Health promotion

The WHO's 1986 Ottawa Charter for Health Promotion and then the 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".^[2] Health promotion is a multifaceted approach that goes beyond individual behavior change. It encompasses a wide range of social and environmental interventions aimed at addressing health determinants such as income, housing, food security, employment, and quality working conditions.^[3][4]

It is important to distinguish between health education and health promotion. Health education refers to structured learning activities aimed at improving health literacy, while health promotion encompasses broader social and environmental interventions designed to support healthy behaviors and lifestyles. The World Health Organization distinguishes between these approaches, emphasizing that health promotion involves not only individual behavior change but also efforts to modify social determinants of health.^[5]

Health promotion involves public policy that addresses health determinants such as income, housing, food security, employment, and quality working conditions.^[6] More recent work has used the term Health in All Policies (HiAP) 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 preventive healthcare rather than a treatment and curative care focused medical model.^{[citation needed][7]}

There is a tendency among some public health officials, governments, and the medical–industrial complex to reduce health promotion to just developing personal skills, also known as health education and social marketing focused on changing behavioral risk factors.^[8] However, recent evidence suggests that attitudes about public health policies are less about personal abilities or health messaging than about individuals' philosophical beliefs about morality, politics, and science.^[9]

This first publication of health promotion is from the 1974 Lalonde report from the Government of Canada,^[10] 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".^[11] Another predecessor of the definition was the 1979 Healthy People report of the Surgeon General of the United States,^[10] 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".^[12]

At least two publications led to a "broad empowerment/environmental" definition of health promotion in the mid-1980s:^[10]

• In the 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".^[13] In addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organizational change, community development and spontaneous local activities against health hazards" as health promotion methods.^[13]
• 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".^[10][14] 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".^[14]
• 1st International Conference on Health Promotion, Ottawa, 1986, which resulted in the "Ottawa Charter for Health Promotion".^[15] According to the Ottawa Charter, health promotion:^[15]
  • "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 Health Promotion Glossary 2021 reinforces the international 1986 definition.^{[citation needed]}

The WHO, in collaboration with other organizations, has subsequently co-sponsored international conferences including the 2015 Okanagan Charter on Health Promotion Universities and Colleges.^{[citation needed]}

In November 2019, researchers reported, based on an international study of 27 countries, that caring for families is the main motivator for people worldwide.^[16][17]

Health promotion is underpinned by several theoretical frameworks that guide its implementation:

1. The Health Belief Model: This model focuses on individual perceptions of health threats and the effectiveness of health promoting behaviors.^[18]
2. The Transtheoretical Model: Also known as the Stages of Change model, it describes how individuals move through different stages when modifying health behaviors.^[18]
3. Social Cognitive Theory: This theory emphasizes the interaction between personal factors, environmental influences, and behavior in health promotion.^[18]

These frameworks provide a foundation for developing effective health promotion strategies and interventions.

Current models of health promotion include the PRECEDE-PROCEED model, which involves planning health promotion interventions based on social and epidemiological assessments, and the Social Cognitive Theory (Bandura, 1986), which emphasizes self-efficacy and the interaction between individuals and their environments. These frameworks enable health professionals to design interventions targeting behavior change at multiple levels—individual, community, and policy.^[19]

Health promotion employs various strategies to achieve its goals:

1.Community-based interventions: These involve engaging local communities in identifying health issues and developing solutions.^[20]

2.Policy-level approaches: This includes advocating for and implementing policies that support health, such as tobacco control measures or food labeling regulations.^[21]

3.Settings-based approach: This strategy focuses on creating health-promoting environments in specific settings like schools, workplaces, and hospitals.^[21]

4.Health literacy initiatives: These aim to improve people's ability to access, understand, and use health information to make informed decisions.^[21]

5.Social mobilization: This involves bringing together societal and personal influences to raise awareness, deliver resources, and cultivate sustainable community involvement in health promotion.^[21]

Global health promotion efforts, such as WHO's "Health for All" initiative, highlight the increasing role of digital health interventions. For example, mHealth programs in sub-Saharan Africa have demonstrated success in improving vaccination rates.^[22] These technologies allow for real-time health education and preventive care to underserved populations.

Evaluating the effectiveness of health promotion initiatives is crucial for ensuring that resources are used efficiently and that interventions achieve their intended outcomes. However, measuring the impact of health promotion can be challenging due to the complex nature of health determinants and the long-term effects of many interventions.

The WHO's settings approach to health promotion, Healthy Settings, looks at the settings as individual systems that link community participation, equity, empowerment, and partnership to actions that promote health. According to the WHO, a setting is "the place or social context in which people engage in daily activities in which environmental, organizational, and personal factors interact to affect health and wellbeing."^[28] There are 11 recognized settings in this approach: cities, villages, municipalities and communities, schools, workplaces, markets, homes, islands, hospitals, prisons, and universities.^{[citation needed][29]}