|Year : 2010 | Volume
| Issue : 3 | Page : 117-119
Health promotion: The new public health agenda
Secretary General, Indian Public Health Association, Director - Professor and Head, Department of Health Education, All India Institute of Hygiene and Public Health, Kolkata - 700 073, India
|Date of Web Publication||18-Jan-2011|
Secretary General, Indian Public Health Association, Director - Professor and Head, Department of Health Education, All India Institute of Hygiene and Public Health, Kolkata - 700 073
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dobe M. Health promotion: The new public health agenda. Indian J Public Health 2010;54:117-9
Over the last decade, a major shift is being observed with regard to health promotion and its role in society necessitating a reorganization of how we approach health in 21 st century societies. "Health" has always been presented as do-able: through behaviors, governmental measures, medical interventions, and through products and services. Health is a major factor in 21 st century economies and a critical component of people's expectations. Recent global happiness surveys have identified health next to wealth and education, as one of the three key factors for societal well-being.
Health promotion has been defined as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health."
The first International Conference on Health Promotion took place in Ottawa, Canada, in 1986. The conference was a response to growing expectations for a new public health movement around the world which culminated in formulation of the Ottawa Charter. The Charter built on many sources, including in particular the work of Thomas McKeown, one of the most influential figures in the development of the social history of medicine during the third quarter of the 20 th century. When McKeown launched his brilliantly conceived and innovative project to investigate the historical demography and epidemiology of 18 th century Britain, little did he know that he was making a powerful play, with high political stakes, to influence the future direction of public health. McKeown examined the major infectious killers of the 19th century-tuberculosis, typhus, typhoid, scarlet fever, diphtheria, pneumonia, and recorded death rates from these individual diseases, invariably showing a steady decline, with places marked where specific therapies or preventives appeared. Most of the decline had always occurred before the specific measures came on the scene. Tuberculosis lost about 75% of its mortality before streptomycin was available. Scarlet fever and pneumonia did the same before the sulfa drugs and penicillin, diphtheria before antisera and inoculation. In each case, the contribution of specific modern medical interventions accounted for only a small part of the historical fall in the mortality of the major infectious diseases. McKeown emphasized the importance of economic growth, rising living standards, and improved nutrition as the primary sources of most historical improvements in the health of developed nations.
The current concepts of Health Promotion were floated in 1974 by Marc Lalonde, who was the Canadian Minister of National Health and Welfare. Drawing from Mckeown's hypotheses, he proposed a new "health field" concept which stated that four interdependent fields were responsible for determining an individual's health -environment, lifestyle, biomedical factors, and healthcare services.
Thus with the Ottawa Charter, the third public health revolution heralded a new concept of public health, which considers health 'a resource for living,' placing it firmly within the context of everyday life and has 'empowerment' at its very core. Health promotion represents a comprehensive social and political process. It not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed toward changing social, environmental, and economic conditions so as to alleviate their impact on public and individual health. Participation is essential to sustain health promotion action.
The Charter outlined five areas for health promotion action under the new public health agenda:
- Build healthy public policies: The primary means of health promotion occur through developing healthy public policy that addresses the prerequisites of health, e.g. income, housing, food security, employment, and quality working conditions.
- Create supportive environments: Health is created by people within the settings of their everyday life; where they learn, work, and play. The "settings approach" was considered a new public health strategy to take this agenda forward-resulting in a shifting of focus from the deficit model of disease to the health potentials inherent in the social and institutional settings of everyday life, e.g. schools, workplaces, marketplaces, etc. Regional agreements, e.g., Framework Convention on Tobacco Control, also moved this health promotion action forward.
- Strengthen community actions and
- Develop personal skills: The aim of health promotion is to combine a social determinants approach with a commitment to individual and community empowerment. The means to this end is Health Education. Health education is not only concerned with the communication of information, but also with fostering the motivation, skills, and confidence (self-efficacy) necessary to take action to improve health. Health education includes the communication of information concerning the underlying social, economic, and environmental conditions impacting on health, as well as individual risk factors and risk behaviors, and use of the health care system.
- Reorient health services: All people involved in health service delivery must work together in a system that sees health promotion as a central goal. This necessitates changes in practices and responsibilities, and adjustment of values. The basis for the work of the health ministry should be a health policy that sets goals and targets with respect to the determinants of health and sets accountability mechanisms throughout government. A strong organizational infrastructure that ensures quality and monitors and measures impact will be an essential component.
In order to develop and sustain health promotion interventions effectively across sectors, it is also necessary that the public health workforce comprising both health and non-health professionals possesses the content and skills necessary to deliver health promotion adequately. In this regard, building their capacity remains a top priority. In addition, there is need to strengthen curriculum and faculty development at all training institutions as well as civil society. The need to establish a mechanism to gather evidence on the effectiveness of health promotion across sectors is equally important.
We have come a long way after the Ottawa Charter and though there is acceptance of the fact that the role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services, the health services are yet to embrace the expanded mandate.
Simultaneously, there has been a rapid growth of a market for health promotion, which attaches the added value "health" to an ever-increasing set of products and services that promise well-being. These include the fitness market, lifestyle drugs, the market for vitamins, minerals and health foods, and new types of health insurance, for example for alternative therapies. This market is of particular relevance in the rapidly growing middle-income countries such as China, India, and Brazil. Governments are beginning to explore the economic potential and global competitiveness of such products and services. The most visible sign of the "wellness revolution" is the explosion of media that focuses on health and wellness in electronic and print format as specialty magazines, newsletters, books, and a plethora of websites and television programming.
All these developments widen the debate from the classic approach to regulate industries that produce ill health (such as tobacco or junk food) and to health education to "increase control over health and its determinants" toward new types of strategies, policies and regulations (e.g., regulations regarding advertisement of fast foods) as well as new forms of public-private partnerships and platforms.
With expansion of choices for health promotion and increasing complexity of health systems higher degree of sophistication and participation is necessary. Health literacy is now of critical importance and new health inequalities are emerging as a result of disparities in health literacy. On the other hand, the interest of the market in health promotion and wellness offers opportunities for new approaches, partnerships, and large-scale health literacy initiatives that have not existed before. Probably, the market model has greater potential than the existing traditional approaches of Health Education, to give a new dimension to social marketing in health promotion.
The dominant issues now revolve around public and private responsibility, privatization and commercialization, empowerment and participation, and social inclusion and exclusion.
Despite mounting evidence that investment in prevention, health promotion, and public health must be increased, countries rarely reach more than a 3% average of the overall "health" budget for these. Other social systems, such as schools or workplaces, are still underutilized in relation to their health promotion potential. Although initiatives for health promotion funding were made in some countries through the establishment of health promotion foundations, e.g. Thai Health Promotion Foundation-an autonomous state agency funded by "sin taxes" collected from producers and importers of alcohol and tobacco-these have not spread or expanded to the extent envisaged. It is time to consider how the expansion of the health promotion market could provide financing for increased health promotion; for example, through a dedicated percentage of the value added tax. Minimum standards for investment in health promotion and prevention also need to be set in other sectors and settings, including the health insurance sector.
At the global level, health issues have received high prominence in the Millennium Development Goals. The world needs to work in unison toward fulfillment of these goals. Health Promotion is certainly the priority new public health to create tomorrow's healthier people today.
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