Health promotion

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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".



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 preventive 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]


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]

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.

In November 2019, researchers reported, based on an international study of 27 countries, that caring for families is the main motivator for people worldwide. [9] [10]

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. [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.

According to the Centers for Disease Control and Prevention (CDC), "Regular physical activity is one of the most effective disease prevention behaviors." [15] 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:

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. [22] 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. [23]

The International Union for Health Promotion and Education, based in France, holds international, regional, and national conferences. [24] [25]

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. [26]


The Australian Health Promotion Association, a professional body, was incorporated in year 1988. [27] In November 2008, the National Health and Hospitals Reform Commission released a paper recommending a national health promotion agency. [28] ACT Health of the Australian Capital Territory supports health promotion with funding and information dissemination. [29] 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." [30] The Australian Government has come up with some initiatives to help Australians achieve a healthy lifestyle. [31] These initiatives are:

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. [36]

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. [37]

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. [38]


The province of Ontario appointed a health promotion minister to lead its Ministry of Health Promotion in the year of 2005. [39]

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. [40]

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. [41]

The BC Coalition for Health Promotion is "a grassroots, voluntary non-profit society dedicated to the advancement of health promotion in British Columbia". [42]


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. [43] [44] 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. [45]

The Health Promotion Agency (HPA), formed July 1, 2012, is a Crown Agency established under the New Zealand Public Health and Disability Amendment Act 2012. [46] Its board has been appointed by the Minister of Health. [47] The work of HPA is divided into three main areas:

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. [49]

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. [50] 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. [51]

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. [52] 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. [53]

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. [54]

Sri Lanka

In 2015, the life expectancy of Sri Lankan people was 72 for male and 78 for female. [55] The disease burden has started to shift towards non-communicable diseases related to lifestyle and environmental factors. [56] The 2012 estimated “healthy life expectancy” at birth of all Sri Lanka's population is 68 for females, 63 for males, and 65 overall. [57]

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. [58]


In Sweden, on a national level, health promotion is primarily the responsibility of the Public Health Agency of Sweden. [59] However, many regional initiatives exist, for example, within clinical health promotion programs in certain geographical areas. [60] 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. [61]

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. [62]

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). [63] 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. [64] 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. [65]

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. [66] 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:

Nongovernmental organizations in the U.S. concerned with health promotion include:

See also

Related Research Articles

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Environmental health Public health branch focused on environmental impacts on human health

Environmental health is the branch of public health concerned with all aspects of the natural and built environment affecting human health. Environmental health is focused on the natural and built environments for the benefit of human health. The major subdisciplines of environmental health are: environmental science; environmental and occupational medicine, toxicology and epidemiology.

A dietitian is an expert in dietetics; that is, human nutrition and the regulation of diet. A dietitian alters their patient's nutrition based upon their medical condition and individual needs. Dietitians are regulated healthcare professionals licensed to assess, diagnose, and treat nutritional problems.

Public health Preventing disease, prolonging life and promoting health through organized efforts and informed choices of society and individuals

Public health has been defined as "the science and art of preventing disease”, prolonging life and improving quality of life through organized efforts and informed choices of society, organizations, public and private, communities and individuals. Analyzing the determinants of health of a population and the threats it faces is the basis for public health. The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological, and social well-being. As such, according to the World Health Organization, it is not merely the absence of disease or infirmity and more recently, a resource for everyday living.

National Institute for Occupational Safety and Health US federal government agency for preventing work-related health and safety problems

The National Institute for Occupational Safety and Health is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services. Its current director is John Howard.

Sedentary lifestyle Inactive lifestyle with health risks

A sedentary lifestyle is a type of lifestyle involving little or no physical activity. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like reading, socializing, watching television, playing video games, or using a mobile phone/computer for much of the day. A sedentary lifestyle can potentially contribute to ill health and many preventable causes of death.

