Health promotion

Editor-In-Chief: Gerald Waagen, D.C., Ph.D., Professor, Palmer College of Chiropractic West [mailto:gerald.waagen@palmer.edu]

Assistant Editor-In-Chief: Michelle Lew

Overview
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". Means of health promotion include health education and social marketing.

History
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". This definition was derived from the 1974 Lalonde report from the Government of Canada, 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". Another predecessor of the definition was the 1979 Healthy People report of the Surgeon General of the United States, 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".

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

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" . According to the Ottawa Charter, health promotion :
 * "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."

Altogether, the documents produced by conference attendees emphasized "investing in health promotion beyond an individual, disease-oriented, behaviour-change model".
 * 2nd International Conference on Health Promotion, Adelaide, 1988, which resulted in the "Adelaide Recommendations on Healthy Public Policy".
 * 3rd International Conference on Health Promotion, Sundsvall, 1991, which resulted in the "Sundsvall Statement on Supportive Environments for Health".
 * 4th International Conference on Health Promotion, Jakarta, 1997, which resulted in the "Jakarta Declaration on Leading Health Promotion into the 21st Century".
 * 5th Global Conference on Health Promotion, Mexico City, 2000, which resulted in the "Mexico Ministerial Statement for the Promotion of Health".
 * 6th Global Conference on Health Promotion, Bangkok, 2005, which resulted in the "Bangkok Charter for Health Promotion in a Globalized World".

Worksite health promotion
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. 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". 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".

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".
 * 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.
 * 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.
 * 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".
 * A meta-analysis of 22 studies published 1997-2007 determined that workplace health promotion interventions led to "small" reductions in depression and anxiety.
 * 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).

Health promotion 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. The International Union for Health Promotion and Education, based in France, holds international, regional, and national conferences.

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

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

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

United Kingdom
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. 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. 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".

United States
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".
 * 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".

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.
 * The Wellness Council of America is an industry trade group that supports workplace health promotion programs.
 * URAC accredits comprehensive wellness programs "that focus on health promotion, chronic disease prevention and health risk reduction".