IUHPE NEWS
The International Union for Health Promotion and Education, in collaboration with the Canadian Consortium for Health Promotion Research, and with support from the Public Health Agency of Canada, have formulated recommendations on priorities for action regarding the policies and system conditions necessary for sustainable and effective health promotion. The statement, launched in June in Vancouver at the IUHPE World Conference on Health Promotion and Health Education, and reproduced below, is the product of of an international Project Advisory Group's reflections derived from a collection of commissioned field reports on renewing commitment to the path set out by the Ottawa Charter. The field reports themselves will be published in their entirety in a special issue of ‘Promotion & Education’, IUHPE's International Journal of Health Promotion and Education, in December 2007. |
Shaping the Future of Health Promotion: Priorities for Action |
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The mission of the International Union for Health Promotion and Education (IUHPE) is to promote global health and to contribute to the achievement of equity in health between and within countries of the world.
Health is a basic human need. It is fundamental to the successful functioning of individuals and of societies. Health promotion aims to empower people to control their own health by gaining control over the underlying factors that influence health. The main determinants of health are people's cultural, social, economic and environmental living conditions, and the social and personal behaviours that are strongly influenced by those conditions.
The Ottawa Charter of 1986 laid a solid foundation for the theory and practice of health promotion, which has stood the test of time. As we move forward in the 21st century, health promotion researchers, practitioners and policy-makers must build on what has been learnt about effective health promotion in different parts of the world, putting widely into practice what works to ensure that all countries and regions fully implement the ambitions of the Ottawa Charter. At the same time, we need to adjust our approach to health promotion to meet emerging challenges to health for all.
This Statement is intended for all those working to promote health, setting out recommendations for strengthening health promotion. It does not stand alone but is supported by a whole programme of work that the IUHPE has underway, to constantly improve health promotion's contribution to the betterment of the human condition.
New challenges, new approaches
Recommitment to the ideas of the Ottawa Charter and strengthening the conditions for effective health promotion are urgent matters. Health inequalities within and between nations are increasing worldwide. With the rise of globalisation, trans-boundary influences on the determinants of health often lie beyond the dominion of individuals, communities and nations. Population growth, urbanisation and consumerism are stretching global resources beyond the limit, and critically damaging the environment. Alongside the increased spread of communicable diseases, the burden of chronic disease is now falling on the most disadvantaged societies.
Health promotion must do its part to address these new challenges. With two decades of experience since Ottawa, we turn to the task of shaping the future of health promotion in the 21st century.
Putting healthy public policy into practice
In many parts of the world health promotion goals and processes are firmly embedded in national and multinational health policies, objectives and targets. The focus of health promotion on the prerequisites for health and equity in health is recognised nationally and globally through the Millennium Development Goals and other policies to address the social and economic determinants of health, and inequalities in health.
The Ottawa Charter's call to work in partnership with other sectors to develop healthier public policy has been widely adopted and implemented locally and nationally. This has taken shape in various ways, reflecting social, cultural and economic contexts and the stage of development of health promotion practice. In nations and cities there are many excellent examples of health policies targeting risk factors and disease reduction, and policies in other sectors focusing on the determinants of health. Comprehensive national policy that integrates actions to improve health and social and economic conditions across sectors is seen more rarely.
Health improvement should be a stated objective of policies in all sectors based on the solid evidence that healthy and more equitable societies are successful societies.
Without the means to deliver its goals, healthy public policy is little more than rhetoric. It is imperative that we draw on existing models of effective health promotion policy at national and local levels to demonstrate its contribution across the span of the policy agenda from action on individual lifestyles to social and economic determinants.
Health promotion policy must articulate what is required in the way of systems, infrastructures, institutions, resources and skills for effective action to deliver healthy public policy.
The need for international action is imperative. National policies have little influence on the potential health impacts of the globalisation of trade and consumerism.
Health promotion must work in harness with consumers and civil society to strengthen efforts to advocate for healthy transnational policies and corporate social responsibility.
Strengthening structures and processes in all sectors
Successful health promotion is delivered through whole systems approaches encompassing all sectors.
To act effectively on the determinants of health, all sectors including healthcare, education, environment, transport, housing, and commerce must take responsibility for promoting health.
The Healthy Cities movement provides successful models for the delivery of integrated inter-sector health promotion based on coordinated healthy public policy. Comprehensive health promotion programmes using a range of interventions with individuals and their environments have also been widely successful in schools and workplaces providing models of good practice in the delivery of integrated complex health promotion interventions.
Health-promoting schools and health-promoting workplaces act effectively on health behaviours and their determinants, and the reach of settings based health promotion should be greatly expanded.
In the health sector, health promotion specialists provide education and training to health care workers and organisational development to develop health promoting hospitals and primary health care, but they should not necessarily shoulder the burden of the provision of preventive health services.
While progress has been made, more needs to be done to reorient the healthcare sector to take greater responsibility for health promotion and chronic disease management as an integral part of service delivery, and an effective contribution to the containment of rising healthcare costs.
Health promotion also has an important role in countering and managing new and re-emergent major health threats.
To address increasing global concerns about the control of communicable disease and chemical, environmental, radiological and biological threats to health, health protection must draw on the health promotion skills of health education and public communication.
Development and co-ordination of local health promotion infrastructure and activity requires national facilitation through government agencies and non-governmental organisations.
National level centres of excellence in health promotion are vital for policy advocacy, the integration of diverse health promotion activities, and technical support - through information provision, knowledge collation, and capacity-building.
