Health promotion

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Editor-In-Chief: Gerald Waagen, D.C., Ph.D., Professor, Palmer College of Chiropractic West [1]

Assistant Editor-In-Chief: Michelle Lew

## Contents

* 1 Overview
* 2 History
* 3 Worksite health promotion
* 4 Health promotion entities and projects by country
* 4.1 International and multinational
* 4.2 Australia
* 4.3 Canada
* 4.4 New Zealand
* 4.5 United Kingdom
* 4.6 United States
* 5 See also
* 6 References
* 7 Further reading
* 8 External links

## Overview

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Health promotion has been defined by the 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"[1]. Means of health promotion include health education and social marketing [2].

## History

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The "first and best known" definition of health promotion, promulgated by the American Journal of Health Promotion since at least 1986, is "the science and art of helping people change their lifestyle to move toward a state of optimal health"[3][4]. This definition was derived 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"[5]. 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"[6].

At least two publications led to a "broad empowerment/environmental" definition of health promotion in the mid-1980s[3]:

* In 1984 the World Health Organization (WHO) Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health"[7]. In addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organisational change, community development and spontaneous local activities against health hazards" as health promotion methods[7].
* In 1986, Jake Epp, Canadian Minister of National Health and Welfare, released Achieving health for all: a framework for health promotion which also came to be known as the "Epp report"[3][8]. This report defined the three "mechanisms" of health promotion as "self-care"; "mutual aid, or the actions people take to help each other cope"; and "healthy environments"[8].

The WHO, in collaboration with other organizations, has subsequently co-sponsored international conferences on health promotion as follows:

* 1st International Conference on Health Promotion, Ottawa, 1986, which resulted in the "Ottawa Charter for Health Promotion"[9]. According to the Ottawa Charter, health promotion[9]:
* "is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being"
* "aims at making... [political, economic, social, cultural, environmental, behavioural and biological factors] favourable through advocacy for health"
* "focuses on achieving equity in health"
* "demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and by the media"
* "should be adapted to the local needs and possibilities of individual countries and regions to take into account differing social, cultural and economic systems"

In addition, the Ottawa Charter conceptualized "health promotion action" as "Build Healthy Public Policy," "Create Supportive Environments," "Strengthen Community Actions," "Develop Personal Skills," "Reorient Health Services" (i.e., "beyond its responsibility for providing clinical and curative services"), and "Moving into the Future."

* 2nd International Conference on Health Promotion, Adelaide, 1988, which resulted in the "Adelaide Recommendations on Healthy Public Policy"[10].
* 3rd International Conference on Health Promotion, Sundsvall, 1991, which resulted in the "Sundsvall Statement on Supportive Environments for Health"[11].
* 4th International Conference on Health Promotion, Jakarta, 1997, which resulted in the "Jakarta Declaration on Leading Health Promotion into the 21st Century"[12].
* 5th Global Conference on Health Promotion, Mexico City, 2000, which resulted in the "Mexico Ministerial Statement for the Promotion of Health"[13].
* 6th Global Conference on Health Promotion, Bangkok, 2005, which resulted in the "Bangkok Charter for Health Promotion in a Globalized World"[14].

Altogether, the documents produced by conference attendees emphasized "investing in health promotion beyond an individual, disease-oriented, behaviour-change model"[15].

## Worksite health promotion

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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[16]. 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"[17][18]. 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"[19].

