discussion and developed a much
more integrative and strategic
approach.[64] This development
adopts a holistic approach,
integrating the learning from
effective health promotion
approaches with relevant learning
from social marketing and other
disciplines. A key finding from the
Delphi consultation was the need to
avoid unnecessary and arbitrary
'methods wars' and instead focus on
the issue of 'utility' and harnessing
the potential of learning from
multiple disciplines and sources.
Such an approach is arguably how
health promotion has developed over
the years pulling in learning from
different sectors and disciplines to
enhance and develop.

United States

Government agencies in the U.S.

concerned with health promotion
include the following:
The Centers for Disease Control
and Prevention has a Coordinating
Center for Health Promotion
whose mission is to "Prevent
disease, improve health, and
enhance human potential through
evidence based interventions and
research in maternal and child
health, chronic disease, disabilities,
genomics, and hereditary
disorders".[65][66]
The National Institute for
Occupational Safety and Health has
developed Total Worker Health, a
strategy incorporating elements of
occupational safety and health and
 health promotion, to advance the
health and well-being of
employees.[67]
The United States Army Center for
Health Promotion and Preventive
Medicine "provide[s] worldwide
technical support for implementing
preventive medicine, public health,
and health promotion/wellness
services into all aspects of
America's Army and the Army
Community".[68]

Nongovernmental organizations in
the U.S. concerned with health
promotion include:
The Public Health Education and
Health Promotion Section is an
active component of the American
Public Health Association.[69]
The National Commission for
Health Education Credentialing
offers the NCHEC, a competency-
based tool used to measure
possession, application and
interpretation of knowledge in the
Seven Areas of Responsibility for
Health Education Specialists. The
exam reflects the entry-level sub-
competencies of these areas of
responsibility.
 The Wellness Council of America is
an industry trade group that
supports workplace health
promotion programs.[70][71]
URAC (Utilization Review
Accreditation Commission)
accredits comprehensive wellness
programs "that focus on health
promotion, chronic disease
prevention and health risk
reduction".[72]

See also
Breastfeeding promotion
Health 21
 Health for all
Health marketing
Health policy
Health promoting hospitals
Health promotion in higher
education
Preventive healthcare