Population health the study of health outcomes for groups of individuals

Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". According to Akarowhe (2018), the working definition of population health is expressed thus; population health is an art, process, science and a product of enhancing the health condition of a specific number of people within a given geographical area - population health as an art, simply means that it is geared towards equal health care delivery to an anticipated group of people in a particular geographical location; as a science, it implies that it adopt scientific approach of preventive, therapeutic, and diagnostic service in proffering medical treatment to the health problem of people; as a product, it means that population health is directed toward overall health performance of people through health satisfaction within the said geographical area; and as a process it entails effective and efficient running of a health management/population health management system to cater for the health needs of the people. It is an approach to health that aims to improve the health of an entire human population. This concept does not refer to animal or plant populations. It has been described as consisting of three components. These are "health outcomes, patterns of health determinants, and policies and interventions". A priority considered important in achieving the aim of Population Health is to reduce health inequities or disparities among different population groups due to, among other factors, the social determinants of health, SDOH. The SDOH include all the factors that the different populations are born into, grow up and function with throughout their lifetimes which potentially have a measurable impact on the health of human populations. The Population Health concept represents a change in the focus from the individual-level, characteristic of most mainstream medicine. It also seeks to complement the classic efforts of public health agencies by addressing a broader range of factors shown to impact the health of different populations. The World Health Organization's Commission on Social Determinants of Health, reported in 2008, that the SDOH factors were responsible for the bulk of diseases and injuries and these were the major causes of health inequities in all countries. In the US, SDOH were estimated to account for 70% of avoidable mortality.

Health education is a profession of educating people about health. Areas within this profession encompass environmental health, physical health, social health, emotional health, intellectual health, and spiritual health, as well as sexual and reproductive health education.

Workplace wellness is any workplace health promotion activity or organizational policy designed to support healthy behavior in the workplace and to improve health outcomes. Known as 'corporate wellbeing' outside the US, workplace wellness often comprises activities such as health education, medical screenings, weight management programs, on-site fitness programs or facilities. A recently published article in Forbes Magazine states that according to the American Psychological Association, five elements should be considered in workplace to make it a healthy working environment. These five elements are work-life balance, health and safety, employee growth and development, employee recognition and employee Involvement. Workplace wellness programs can be categorized as primary, secondary, or tertiary prevention efforts, or an employer can implement programs that have elements of multiple types of prevention. Primary prevention programs usually target a fairly healthy employee population, and encourage them to more frequently engage in health behaviors that will encourage ongoing good health. Example of primary prevention programs include stress management, and exercise and healthy eating promotion. Secondary prevention programs are targeted at reducing behavior that is considered a risk factor for poor health. Examples of such programs include smoking cessation programs and screenings for high blood pressure or other cardiovascular disease related risk factors. Tertiary health programs address existing health problems, and aim to help control or reduce symptoms, or to help slow the progression of a disease or condition. Such programs might encourage employees to better adhere to specific medication or self-managed care guidelines.

A patient safety organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection and analysis, reporting, education, funding, and advocacy.

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A health risk assessment is one of the most widely used screening tools in the field of health promotion and is often the first step in multi-component health promotion programs.

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California Department of Public Health

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The Health Sponsorship Council (HSC) was a New Zealand Crown entity that used health promotion to promote health and encourage healthy lifestyles.

Workplace health promotion combined efforts of employers, employees, and society to improve the mental and physical health and well-being of people at work

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Occupational safety and health Field concerned with the safety, health and welfare of people at work

Occupational safety and health (OSH), also commonly referred to as health and safety, occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at work. These terms also refer to the goals of this field, so their use in the sense of this article was originally an abbreviation of occupational safety and health program/department etc.

Health in All Policies (HiAP) was a term first used in Europe during the Finnish presidency of the European Union (EU), in 2006, with the aim of collaborating across sectors to achieve common goals. It is a strategy to include health considerations in policy making across different sectors that influence health, such as transportation, agriculture, land use, housing, public safety, and education. It reaffirms public health's essential role in addressing policy and structural factors affecting health, as articulated by the Ten Essential Public Health Services, and it has been promoted as an opportunity for the public health sector to engage a broader array of partners.

FOOD Programme

FOOD started in 2009 in six countries as a European project co-funded by the European Commission and gathering public and private partners to promote balanced nutrition. Since 2012, it has become an independent programme existing in 10 countries: Austria, Belgium, Czech Republic, France, Spain, Italy, Portugal, Romania, Slovakia and Sweden.


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Further reading