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. Reviews and meta-analyses published between 2005 and 2008 that examined the scientific literature on worksite health promotion programs include the following:

* A review of 13 studies published through January 2004 showed "strong evidence... for an effect on dietary intake, inconclusive evidence for an effect on physical activity, and no evidence for an effect on health risk indicators"[20].
* In the most recent of a series of updates to a review of "comprehensive health promotion and disease management programs at the worksite," Pelletier (2005) noted "positive clinical and cost outcomes" but also found declines in the number of relevant studies and their quality[21].
* A "meta-evaluation" of 56 studies published 1982-2005 found that worksite health promotion produced on average a decrease of 26.8% in sick leave absenteeism, a decrease of 26.1% in health costs, a decrease of 32% in workers’ compensation costs and disability management claims costs, and a cost-benefit ratio of 5.81[22].
* A meta-analysis of 46 studies published 1970-2005 found moderate, statistically significant effects of work health promotion, especially exercise, on "work ability" and "overall well-being"; furthermore, "sickness absences seem to be reduced by activities promoting healthy lifestyle"[23].
* A meta-analysis of 22 studies published 1997-2007 determined that workplace health promotion interventions led to "small" reductions in depression and anxiety[24].
* A review of 119 studies suggested that successful work site health-promotion programs have attributes such as: assessing employees' health needs and tailoring programs to meet those needs; attaining high participation rates; promoting self-care; targeting several health issues simultaneously; and offering different types of activities (e.g., group sessions as well as print materials)[25].

## Health promotion entities and projects by country

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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

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The WHO and its Regional Offices such as the Pan American Health Organization are influential in health promotion around the world[26]. The International Union for Health Promotion and Education, based in France, holds international, regional, and national conferences[27][28].

### Australia

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The Australian Health Promotion Association, a professional body, was incorporated in 1988[29]. In November 2008, the National Health and Hospitals Reform Commission released a paper recommending a national health promotion agency[30]. ACT Health of the Australian Capital Territory supports health promotion with funding and information dissemination[31]. The Victorian Health Promotion Foundation (VicHealth)] from the state of Victoria was "the world’s first health promotion foundation"[32].

### Canada

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The province of Ontario appointed a health promotion minister to lead its Ministry of Health Promotion in 2005[33]. 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[34]. The BC Coalition for Health Promotion is "a grassroots, voluntary non-profit society dedicated to the advancement of health promotion in British Columbia"[35].

### New Zealand

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The Health Promotion Forum of New Zealand is the national umbrella organization of over 150 organisations committed to improving health[36][37].

### United Kingdom

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CHAPS is "a partnership of community-based organisations, co-ordinated by Terrence Higgins Trust, carrying out HIV health promotion with gay men in England]] and Wales" that has been funded since 1996[38][39]. In October 2008, the Royal Society for the Promotion of Health merged with the Royal Institute of Public Health to form the Royal Society for Public Health[40]. The Health Promotion Agency for Northern Ireland, part of the government, "provide[s] leadership, strategic direction and support, where possible, to all those involved in promoting health in Northern Ireland"[41].

### United States

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Government agencies in the U.S. concerned with health promotion include:

* The Centers for Disease Control and Prevention has a Coordinating Center for Health Promotion who mission is "Prevent disease, improve health, and enhance human potential through evidence based interventions and research in maternal and child health, chronic disease, disabilities, genomics, and hereditary disorders"[42][43].
* The United States Army Center for Health Promotion and Preventive Medicine "provide[s] worldwide technical support for implementing preventive medicine, public health, and health promotion/wellness services into all aspects of America's Army and the Army Community"[44].

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

* The Public Health Education and Health Promotion Section is an active component of the American Public Health Association[45].
* The Wellness Council of America is an industry trade group that supports workplace health promotion programs[46][47].
* URAC accredits comprehensive wellness programs "that focus on health promotion, chronic disease prevention and health risk reduction"[48].

