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European capacity for health promotion at the national level1 |
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 Top European capacity for health... Overview of health promotion...National health promotion policyNational-level health promotion...References |
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The International Union for Health Promotion and Education (IUHPE) headquarters office in Paris is the Dissemination Centre for HP-Source.net, a web-based collection of data sets holding key information on health promotion infrastructure, policies and programs at the national level. Data sets already available at www.hp-source.net, or soon online, have foci on health promotion in Europe, European mental health, alcohol control policy in Europe and child and adolescent mental health policy in Australia, New Zealand and other countries and territories in the southern part of the Western Pacific Ocean. In Europe, Hp-Source.net data collection in eastern and central Europe is sponsored by the IUHPE-EURO Regional Committee. Other data sets are in the planning phase, expanding HP-Source.net from its origins in Europe to all continents. The details of the history and present activities of HP-Source.net are available elsewhere (www.hp-source.net) [1
]. Briefly, HP-Source.net aims to meet the need for a system of data collection and data dissemination on essential policy, infrastructure and practice useful not only to policy makers but also to service planners and deliverers, to educators and to researchers, among others. Starting from the network funded originally by the European Commission, with collaborators from 24 European countries, HP-Source.net has evolved into a voluntary, global collaboration of researchers, practitioners and policy makers, having the common goal to maximize the efficiency and effectiveness of health promotion by:
- Developing a uniform system for collecting information on health promotion policies, infrastructures and practices;
- Creating databases and an access strategy so that information can be accessed at inter-country, country and intra-country levels by policy makers, international public health organizations and researchers;
- Analyzing the databases to support the generation of models for optimum effectiveness and efficiency of health promotion policy, infrastructure and practice;
- Actively imparting this information and knowledge and actively advocating the adoption of models of proven effectiveness and efficiency by means of publications, seminars, conferences and briefings, among other means.
HP-Source.net consists today of a series of universally accessible online databases, referred to above, each of which documents the degree to which these key aspects of health promotion capacity are in place:
- Written national policy and priorities related to health promotion;
- Published evaluations of activities arising from health promotion policy;
- Publicly reported health promotion monitoring and/or surveillance activities;
- Research capacity and knowledge development for health promotion;
- National and local implementation of health promotion programs;
- Availability of education in health promotion at the graduate level;
- Professional associations;
- Funding earmarked for health promotion in national budgets.
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Overview of health promotion capacity in Europe |
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TopEuropean capacity for health...Overview of health promotion...National health promotion policyNational-level health promotion...References |
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Ten countries provided overviews of health promotion capacity using a common template. These were Austria, Czech Republic, Denmark, Latvia, Luxembourg, Netherlands, Norway, Spain, England and Scotland. The template consists of the following elements:
- (i) Policy
- (ii) Tackling health inequalities
- (iii) National/regional/local-level policies and programs
- (iv) Governance and accountability
- (v) Local strategies
- (vi) Research and development
- (vii) Capacity of health promotion/public health function
- (ii) Tackling health inequalities
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National health promotion policy |
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TopEuropean capacity for health...Overview of health promotion...National health promotion policyNational-level health promotion...References |
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The countries were asked to identify national health promotion policy documents that made explicit reference to the Ottawa Charter. The documents were defined in the following categories: Bills decided by Parliament, Government Green papers, Government White Papers, Government Committee proposals and others. Twenty-two of the 24 countries had published policy documents on one or more themes of the Ottawa Charter.
Policy documents were categorized as (i) having a focus mainly on disease prevention and the health sector, and typically aimed at life style factors and individual interventions (referred to hereafter as disease prevention policies) or (ii) having a focus mainly on several sectors including, but not limited to, the health sector, addressing determinates of health beyond life style and often making reference to the World Health Organization, the Ottawa Charter, Health for All, and Health 21 (referred to hereafter as health promotion policies).
Of the 22 countries responding, 13 had policy documents that may be characterized as having a health promotion focus. These were Austria, Denmark, Finland, Latvia, Luxembourg, Netherlands, Norway, Sweden, Switzerland and the UK countries England, Scotland, Northern Ireland and Wales. Many of these are countries that have had such policies in place for a long time and have long traditions as welfare states. The documents of these countries have a clear focus on structural conditions for health and well being and a inter-sector focus. Typically, these documents contain explicit statements regarding health as being the responsibility of several sectors of society, not just the health sector.
