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Petra Heitkamp has worked for the World
Health Organisation in its Health Education & Health
Promotion Unit for the last two and a half years. Since
mid-August 1998, she has been working with VHAI.
"Health is created and lived by people within
settings of their every day life: where they learn, work,
play and love. Health Promotion is the process of
enabling people to increase control over the determinants
of health and thereby to improve their health. It is
carried out by and with people, not on or to
people".
In creating health the focus is on a range of personal,
social, economic and environmental factors which
determine the health status of individuals and
populations. Health promotion not only embraces actions
directed at strengthening the skills and capabilities of
individuals, but its action is also directed towards
changing social, environmental and economic conditions so
as to improve their impacts on public and individual
health.
Promoting health underlines the right of each individual
to the highest attainable standard of health. It stresses
the importance of the participation of people and
recognises different sociocultural values and beliefs
that are prevalent throughout the world. People have to
be at the centre of health promotion activities and
decision-making processes for them to be effective. Most
importantly, health promotion is about the health of a
system, so that the wheel does not need to be reinvented
with each new generation. Working on health development
has a sustainable effect only when done comprehensively:
personal development, community development,
organisational development and political development.
Within this arena health promotion works as a catalyst
for health awareness and action. Health promoters are
social entrepreneurs, change-makers for solidarity and
social justice.
It is now 20 years since WHO’s commitment to the
Alma Ata Declaration on Primary Health Care was made
(1978). The first of the eight basic elements of primary
health care is: "Education concerning prevailing
health problems and the methods of preventing and
controlling them". Health is at the core of the
triangle: disease prevention, primary health care and
education. In this regard, the Ottawa Charger on Health
Promotion, as an outcome of the first International
Conference on Health Promotion in 1986, has been a
worldwide source of guidance and inspiration for health
promotion through its five essential strategies:
- Build healthy public
policy;
- Create supportive
environments;
- Strengthen community
action;
- Develop personal
skills;
- Reorient health
services.
The Ottawa Charter also
referred to the following:
- advocating: putting
health high on the political agenda;
- enabling: knowledge
and skills development;
- mediation: building
bridges and partnerships, and negotiate.
The Second and Third
International Conference on Health Promotion in
Australia, Adelaide (1988) and Sweden, Sundsvall (1991)
resulted respectively in the adoption of the Adelaide
Recommendations on Healthy Public Policy and the
Sundsvall Statement on Supportive Environments.
The international conferences that have marked the way of
health promotion have been goal posts of an energetic
movement to strengthen health globally. Over the past ten
years WHO has initiated successful health promotion
projects such as healthy cities, global school health
initiative, health promoting hospitals,
municipalities/villages, islands and workplaces.
New challenges and determinants of health call for new
forms of action. The world is changing rapidly! It’s
not only the speed at which it changes, which has a major
impact on the health status of the world, but just as
much the diversity and complex interdependence of
influencing trends; for example the widening gap between
rich and poor, demographic changes, communications
revolution, globalization of markets, and the double
burden of disease (World Health Report 1998, WHO). There
is a clear need to break through traditional boundaries
within government sector, between governmental and
non-governmental organisations, and between the public
and private sector. New responses are needed to free the
potential for health promotion in many sectors of society
- among local communities and within families. The
Jakarta Declaration on ‘Leading Health Promotion
into the 21st Century’ identifies five priorities or
health promotion in the next millennium.
- Promote social
responsibility for health;
- Increase investments
for health development;
- Consolidate and
expand "Partnerships for health;
- Increase community
capacity and ‘empower’ the individual
in matters of health;
- Secure an
infrastructure for health promotion.
Health promotion is placed
firmly at the centre of health development. The time is
right for a shift in action on the priorities. All WHO
Member States have adopted the first ever Resolution on
Health Promotion in May 1988, fully underlining the
Jakarta Declaration. Doors are open for various forms of
partnerships at all levels of society towards a global
alliance promoting health for all.
Health promotion calls for solidarity and social
responsibility on a variety of partners. With its
strategic approach of intersectoral collaboration, it
builds on the skills, knowledge and resources of a wide
and expanding variety of professions and institutions.
Only with collaborative efforts a real impact on
people’s lives, health and well-being can be made.
Dr. Illona Kickbusch, Director of the World Health
Organization’s Division of Health Promotion,
Education and Communication (HPR) says:
"Partnerships are the key to successfully promoting
health and thus improving people’s lives. We need to
reach out to organizations not traditionally involved in
health, but which are nonetheless able to influence the
health of their constituents, and co-opt them into the
worldwide drive to achieve health for all in the 21st
century. Only through the implication of all sectors of
civil society can we hope to achieve this monumental
goal". So the 21st Century should be an era of
partnerships to achieve Health For All.
In line with "Health for All in the Twenty-first
Century" (WHO, 1998), health promotion stresses
equity-oriented policies and strategies that emphasize
solidarity and that incorporate a gender perspective into
health policies and strategies. In government, diverse
authorities take decisions that affect health including
those in the sectors of agriculture, housing, energy,
water and sanitation, labour, transportation, trade,
finance, education, environment, justice and foreign
affairs. The policies of all sectors that affect health
directly or indirectly need to be analyzed and aligned to
maximize opportunities for health promotion and
protection. Health promoters should confront those not
directly involved in health with the health potential and
consequences of their work.