## See also

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* American Academy of Health Behavior
* Health 2.0
* Health 21
* Health disparities
* Health literacy
* Health promoting hospitals
* Health promotion in higher education
* Prevention (medical)
* Social determinants of health

## References

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1. ↑ Participants at the 6th Global Conference on Health Promotion. The Bangkok Charter for health promotion in a globalized world. Geneva, Switzerland: World Health Organization, 2005 Aug 11. Accessed 2009 Feb 4.
2. ↑ Bunton R, Macdonald G. Health promotion: disciplines, diversity, and developments. 2nd ed. London & New York: Routledge, 2002. ISBN 0415235693.
3. ↑ 3.0 3.1 3.2 3.3 3.4 Minkler M. Health education, health promotion and the open society: an historical perspective. Health Educ Q 1989 Spring;16(1):17-30.
4. ↑ American Journal of Health Promotion. Accessed 2009 Feb 4.
5. ↑ Lalonde M. A new perspective on the health of Canadians. A working document. Ottawa: Government of Canada, 1974.
6. ↑ Healthy people: the Surgeon General's report on health promotion and disease prevention. Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, Office of the Assistant Secretary for Health and Surgeon General, 1979. DHEW (PHS) Publication No. 79-55071. Accessed 2009 Feb 4.
7. ↑ 7.0 7.1 A discussion document on the concept and principles of health promotion. Health Promot 1986 May;1(1):73-6. Accessed 2009 Feb 4.
8. ↑ 8.0 8.1 Epp J. Achieving health for all. A framework for health promotion. Health Promot 1986;1(4):419-28. Accessed 2009 Feb 4.
9. ↑ 9.0 9.1 The Ottawa Charter for Health Promotion. First International Conference on Health Promotion, Ottawa, 21 November 1986. Accessed 2009 Feb 4.
10. ↑ Adelaide Recommendations on Healthy Public Policy. Second International Conference on Health Promotion, Adelaide, South Australia, 5-9 April 1988. Accessed 2009 Feb 4.
11. ↑ Sundsvall Statement on Supportive Environments for Health. Third International Conference on Health Promotion, Sundsvall, Sweden, 9-15 June 1991. Accessed 2009 Feb 4.
12. ↑ Fourth International Conference on Health Promotion. New players for a new era - leading health promotion into the 21st century. Accessed 2009 Feb 4.
13. ↑ Fifth Global Conference on Health Promotion. Health Promotion: Bridging the Equity Gap, Mexico City, June 5th, 2000. Accessed 2009 Feb 4.
14. ↑ The 6th Global Conference on Health Promotion. Accessed 2009 Feb 4.
15. ↑ de Leeuw E, Tang KC, Beaglehole R. Ottawa to Bangkok -- health promotion's journey from principles to 'glocal' implementation. Health Promot Int 2006 Dec;21 Suppl 1:1-4.
16. ↑ Tones K, Tilford S. Health promotion: effectiveness, efficiency and equity. 3rd ed. Cheltenham, UK: Nelson Thornes, 2001. ISBN 0748745270.
17. ↑ European Network for Workplace Health Promotion. Workplace health promotion. Accessed 2009 Feb 4.
18. ↑ World Health Organization. Workplace health promotion. Benefits. Accessed 2009 Feb 4.
19. ↑ World Health Organization. Workplace health promotion. The workplace: a priority setting for health promotion. Accessed 2009 Feb 4.
20. ↑ Engbers LH, van Poppel MN, Chin A Paw MJ, van Mechelen W. Worksite health promotion programs with environmental changes: a systematic review. Am J Prev Med 2005 Jul;29(1):61-70. Accessed 2009 Feb 4.