Importantly, all the countries having health promotion policies with a health promotion focus also had national bodies responsible for the implementation of policies. On the other hand, only one of the countries that mainly had disease prevention policies had national bodies that were responsible for the implementation of the policies. More research is needed to understand the processes by which national health promotion policies and national health promotion bodies come into existence and how the existence of one affects the existence of the other.
Figure 1 summarizes the state of health promotion capacity at the national level as characterized by the data collected in 2002–03.
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Figure 1 illustrates that while there was a way to go before most countries would have had comprehensive capacity for health promotion, each element of capacity existed in at least a handful of countries. This suggests the potential for developing health promotion capacity that exists in the many pan-European networks dedicated to health promotion's development. Exemplar policies existing in various countries provide a good starting point for countries wishing to develop such policies. The easy accessibility of these policies—and contact information for key organizations and persons—via the HP-Source.net database is a resource for health promotion's development. However, it is premature to expect such optimal use of the HP-Source.net data yet, since the project is just a few years in development and still growing.
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National-level health promotion capacity mapping in Europe (data entry 2005) |
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TopEuropean capacity for health...Overview of health promotion...National health promotion policyNational-level health promotion...References |
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Based on experience collecting and analyzing data from the 2002–03 database, major revisions in the data collection protocol were made to simplify data collection and automatic data entry. The general structure of the database remained intact but fewer questions were included and fewer open-ended questions were posed. Due to these changes, many more countries participated in the 2005 round of data collection including a large number in eastern and central Europe. Figure 2 summarizes the state of health promotion capacity as characterized by the 2005 database.
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The pattern of health promotion capacity illustrated from the 2005 data cannot be compared directly with Fig. 2 based on 2002–03 data because the samples are not the same and there are some differences in the items themselves. However, the general impression remains the same: no aspect of capacity exists in every country, but models of policy, infrastructure and key programs are available from every corner of Europe, available to any country that wishes to build on existing experience. The 2005 database contains many more eastern and central European countries than did the 2002–03 database. Examination of the state of health promotion capacity in the west of Europe compared with the east shows that in general capacity is greater in the West, not unexpectedly. However, it would be a mistake to assume that good exemplars are missing in eastern and central Europe. For example, Kazakhstan today reports having every element of capacity that is captured by the HP-Source.net database, if not sufficient amounts to meet all the needs. Also, some weaknesses seem as prevalent in the west and in the east. As a prime example, only 40% of countries have in-country systems/organizations in place to disseminate information about health promotion to health care professionals. This lack of capacity is just as evident in the west as in the east.
While much data is soon to be available from the 2005 round of data collection that will be useful in evaluating in some detail the state of health promotion capacity in every part of Europe, data collection has in fact just been completed and it will take some time to check and clean the data set, obviously important prior to any detailed analysis. However, even the preliminary analyses have identified one major difficulty related to tracking health promotion funding. Only 7 of 40 countries report that funding is earmarked for health promotion in the national budget, although it is clear that funding for health promotion is available through various lines not identified specifically as health promotion. For now, the best data we have regarding funding is judgments of HP-Source.net collaborators about funding trends in their countries. Of the 23 countries reporting, 5 reported the judgment that the recent trend in national-level health promotion funding has been steady, 2 report that funding levels have declined, and 16 report increases—in 5 countries the reported increase has been substantial. Thus, the overall trend is positive, although the data are admittedly subjective.
As a final note, perhaps the most important feature of HP-Source.net is that the documents which back up the data are almost all available via links at www.hp-source.net. For example, if a country is reported to have advanced training capacity in health promotion, links will normally be available to key documents, organizations and persons so that interested parties can access relevant information quickly and directly. That is, in fact, the core idea behind HP-Source.net—that it serves as a discovery tool, a portal, the use of which cuts time and effort to a minimum in the search for resources related to building capacity for health promotion.
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Notes |
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1 This text was extracted from a report prepared by the HP-Source.net Coordinating Centre at the University of Bergen in Norway for the WHO Regional Office for Europe as a background paper for the Sixth Global Conference on Health Promotion, Bangkok, 7–11 August 2005. A full list of the contributors to this document, partners, advisors, national counterparts and researchers is available on www.hp-source.net.
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References |
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TopEuropean capacity for health...Overview of health promotion...National health promotion policyNational-level health promotion...References |
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1. Mittelmark MB, Fosse E, Jones C, Davies M, Davies JK. Mapping European capacity to engage in health promotion at the national level: HP-Source.net. Promot Educ 2005 (Suppl. 1): 33–9.
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