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What is Health Promotion?

Introduction

Over the past three decades, the field of health promotion has emerged as a new cost-effective and efficient way to maintain health and wellness – for individuals and communities. Health promotion helps people take control of, and improve, their own health. Rather than focusing on people at risk for specific diseases, it involves the population as a whole in the context of our everyday lives.

Health promotion activities are largely directed towards the prevention of disease and injury before they occur, and it also supports optimum health and quality of life for those who are ill, injured or living with a disability. Health promotion involves the population as a whole, rather than focusing individually on people at risk for specific diseases.

PDF Cover - WHO Health Promotion Glossary

The most widely used definition of health promotion comes from the World Health Organization (WHO). Their Health Promotion Glossary (WHO, 1998) defines health promotion as:

“a process of enabling people to increase control over their health and its determinants, and thereby improve their health.”

The definition above also notes that health promotion is a process that “not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health”. These social, environmental and economic conditions that influence our health are called the determinants of health.

Features of Health Promotion

What makes health promotion unique?

  • Health promotion takes a holistic view of health.
  • Health promotion focuses on participatory approaches.
  • Health promotion addresses health inequities and aims to lessen negative impacts of determinants of health.

 

Health inequities are avoidable and unfair differences in health between groups of the population. Determinants of health are the social, behavioural, economic and environmental conditions that are the root causes of health and illness.

  • Health promotion builds on existing strengths and assets instead of just addressing health problems and deficits.
  • Health promotion uses a variety of complementary strategies to promote health at the individual and community levels. Increasingly, health promotion strategies are grounded in evidence of what works.

 

What is a Health Promoter?

The Health Promotion Clearinghouse defines health promoters to include those who work to promote health as defined in the Ottawa Charter, regardless of professional designation or occupational sector or whether the work is paid or voluntary. The section below, written by Health Nexus (2010), takes the same approach.

Emblem - Ottawa Charter for Health Promotion

Factors that affect health are:
  • income and social status
  • social support networks
  • biology and genetics
  • healthy child development
  • education
  • working conditions
  • physical, emotional and cultural environments
  • personal behaviours and coping skills
  • health services
Health promotion encompasses, at minimum, five action areas:
  • building healthy public policy
  • developing personal skills
  • creating supportive environments
  • reorienting health systems
  • strengthening community action

An Overview of the Field

People in many walks of life promote health. Most people engaged in promoting health aren’t specialists — they are social workers, childcare workers, educators, employment counsellors, settlement workers, recreation workers or youth workers. Volunteers active in local groups concerned about the environment, self-help, neighbourhood improvement, poverty reduction or food action frequently promote health. Public health units, community health centres and universities have specialists whose job titles include the words health promotion. Health Nexus calls all of these people “health promoters.”

Prevention simply means keeping something from happening. In health and social terms, it is an effort to avoid problems, especially those that reduce community well-being. It also means making efforts to reduce the incidence of diseases, disorders and poor health, as well as the environments and behaviours that can lead to poorer health.

Health promotion and prevention go hand in hand. Health promotion emphasizes processes to enable people to increase control over, and to improve, their health.

Health promotion works with entire populations, communities, groups and individuals. It uses approaches that typically start by building on the good that is already there, rather than emphasizing what is missing. Health promotion encourages sharing, caring, participation, respect, empowerment and balance. Community engagement, collaboration and partnership are central to health promotion.

Some health promotion interventions emphasize a particular group (such as immigrants or parents) or place (such as schools or workplaces). Health promotion may focus on personal behaviours (such as smoking or physical activity), particular diseases (such as cancer or diabetes), or specific stages of life (such as early childhood or seniors).

Ultimately, health promotion thinks holistically, beyond doctors and hospital waiting lists, to the underlying reasons of why some people are healthy and other people are not.

As knowledge about what works in health promotion grows, new definitions and concepts emerge. Population Health is one such concept. Population health is an approach that addresses the entire range of factors that determine health and, by so doing, affects the health of the entire population. The main interventions used by population health are societal-level policies affecting the health of entire populations (e.g., increasing tobacco taxes). Population health does not place much emphasis on strategies promoting individual and community level change, such as education, organizational change and community mobilization. Interestingly, although you might think population health and health promotion would be all one field of practice; some researchers specialize in population health. These researchers mostly specialize in acquiring evidence about socio-economic influences on health outcomes. At the front-line and intervention level, these approaches are usually fully merged.

Application, Planning and Implementation Tools

Why re-invent the wheel? Finding and using promising and evidence based practices, as well as models and tools developed by other organizations, is an important way to learn from one another as we strive to deliver the most effective initiatives possible.

Increasingly, we are able to base health promotion decisions and interventions on evidence. This involves using information derived from formal research, systematic investigation, intervention assessment and program evaluation. The intention is to sharpen our knowledge about causes and contributing factors that influence health and about the most effective health promotion actions to address these in given contexts and populations. Research has demonstrated that the most effective health promotion uses multiple strategies, and usually involves several sectors (e.g. nursing, social services, and education). This means that research and evaluation is usually complex. It’s important to glean evidence from large-scale comparative research and reviews of research. It’s also important to learn from interventions perceived to have positive impact. Thus evidence is drawn from both research and practice. Increasingly, health promoters are able to identify promising practices and understand how to adapt them to work in varying contexts.

 

Where does health promotion happen?

Health promotion work takes place wherever people live, work and gather. The following examples and organizations are good illustrations of this:

  • Workplaces
    The Canadian Centre for Occupational Health and Safety provides resources and information about the strong connection between the health and well-being of people and their work environments. The Health Communication Unit at the Centre for Health Promotion at the University of Toronto leads a workplace health promotion project.
  • Communities
    “Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love” (WHO, 1986), and “‘settings for health’ represent the organizational base of the infrastructure required for health promotion”.
  • Action for Neighbourhood Change
    is an example of a settings-based health promotion (community-based) program that engages citizens to identify and find solutions to local community needs. Community programs such as these may embrace environmental, economic and health issues.