Health promoting hospitals

Introduction
Health Promoting Hospitals (HPH) is a network of the World Health Organization - Regional Office for Europe. It is based on the health promotion philosophy of the World Health Organization (WHO) as outlined in the WHO Ottawa Charter for Health Promotion (WHO 1986) which was re-confirmed in the WHO Bangkok Charter for Health Promotion in a Globalised World (WHO 2005). The Ottawa Charter lists five action areas for health promotion, of which health care services are one:

The responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health service institutions and governments.

They must work together towards a health care system which contributes to the pursuit of health. The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services. Health services need to embrace an expanded mandate which is sensitive and respects cultural needs. This mandate should support the needs of individuals and communities for a healthier life, and open channels between the health sector and broader social, political, economic and physical environmental components.

Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization of health services which refocuses on the total needs of the individual as a whole person. (Ottawa Charter, WHO 1986)

Accordingly, HPHs aim at improving the health gain of hospitals (and other health services) by a bundle of strategies targeting ´
 * patients,
 * staff and
 * the community.

Short history of HPH
Based on the Ottawa Charter, first conceptual developments on HPH started in 1988. A first model project "Health and Hospital", was initiated in 1989 at the Rudolfstiftung Hosptial in Vienna, Austria, and successfully finished in 1996. 10 model documents (in German language) summarise the learnings from the pilot project and are available online to guide hospital projects related to health promotion.

In 1990, the WHO International Network of Health Promoting Hospitals was founded as a multi city action plan of the WHO Healthy Cities Network. In 1991, the HPH network, which was in the beginning an alliance of experts, launched its first policy document, the Budapest Declaration on Health Promoting Hospitals. This document introduces the HPH concept and target groups - patients, staff, community - as well as related HPH strategies and action areas.

In order to implement HPH on a broader basis, a European Pilot Hospital Project of Health Promoting Hospitals was initiated in 1993, and finisehd in 1997. 20 hospitals from 11 European countries participated, 19 of which finished the project successfully. Also in 1993, the first international HPH conference was organised, and the first international HPH Newsletter was published.

Since 1995, national and regional networks of HPH, all coordinated by their own national or regional coordinating centres, are being implemented and developed in order to disseminate HPH to as many hospitals and health care institutions as possible. The development of the HPH networks called for a new policy document: The Vienna Recommendations on Health Promoting Hospitals were launched in 1997.

In 2007, HPH has become a global movement with networks, single partner hospitals and initiatives in all continents, although most hospitals and networks are located in Europe. HPH currently exists in Australia, Austria, Belgium, Bulgaria, Canada, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Ireland, Israel, Italy, Lithuania, Northern Ireland, Norway, Poland, Russian Federation, Scotland, Serbia, Slovakia, South Africa, Sweden, Switzerland, Thailand, Taiwan.

In addition, several task forces develop specific HPH concepts, strategies and tools on specific subjects or for specific clinical areas:


 * Health Promoting Psychiatric Services
 * Migrant Friendly and Culturally Competent Hospitals


 * Health promotion for children and adolescents in hospitals

HPH: The concept
HPH combines a vision, a concept, and a set of 18 core strategies and 5 standards.

In accordance to health promotion theory, the HPH standards and strategies are based on the principles of the settings approach, empowerment and enablement, participation, a holistic concept of health (somato-psycho-social concept of health), intersectoral cooperation, equity, sustainability, and multi-stratgy (Rootman et al. 2001).

In order to realise the full potential of the comprehensive HPH approach for increasing the health gain of hospital patients, staff, and the community, HPH needs to be supported by an organisatial structure: Support from top management, a management structure that embraces all organisatial units, a budget, specific aims and targets, action plans, projects, and programs, standards, guidelines and other tools for implementing health promotion into everyday business. This needs to be supported by evaluation and monitoring, professional training and education, research and dissemination.

One way to implement HPH in a hospital or other health care organisation is by linking HPH aims and targets with quality management, thus understanding health promotion as one specific quality aspect in hospitals and health care. Ideally any managerial or professional decision in an HPH should also consider the health / disease impact of that decision, together with other decision criteria (e.g. effectivness, sustainability).

HPH structure
The internatinoal HPH Network was initiated by and is affiliated to WHO-Euro. It is goverened by a steering committee which is composed of elected national / regional network coordinators and representatives of WHO and WHO Collaborating Centres who support the network internationally:

The WHO Collaborating Centre on Evidence Based Health Promotion in Hospitals, Copenhagen, Denmark, runs amongst others the international network secretariat. The WHO Collaborating Centre on Health Promotion in Hospitals and Health Care, Vienna, Austria, is amongst others responsible for the scientific preparation of the annual international HPH conferences and for the scientific editing of the semi-annual HPH Newsletter.