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".

World Health Organization Specialized agency of the United Nations

The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations.

The Ottawa Charter for Health Promotion is the name of an international agreement signed at the First International Conference on Health Promotion, organized by the World Health Organization (WHO) and held in Ottawa, Canada, in November 1986. It launched a series of actions among international organizations, national governments and local communities to achieve the goal of "Health For All" by the year 2000 and beyond through better health promotion.



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]

The Bangkok Charter for Health Promotion in a Globalized World is the name of an international agreement reached among participants of the 6th Global Conference on Health Promotion held in Bangkok, Thailand in August 2005, convened by the World Health Organization. It identifies actions, commitments and pledges required to address the determinants of health in a globalized world through health promotion.

Health is a state of physical, mental and social well-being in which disease and infirmity are absent.

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.

Public policy is the principled guide to action taken by the administrative executive branches of the state with regard to a class of issues, in a manner consistent with law and institutional customs. There has recently been a movement for greater use of evidence in guiding policy decisions. Proponents of evidence-based policy argue that high quality scientific evidence, rather than tradition, intuition, or political ideology, should guide policy decisions.

The social determinants of health are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk for a disease, or vulnerability to disease or injury. The distributions of social determinants are often shaped by public policies that reflect prevailing political ideologies of the area. The World Health Organization says, "This unequal distribution of health-damaging experiences is not in any sense a 'natural' phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements [where the already well-off and healthy become even richer and the poor who are already more likely to be ill become even poorer], and bad politics."

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.

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]

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 promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the 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.

Social marketing has the primary goal of achieving "social good". Traditional commercial marketing aims are primarily financial, though they can have positive social effects as well. In the context of public health, social marketing would promote general health, raise awareness and induce changes in behaviour. Social marketing has been a large industry for some time now and was originally done with newspapers and billboards, but similar to commercial marketing has adapted to the modern world. The most common use of social marketing in today's society is through social media.. However, to see social marketing as only the use of standard commercial marketing practices to achieve non-commercial goals is an oversimplified view.


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]

The Lalonde Report is a 1974 report produced in Canada formally titled A new perspective on the health of Canadians. It proposed the concept of the "health field", identifying two main health-related objectives: the health care system; and prevention of health problems and promotion of good health. The report is considered the "first modern government document in the Western world to acknowledge that our emphasis upon a biomedical health care system is wrong, and that we need to look beyond the traditional health care system if we wish to improve the health of the public."

Canada Country in North America

Canada is a country in the northern part of North America. Its ten provinces and three territories extend from the Atlantic to the Pacific and northward into the Arctic Ocean, covering 9.98 million square kilometres, making it the world's second-largest country by total area. Its southern border with the United States, stretching some 8,891 kilometres (5,525 mi), is the world's longest bi-national land border. Canada's capital is Ottawa, and its three largest metropolitan areas are Toronto, Montreal, and Vancouver.

Surgeon General of the United States Head of the U.S. Public Health Service Commissioned Corps

The surgeon general of the United States is the operational head of the U.S. Public Health Service Commissioned Corps (PHSCC) and thus the leading spokesperson on matters of public health in the federal government of the United States. The surgeon general's office and staff are known as the Office of the Surgeon General (OSG) which is housed within the Office of the Assistant Secretary for Health.

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.

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:

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]


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:

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]


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]


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:

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]


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.[ 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. [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:

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

See also

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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.

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Workplace health promotion

Workplace health promotion is the combined efforts of employers, employees, and society to improve the mental and physical health and well-being of people at work. The term workplace health promotion denotes a comprehensive analysis and design of human and organizational work levels with the strategic aim of developing and improving health resources in an enterprise.

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Further reading