21. ↑ Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VI 2000-2004. J Occup Environ Med 2005 Oct;47(10):1051-8. Accessed 2009 Feb 4.
22. ↑ Chapman LS. Meta-evaluation of worksite health promotion economic return studies: 2005 update. Am J Health Promot 2005 Jul-Aug;19(6):1-11. Accessed 2009 Feb 4.
23. ↑ Kuoppala J, Lamminpää A, Husman P. Work health promotion, job well-being, and sickness absences - a systematic review and meta-analysis. J Occup Environ Med 2008 Nov;50(11):1216-27. Accessed 2009 Feb 4.
24. ↑ Martin A, Sanderson K, Cocker F. Meta-analysis of the effects of health promotion intervention in the workplace on depression and anxiety symptoms. Scand J Work Environ Health 2008 Dec 9. [Epub ahead of print.] Accessed 2009 Feb 4.
25. ↑ Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health-promotion programs. Annu Rev Public Health 2008;29:303-23.
26. ↑ Kickbusch I. The contribution of the World Health Organization to a new public health and health promotion. Am J Public Health 2003 Mar;93(3):383-8. Accessed 2009 Feb 4.
27. ↑ International Union for Health Promotion and Education. Accessed 2009 Feb 4.
28. ↑ Cheung, Robin. Overall health and wellbeing deserves more than lip service. South China Morning Post 2007 Jul 7.
29. ↑ Australian Health Promotion Association. Providing knowledge, resources and perspective. Accessed 2009 Feb 4.
30. ↑ Cresswell, Adam. Plan for agency to prevent illness. The Australian 2008 Nov 7. Accessed 2009 Feb 4.
31. ↑ ACT Health Promotion. Online support for health promotion workers in the ACT. Accessed 2009 Feb 4.
32. ↑ About VicHealth. Accessed 2009 Feb 4.
33. ↑ Benzie, Robert. Obesity now on Ontario hit list - Health promotion minister's new job. Toronto Star 2005 Jul 14.
34. ↑ Goar C. Conservatives axe health network. Toronto Star 2007 Nov 16. Accessed 2009 Feb 4.
35. ↑ BC Coalition for Health Promotion. Who we are. Accessed 2009 Feb 4.
36. ↑ Health Promotion Forum of New Zealand. Accessed 2009 Feb 4.
37. ↑ Wise M, Signal L. Health promotion development in Australia and New Zealand. Health Promot Int 2000;15(3):237-248. Accessed 2009 Feb 4.
38. ↑ About Chaps. Accessed 2009 Feb 4.
39. ↑ Department of Health, United Kingdom. Minister announces boost for gay men's health. 2007 Mar 6. Accessed 2009 Feb 4.
40. ↑ Sim F, Mackie P. A time of change and erosion of borders. Public Health 2008 Oct;122(10):979-80. Accessed 2009 Feb 4.
41. ↑ Health Promotion Agency for Northern Ireland. What is the HPA? Accessed 2009 Feb 4.
42. ↑ Smith, Sandy. The CDC reorganization and its impact on NIOSH. EHS Today 2004 May 28. Accessed 2009 Feb 4.
43. ↑ Centers for Disease Control and Prevention. About CDC’s Coordinating Center for Health Promotion. 2008 Jul 2. Accessed 2009 Feb 4.
44. ↑ U.S. Army Center for Health Promotion and Preventive Medicine. About USACHPPM. Accessed 2009 Feb 4.
45. ↑ McQueen DV, Kickbusch I. Health and modernity: the role of theory in health promotion. New York: Springer, 2007. ISBN 9780387377575. Page 15.
46. ↑ Wellness Council of America. WELCOA overview. Accessed 2009 Feb 4.
47. ↑ Hobart honored as state's first "well city." Wellness Council of America honors city for promoting safe workplaces. Post-Tribune (IN) 2000 Oct 16.
48. ↑ URAC announces accreditation standards for Comprehensive Wellness programs. Washington, D.C.: URAC, 2008 Nov 19. At Accessed 2009 Feb 4.