Increasing the investment in health development calls for
the need to find new mechanisms for funding. It also
means reorienting existing resources towards health
promotion and health education.
One major challenge within this area is transparency and
accountability. We have to find ways to clarify the costs
and benefits of health promotion. These data should be
based on clear evidence, quantitative as well as
qualitative. Defining health potential is not just
mortality, morbidity and disability rates! It is but
defining new ‘health indicators’ and outcome
measures on human development, such as health equity
index, health expectancy rates and social security
measures. Indicators and measures support increasing the
investment in health development.
On the action level, a number of approaches or foci are
used as entry points to develop a comprehensive approach
to health promotion. Three main entry points are:
- settings
- populations
- Issues
Certain settings, such as
cities, islands, local communities, markets, schools,
workplaces and health facilities offer practical
opportunities for health gain. Health promoting schools
is concerned not only with the health, and health skills
of children, but also of the teachers and staff, and of
the physical and social environment at the schools.
Populations may include any group along the lifespan -
mothers, children, adolescence, girls, marginalized
groups etc. In recent times a wide variety of programmes
have been developed for ageing populations as well.
The issue of tobacco prevention provides an excellent
example of comprehensive health promotion, incorporating
educational, fiscal, environmental and legal components
for concerted actions.
Given their shared values and commitment to
participation, solidarity and empowerment of people, NGOs
will no doubt have an increasing role to play as a
driving force for health promotion as we move into the
new millennium.
The challenges of the current world situation and the
global health status will shape people’s values,
their lifestyles and their living conditions. In
responding to these, health promotion is a challenge in
itself: for finding innovative ways to cope with
increasingly complex health problems despite dwindling
resources. Shared commitment and collaborative efforts
can make a difference!
More information on
WHO’s activities on Health Promotion is available
at: http://www.who.ch/hpr
RESOLUTION OF THE 51ST
WORLD HEALTH ASSEMBLY HEALTH PROMOTION
The Fifty-first
World Health Assembly,
Recalling
resolution WHA42.44 on health promotion, public
information and education for health and the
outcome of the four international conferences on
health promotion (Ottawa, 1986, Adelaide,
Australia in 1988; Sundsvall, Sweden in 1991;
Jakarta, 1997);
Recognizing that the Ottawa Charter for Health
Promotion has been a worldwide source of guidance
and inspiration for health promotion development
through its five essential strategies to build
healthy public policy, create supportive
environments, strengthen community action,
develop personal skills, and reorient health
services;
Mindful that there is now clear evidence that:
(a) comprehensive approaches that use
combinations of the five strategies are the most
effective; (b) certain settings offer practical
opportunities for the implementation of
comprehensive strategies, such as cities,
islands, local communities, markets, schools,
workplaces, and health services; (c) people have
to be at the centre of health promotion action
and decision-making process if they are to be
effective; (d) access to education and
information is essential in achieving effective
participation and the ‘empowerment’ of
people and communities; (e) health promotion is a
‘key investment’ and an essential
element of health development.
Mindful of the new challenges and determinants of
health and that new forms of action are needed to
free the potential for health promotion in many
sectors of society, among local communities, and
within families, using an approach based on sound
evidence;
Appreciating the potential of health promotion
activities to act as a resource for societal
development and that there is a clear need to
break through traditional boundaries within
government sectors, between governmental and
non-governmental organizations, and between the
public and private sectors;
Noting the efforts made by the 10 countries with
a population of over 100 million to promote the
establishment of a network of most-populous
countries for health promotion; Confirming the
priorities set out in the Jakarta Declaration for
Health Promotion in the Twenty-first Century;
1. URGES
all Member States;
- to promote
social responsibility for health
- to increase
investments for health development
- to
consolidate and expand ‘partnerships
for health’
- to increase
community capacity and
‘empower’ the individual in
matters of health’
- to strengthen
consideration of health requirements and
promotion in all policies
- to adopt an
evidence-based approach to health
promotion polity and practice, using the
full range of quantitative and
qualitative methodologies;
2. CALLS
ON organisations of the United Nations system,
intergovernmental and non-governmental
organisations and foundations, donors and the
international community as a whole:
- to mobilize
Member States and assist them to
implement these strategies.
- to form
global, regional and local health
promotion networks;
3. CALLS
ON the Director-General:
- to enhance
the Organization’s capacity with
that of the Member States to foster the
development of health- promoting cities,
islands, local communities, markets,
schools, workplaces, and health services;
- to implement
strategies for health promotion
throughout the lifespan with particular
attention to the vulnerable groups to
decrease inequities in health;
4.
REQUESTS the Director-General:
- to take the
lead in establishing an alliance for
global health promotion and in enabling
Member States to implement the Jakarta
Declaration and other local/regional
declarations on health promotion;
- to support
the development of evidence-based health
promotion policy and practice within the
Organization;
- to raise
health promotion to the top priority list
of WHO in order to support the
development of health promotion within
the Organization;
- to report
back to the 105th session of the
Executive Board and to the Fifty-third
World Health Assembly on the progress
achieved.
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