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Further reading
Taylor RB, Ureda JR, Denham JW (1982).
Health promotion: principles and
clinical applications. Norwalk CT:
Appleton-Century-Crofts. ISBN 978-0-
8385-3670-4.
Dychtwald K (1986). Wellness and
health promotion for the elderly.
Rockville MD: Aspen Systems.
ISBN 978-0-87189-238-6.
Green LW, Lewis FM (1986).
Measurement and evaluation in health
education and health promotion. Palo
Alto CA: Mayfield. ISBN 978-0-87484-
481-8.
Teague ML (1987). Health promotion
programs: achieving high-level
wellness in the later years.
Indianapolis: Benchmark Press.
ISBN 978-0-936157-08-5.
Heckheimer E (1989). Health promotion
of the elderly in the community.
Philadelphia: W.B. Saunders. ISBN 978-
0-7216-2136-4.
Fogel CI, Lauver D (1990). Sexual health
promotion. Philadelphia: W.B. Saunders.
ISBN 978-0-7216-3799-0.
Hawe P, Degeling D, Hall J (1990).
Evaluating health promotion: a health
worker's guide. ISBN 978-0-86433-067-
3.
Dines A, Cribb A (1993). Health
promotion: concepts and practice.
Blackwell Science. ISBN 978-0-632-
03543-4.
Downie RS, Tannahill C, Tannahill A
(1996). Health promotion: models and
values (2nd ed.). Oxford University
Press. ISBN 978-0-19-262592-2.
Seedhouse, David (1997). Health
promotion: philosophy, practice, and
prejudice. New York: Wiley. ISBN 978-0-
471-93910-8.
Bracht NF (1999). Health promotion at
the community level: new advances
(2nd ed.). Thousand Oaks: SAGE.
ISBN 978-0-7619-1844-8.
Green LW, Kreuter MW (1999). Health
promotion planning: an educational and
ecological approach (3rd ed.). Mountain
View CA: Mayfield. ISBN 978-0-7674-
0524-9.
Mittelmark, M; Kickbusch, I; Rootman, I;
Scriven, A and Tones, K. (2008) Health
Promotion Encyclopedia of Public
Health. London: Elsevier
Naidoo J, Wills J (2000). Health
promotion: foundations for practice
(2nd ed.). Baillière Tindall. ISBN 978-0-
7020-2448-1.
DiClemente RJ, Crosby RA, Kegler MC
(2002). Emerging theories in health
promotion practice and research:
strategies for improving public health.
San Francisco: Jossey-Bass. ISBN 978-
0-7879-5566-3.
O'Donnell MP (2002). Health promotion
in the workplace (3rd ed.). Albany:
Delmar Thomson Learning. ISBN 978-0-
7668-2866-7.
Cox CC, American College of Sports
Medicine (2003). ACSM's worksite
health promotion manual: a guide to
building and sustaining healthy
worksites. Champaign IL: Human
Kinetics. ISBN 978-0-7360-4657-2.
Lucas K, Lloyd BB (2005). Health
promotion: evidence and experience.
SAGE. ISBN 978-0-7619-4005-0.
Bartholomew LK, Parcel GS, Kok G,
Gottlieb NH (2006). Planning health
promotion programs: an intervention
mapping approach (2nd ed.). San
Francisco: Jossey-Bass. ISBN 978-0-
7879-7899-0.
Edelman CL, Mandle CL (2006). Health
promotion throughout the life span (6th
ed.). St. Louis MO: Mosby Elsevier.
ISBN 978-0-323-03128-8.
Pender NJ, Murdaugh CL, Parsons MA
(2006). Health promotion in nursing
practice (5th ed.). Upper Saddle River
NJ: Prentice Hall. ISBN 978-0-13-119436-
6.
Scriven A, Garman S (2007). Promoting
Health: Global Perspectives.
Basingstoke: Palgrave Macmillan.
ISBN 978-1-4039-2136-9. paperback
ISBN 1-4039-2137-7.
Scriven A (2007). "Developing local
alliance partnerships through
community collaboration and
participation". In Handsley, S.; Lloyd,
C.E.; Douglas, J.; Earle, S.; Spurr, S.M.
(eds.). Policy and Practice in Promoting
Public Health. London: SAGE.
ISBN 9781412930734.
Scriven, A, ed. (2005). Health Promoting
Practice: the contribution of nurses and
Allied Health Professionals.
Basingstoke: Palgrave. ISBN 978-1-
4039-3411-6.
Scriven, A (2010). Promoting Health: a
Practical Guide (6th ed.). Edinburgh:
Balliere Tindall/ Elsivier. ISBN 978-0-
7020-3139-7.
Leddy, Susan (2006). Health promotion:
mobilizing strengths to enhance health,
wellness, and well-being. Philadelphia:
F.A. Davis. ISBN 978-0-8036-1405-5.
Chenoweth DH (2007). Worksite health
promotion (2nd ed.). Champaign IL:
Human Kinetics. ISBN 978-0-7360-6041-
7.
Cottrell RR, Girvan JT, McKenzie JF
(2008). Principles & foundations of
health promotion and education (4th
ed.). San Francisco: Benjamin
Cummings. ISBN 978-0-321-53235-0.
 Murray RB, Zentner JP, Yakimo R
(2009). Health promotion strategies
through the life span (8th ed.). Upper
Saddle River NJ: Pearson Prentice Hall.
ISBN 978-0-13-513866-3.
McKenzie JE, Thackeray R, Neiger BL
(2009). Planning, implementing, and
evaluating health promotion programs:
a primer (5th ed.). San Francisco:
Benjamin Cummings. ISBN 978-0-321-
49511-2.

External links
Healthy Cities – WHO EURO Office
Health-EU Portal Health
Prevention and Promotion in the
 EU
EuroHealthNet: The European
Partnership for Improving Health,
Equity and Well-Being

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