## Further reading

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* Taylor RB, Ureda JR, Denham JW. Health promotion: principles and clinical applications. Norwalk, CT: Appleton-Century-Crofts, 1982. ISBN 0838536700.
* Dychtwald K. Wellness and health promotion for the elderly. Rockville, MD: Aspen Systems Corp., 1986. ISBN 0871892383.
* Green LW, Lewis FM. Measurement and evaluation in health education and health promotion. Palo Alto, CA: Mayfield Pub. Co., 1986. ISBN 0874844819.
* Teague ML. Health promotion programs: achieving high-level wellness in the later years. Indianapolis: Benchmark Press, 1987. ISBN 0936157089.
* Heckheimer E. Health promotion of the elderly in the community. Philadelphia: W.B. Saunders, 1989. ISBN 0721621368.
* Fogel CI, Lauver D. Sexual health promotion. Philadelphia: W.B. Saunders, 1990. ISBN 072163799X.
* Hawe P, Degeling D, Hall J. Evaluating health promotion: a health worker's guide. Sydney & Philadelphia: MacLennan+Petty, 1990. ISBN 0864330677.
* Dines A, Cribb A. Health promotion: concepts and practice. Oxford, England & Cambridge, MA, USA: Blackwell Science, 1993. ISBN 0632035439.
* Downie RS, Tannahill C, Tannahill A. Health promotion: models and values. 2nd ed. Oxford & New York: Oxford University Press, 1996. ISBN 0192625926.
* Seedhouse, David. Health promotion: philosophy, practice, and prejudice. New York: J. Wiley, 1997. ISBN 0471939102.
* Bracht NF. Health promotion at the community level: new advances. 2nd ed. Thousand Oaks: Sage Publications, 1999. ISBN 0761918442.
* Green LW, Kreuter MW. Health promotion planning: an educational and ecological approach. 3rd ed. Mountain View, CA: Mayfield Pub. Co., 1999. ISBN 0767405242.
* Naidoo J, Wills J. Health promotion: foundations for practice. 2nd ed. Edinburgh & New York: Baillière Tindall, 2000. ISBN 0702024481.
* DiClemente RJ, Crosby RA, Kegler MC. Emerging theories in health promotion practice and research: strategies for improving public health. San Francisco: Jossey-Bass, 2002. ISBN 0787955663.
* O'Donnell MP. Health promotion in the workplace. 3rd ed. Albany: Delmar Thomson Learning, 2002. ISBN 0766828662.
* Cox CC, American College of Sports Medicine. ACSM's worksite health promotion manual: a guide to building and sustaining healthy worksites. Champaign, IL: Human Kinetics, 2003. ISBN 0736046577.
* Lucas K, Lloyd BB. Health promotion: evidence and experience. London & Thousand Oaks, CA: Sage, 2005. ISBN 0761940057.
* Bartholomew LK, Parcel GS, Kok G, Gottlieb NH. Planning health promotion programs: an intervention mapping approach. 2nd ed. San Francisco: Jossey-Bass, 2006. ISBN 078797899X.
* Edelman CL, Mandle CL. Health promotion throughout the life span. 6th ed. St. Louis, MO: Mosby Elsevier, 2006. ISBN 0323031285.
* Pender NJ, Murdaugh CL, Parsons MA. Health promotion in nursing practice. 5th ed. Upper Saddle River, NJ: Prentice Hall, 2006. ISBN 0131194364.
* Leddy, Susan. Health promotion: mobilizing strengths to enhance health, wellness, and well-being. Philadelphia: F.A. Davis, 2006. ISBN 0803614055.
* Chenoweth DH. Worksite health promotion. 2nd ed. Champaign, IL: Human Kinetics, 2007. ISBN 9780736060417.
* Cottrell RR, Girvan JT, McKenzie JF. Principles & foundations of health promotion and education. 4th ed. San Francisco: Benjamin Cummings, 2008. ISBN 9780321532350.
* Murray RB, Zentner JP, Yakimo R. Health promotion strategies through the life span. 8th ed. Upper Saddle River, NJ: Pearson Prentice Hall, 2009. ISBN 9780135138663.
* McKenzie JE, Thackeray R, Neiger BL. Planning, implementing, and evaluating health promotion programs: a primer. 5th ed. San Francisco: Benjamin Cummings, 2009. ISBN 9780321495112.

## External links

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* Template:Dmoz
* Healthy Cities – WHO EURO Office
* HSE Health Promotion Website from the Health Service Executive, Republic of Ireland
* Politics of Health Group

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