A few countries have successfully introduced hypothecated taxation, derived from tobacco or alcohol tax revenues, creating a sustainable source of funding for health promotion and increasing its profile and bargaining power. Others have dedicated a percentage of national health insurance funds to health promotion or created health promotion foundations. Using evidence in making policy, and developing a visible, competent health promotion workforce has a positive impact on funding. Significantly raised funding streams allow the development of technical health promotion capacity and increase the population reach and impact of health promotion programmes. If progress is to be made in reflecting health promotion in national accounts and for international comparisons, an agreed operational definition for health promotion budgets is required.
While specific disease prevention programmes may be attractive to funders, a comprehensive technical skills base will underpin all health promotion programmes, avoiding duplication of effort and the creation of silos of uncoordinated activity.
Adequate funding is essential to ensure the availability and sustainability of technical and scientific health promotion expertise and research, and comprehensive action on the determinants of inequity in health.
Towards knowledge-based practice
The requirement to work in an evidence-based way has challenged health promotion practice in recent years. Health promotion uses complex processes acting on complex social phenomena, which are not readily evaluated by traditional experimental research methods. Rigorous systematic review methodologies, drawing on both quantitative and qualitative research appropriate for judging the effectiveness of health promotion actions, exist. Health promotion has succeeded in influencing the healthcare evidence ‘industry’ to recognise the importance of the evaluation of intervention processes and quality, but significant gaps in knowledge remain.
Knowledge-based practice necessitates a rapid increase in the proportion of research funding spent on evaluating complex, community-based health promotion interventions, longitudinal studies, impacts of policy and effect on health inequities.
There is a substantial body of knowledge of effective health promotion interventions that meets internationally recognised standards, but it is not routinely used.
Evidence on the effectiveness and cost-effectiveness of health promotion actions must be translated into guidance for policy and practice, clearly communicated and applied. Policy-makers and health promotion practitioners must know how to access and use available information and evidence.
Health promoters must increase their competence in formative and summative evaluation of interventions, and share learning of what works within and between countries. This will broaden the knowledge base for health promotion while respecting different research perspectives and cultural traditions, and ensuring rigour in research methods and quality control of interventions.
National and transnational mechanisms for the collection, collation and transfer of knowledge of effective health promotion must be extended to improve practice.
Health improvement goals and targets are dependent on the existence of robust information systems to monitor progress. However, access to good quality data on public health and its determinants varies enormously amongst countries. Where information is available, it should be used routinely in planning and evaluating health promotion programmes. However, we need to further develop and use indicators that demonstrate health promotion processes, and that monitor progress in promoting health, in addition to reducing mortality and morbidity.
There is an urgent need to develop internationally comparable data systems that integrate information on health promotion, public health and social determinants.
Building a competent health promotion workforce
Workforce capacity and capability for health promotion is well developed in only a few countries, and under resourced or entirely lacking in many.
In all parts of the world there is a pressing requirement for further investment in the education and training of health promotion specialists, practitioners and other workers. Essential training should include: developing the knowledge and skills for advocacy and mediation with politicians and the private sector, assessing the impact of policies on health and its determinants, accessing and using available information and evidence, and evaluating interventions.
Urgent and sustained attention is required to strengthen the capacity of academic health promotion. Appropriate alliances are needed with professionals and academics from related fields that share the common goal of promoting health, while acknowledging that health promotion is a distinct field and body of knowledge in its own right. Health education based on sound educational principles and practice is an important integral health promotion strategy.
Closer links and coalitions must be made with complementary disciplines such as public health, nursing, environmental health, education, psychology, social sciences, management sciences, development studies et cetera, which contribute both conceptually and practically to health promotion.
The recognition of specialist health promotion competence through professional accreditation schemes can be helpful to increase training and visibility of the field, and extend the sharing of skills and knowledge more widely to others.
Transnational agreement on health promotion core competencies is needed to further define the field and provide common direction for curriculum development.
Empowering communities
Empowering individuals and communities, valuing the assets they bring to improve health, is a fundamental health promotion principle. Empowerment is proven to be an effective tool for health improvement and a legitimate public health goal in its own right. Health promotion strategies that strengthen community action and involvement in planning, policy-making, delivery and evaluation of health promotion programmes, are powerful and successful all over the world.
In many places it is standard practice for community voices to be heard in policy and planning processes, with co-responsibility for action being a guiding principle. Health promotion has thrived at community level even when the national policy environment has been less supportive.
Health promotion programmes are most successful when linked to the normal daily life of communities, building on local traditions and led by community members.
Civil society significantly influences local, national and global policy through advocacy, organising, mobilisation, choice of goods and services, and the ballot box. Communication technology has become ubiquitous in the last decade, linking communities and social networks globally. Its potential to improve health, through increased information, support and social mobilisation, is increasing as the digital divide decreases.
To influence future healthy public policy we must work hand in hand with communities and civil society, and ensure that our communications are accessible to all and understood by all.
Health promotion is now established as a recognised field in some parts of the world, while it is still emerging in others. We are on course to realise the aspirations of the Ottawa Charter, but now need to implement it fully, in all parts of the world, in ways that best fit local political, cultural, social and economic conditions, to address 21st century challenges to health.
Health Promotion Milestones --
- Declaration of Alma Ata on Primary Health Care (1978)
- Ottawa Charter for Health Promotion (1986)
- Sundsvall Statement on Supportive Environments for Health (1991)
- Jakarta Declaration on Leading Health Promotion into the 21st Century (1997)
- Adelaide Recommendations on Healthy Public Policy (1998)
- Mexico Ministerial Statement for the Promotion of Health (2000)
- The Bangkok Charter for Health Promotion in a Globalized World (2005)
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