Health promotion

Health promotion has been defined by the World Health Organization's (WHO) 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health".[1] The primary means of health promotion occur through developing healthy public policy that addresses the prerequisites of health 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 to incorporate health into all public policies. There is a tendency among public health officials and governments—and this is especially the case in neoliberal nations such as Canada and the USA—to reduce health promotion to health education and social marketing focused on changing behavioral risk factors.[2]

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 relationship between health promotion and social marketing has highlighted and reinforce the potential integrative nature of the approaches. While an independent review (NCC 'It's Our Health!' 2006) identified that some social marketing has in 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[3] which 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.

History The "first and best known" definition of health promotion, promulgated by the American Journal of Health Promotion since at least year 1986, is "the science and art of helping people change their lifestyle to move toward a state of optimal health".[4][5] This definition was derived from the 1974 Lalonde report from the Government of Canada,[4] 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".[6] Another predecessor of the definition was the 1979 Healthy People report of the Surgeon General of the United States,[4] 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".[7]

At least two publications led to a "broad empowerment/environmental" definition of health promotion in the mid-1980s:[4]

In year 1984 the World Health Organization (WHO) Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health".[8] 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.[8]
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".[4][9] 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".[9]
The WHO, in collaboration with other organizations, has subsequently co-sponsored international conferences on health promotion as follows:

1st International Conference on Health Promotion, Ottawa, 1986, which resulted in the "Ottawa Charter for Health Promotion".[10] According to the Ottawa Charter, health promotion:[10]
"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.
Workplace health promotion Main article: Workplace health promotion
Work site health focus on the prevention and the intervention that reduce 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.[11] 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".[12][13] 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".[14]

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. 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".[15]
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.[16]
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.[17]
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".[18]
A meta-analysis of 22 studies published 1997–2007 determined that workplace health promotion interventions led to "small" reductions in depression and anxiety.[19]
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 print materials).[20]
Health promotion 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.[21] The International Union for Health Promotion and Education, based in France, holds international, regional, and national conferences.[22][23]

Australia The Australian Health Promotion Association, a professional body, was incorporated in year 1988.[24] In November 2008, the National Health and Hospitals Reform Commission released a paper recommending a national health promotion agency.[25] ACT Health of the Australian Capital Territory supports health promotion with funding and information dissemination.[26] 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. ".[27]

Canada The province of Ontario appointed a health promotion minister to lead its Ministry of Health Promotion in year 2005.[28]

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.[29]

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.[30]

The BC Coalition for Health Promotion is "a grassroots, voluntary non-profit society dedicated to the advancement of health promotion in British Columbia".[31]

New Zealand The Health Promotion Forum of New Zealand is the national umbrella organization of over 150 organisations committed to improving health.[32][33]

Norway The Research Centre for Health Promotion and Resources HiST/NTNU (http://www.rchpr.org) was established in Trondheim in 2010. The Centre, led by Professor Geir Arild Espnes, takes part in the scientific exploration of what promotes, maintains and restores good health – both in healthy, vulnerable and diseased populations. The research group has a bio-psycho-social- existential health understanding. Health is understood as a positive resource which every person has more or less of. The Centre will contribute to new knowledge about the following:Factors that promote, sustain, and restore good health in healthy people, vulnerable or exposed groups, and those with health deficiencies.Factors that promote health (i.e., salutogenesis) as opposed to focusing on factors that generate illness and disease (i.e., pathogenesis).

Sri Lanka Health promotion in Sri Lanka has been very successful during recent decades as shown by the health indicators. Despite the numerous successes over the years, the integrity of the health system has been subjected to many challenges. Sri Lanka is already facing emerging challenges due to demographic, epidemiological, technological and socio-economic transitions. The disease burden has started to shift rapidly towards lifestyle and environmental related non-communicable diseases. These are chronic and high cost and will cause more and perhaps unaffordable burden to the country’s health care expenditure, under the free of charge health services policy. The previous success of health development increased the life expectancy of Sri Lankan people to 72 for male and 76 for women but the estimated “healthy life expectancy” at birth of all Sri Lanka population is only 61.6

Health is affected by biological, psychological, chemical, physical, social, cultural and economic factors in people’s normal living environments and lifestyles. With the current rapid changing demographic, social and economic context and the epidemiological pattern of diseases, the previous health promotion interventions which found to be effective in the past may not be effective enough now and the future to address all the important determinants that affect health. Promoting people’s health must be the joint responsibility of all the social actors. These challenges require significant changes in the national health system toward new effective health promotion which has been accepted worldwide as the most cost effective measure to reduce the disease burden of the people and the burden of the nation on the increasing cost for treatment of diseases.

The development of this National Health Promotion Policy is based on: (a) the evidences from Sri Lanka health promotion situation analysis, (b) the international accepted concept, the WHO guiding principle for health promotion and the World Health Assembly resolutions and WHO South East Asia Regional Committee Resolution, and (c) the State Policy and Strategy for Health and the Health Master Plan 2007–2016.

The key strategies for health promotion are: advocacy and mediate between different interests in society for the pursuit of health; empower and enable individual and communities to take control over their own health and all determinants of health; improve the health promotion management, health promotion interventions, programs, plans and implementation; and partnership, networking, alliance building and integration of health promotion activities across sectors.

 

In Sri Lanka, other non health government sectors and NGOs are currently active implementing their community development projects with the community empowerment concept that resemble the healthy setting approach for health promotion. These projects are the high potential entry points and good opportunity for the formal commencement of the new effective setting approach health promotion and the holistic life course health promotion. It is also an opportunity for partnerships and alliance building for concerted action to promote health of the nation. This policy is formulated to promote health and well-being of the people by enabling all people to be responsible for their own health and address the broad determinants of health through the concerted actions of health and all other sectors to make Sri Lanka a Health Promoting Nation where all the citizens actively participate in health promotion activities continuously for a healthy life expectancy.

The policy objectives are as follow :

1.To strengthen leaderships for health promotion at all levels and all sectors through advocacy.
2.To mobilize the society and create nationwide health promotion actions.
3.To develop and implement effective comprehensive holistic and multisectoral approach health promotion interventions.
4.To establish an effective system and mechanism for health promotion management and coordination at all levels.
5.To build capacity for health promotion at all levels and across sectors.
6.To improve financing and resources allocation and utilization for health promotion.
7.To establish an evidence-base for health promotion effectiveness.
Various strategies have been developed for the attainment of each objective focus on the multi-sectoral comprehensive approach and participation of all stakeholders and the people themselves. This National Health Promotion Policy will be monitored and evaluated at all levels. Participatory monitoring and evaluation will be encouraged at implementation level.The National Health Promotion Consortium and the National Health Council will be responsible for the regular monitoring and evaluation of the implementation of this National Health Promotion Policy. Implementation of this policy will also be monitored regularly as part of the overall process of monitoring the activities of the Government and Ministries and covering various sectors and levels of government.

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).[citation needed] 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.[citation needed] 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.[citation needed] 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.(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 which 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.[34]

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 who mission is "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".[35][36]
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.[37]
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".[38]
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.[39]
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.[40][41]
URAC accredits comprehensive wellness programs "that focus on health promotion, chronic disease prevention and health risk reduction".[42]