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Health promotion

Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health."[1]


The WHO's 1986 Ottawa Charter for Health Promotion and then the 2005 Bangkok Charter for Health Promotion in a Globalized World defines health promotion as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health".[2]

Health promotion involves public policy that addresses health determinants such as income, housing, food security, employment, and quality working conditions.[3] More recent work has used the term Health in All Policies (HiAP) to refer to the actions that incorporate health into all public policies. Health promotion is aligned with health equity and can be a focus of non-governmental organizations (NGOs) dedicated to social justice or human rights. Health literacy can be developed in schools, while aspects of health promotion such as breastfeeding promotion can depend on laws and rules of public spaces. One of the Ottawa Charter Health Promotion Action items is infusing prevention into all sectors of society, to that end, it is seen in preventive healthcare rather than a treatment and curative care focused medical model.[citation needed][4]

There is a tendency among some public health officials, governments, and the medical–industrial complex to reduce health promotion to just developing personal skills, also known as health education and social marketing focused on changing behavioral risk factors.[5] However, recent evidence suggests that attitudes about public health policies are less about personal abilities or health messaging than about individuals' philosophical beliefs about morality, politics, and science.[6]


This first publication of health promotion is from the 1974 Lalonde report from the Government of Canada,[7] 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".[8] Another predecessor of the definition was the 1979 Healthy People report of the Surgeon General of the United States,[7] 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".[9]

At least two publications led to a "broad empowerment/environmental" definition of health promotion in the mid-1980s:[7]

  • In the year 1984 the WHO Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health".[10] In addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organizational change, community development and spontaneous local activities against health hazards" as health promotion methods.[10]
  • 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".[7][11] 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".[11]
  • 1st International Conference on Health Promotion, Ottawa, 1986, which resulted in the "Ottawa Charter for Health Promotion".[12] According to the Ottawa Charter, health promotion:[12]
    • "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 organizations."

The "American" definition of health promotion, first promulgated by the American Journal of Health Promotion in the late 1980s, focuses more on the delivery of services with a bio-behavioral approach rather than environmental support using a settings approach. Later the power on the environment over behavior was incorporated. The Health Promotion Glossary 2021 reinforces the international 1986 definition.[citation needed]

The WHO, in collaboration with other organizations, has subsequently co-sponsored international conferences including the 2015 Okanagan Charter on Health Promotion Universities and Colleges.[citation needed]

In November 2019, researchers reported, based on an international study of 27 countries, that caring for families is the main motivator for people worldwide.[13][14]

Settings-Based Approach

The WHO's settings approach to health promotion, Healthy Settings, looks at the settings as individual systems that link community participation, equity, empowerment, and partnership to actions that promote health. According to the WHO, a setting is "the place or social context in which people engage in daily activities in which environmental, organizational, and personal factors interact to affect health and wellbeing."[15] There are 11 recognized settings in this approach: cities, villages, municipalities and communities, schools, workplaces, markets, homes, islands, hospitals, prisons, and universities.[citation needed][16]

Health Promoting Hospitals

Health promotion in the hospital setting aims to increase health gain by supporting the health of patients, staff, and the community. This is achieved by integrating health promotion concepts, strategies, and values into the culture and organizational structure of the hospital. Specifically, this means setting up a management structure, involving medical and non-medical staff in health promotion communication, devising action plans for health promotion policies and projects, and measuring and measuring health outcomes and impact for staff, patients, and the community.[citation needed]

The International Network of Health Promoting Hospitals and Health Services is the official, international network for the promotion and dissemination of principles, standards, and recommendations for health promotion in the hospital and health services settings.[17]

Workplace Setting

The process of health promotion works in all settings and sectors where people live, work, play and love. A common setting is the workplace. The focus of health on the work site is that of prevention and the intervention that reduces the health risks of the employee. In 1996, the U.S. Public Health Service issued a report titled "Physical Activity and Health: A Report of the Surgeon General" that provided a comprehensive review of the available scientific evidence about the relationship between physical activity and an individual's health status at that time. The report showed that over 60% of Americans were not regularly active and that 25% are not active at all. There is very strong evidence linking physical activity to numerous health improvements. 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.[18] 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".[19][20] 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".[21]

Worksite health promotion programs (also called "workplace health promotion programs", "worksite wellness programs", or "workplace wellness programs") include adequate sleep,[22] cooking classes,[23] exercise,[22][24] nutrition,[23] physical activity,[25][26][27] smoking cessation,[22][23][28] stress management,[citation needed][23][29] and, weight loss.[30]

According to the Centers for Disease Control and Prevention (CDC), "Regular physical activity is one of the most effective disease prevention behaviors."[31] Physical activity programs reduce feelings of anxiety and depression, reduce obesity (especially when combined with an improved diet), reduce risk of chronic diseases including cardiovascular disease, high blood pressure, and type 2 diabetes; and finally improve stamina, strength, and energy.[citation needed]

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".[32]
  • 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.[33]
  • 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.[34]
  • A meta-analysis of 46 studies published in 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 a healthy lifestyle".[35]
  • A meta-analysis of 22 studies published 1997–2007 determined that workplace health promotion interventions led to "small" reductions in depression and anxiety.[36]
  • 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 printed materials).[37]

A study conducted by the World Health Organization and the International Labour Organization found that exposure to long working hours is the occupational risk factor with the largest attributable burden of disease, i.e. an estimated 745,000 fatalities from ischemic heart disease and stroke events in 2016.[38] This landmark study established a new global policy argument and agenda for health promotion on psychosocial risk factors (including psychosocial stress) in the workplace setting.

See also


  1. ^ Health Promotion Glossary of Terms 2021, Geneva: World Health Organization, 2021, p. 1, ISBN 9789240038349
  2. ^ Participants at the 1st Global Conference on Health Promotion in Ottawa, Canada, Geneva, Switzerland: World Health Organization, 1986. Retrieved September 15, 2021.
  3. ^ "Social Determinants of Health - Healthy People 2030 |". Retrieved November 18, 2022.
  4. ^ "Ottawa Charter for Health Promotion: An International Conference on Health Promotion". Public Health Agency of Canada. November 17–21, 1986. Retrieved October 28, 2023.
  5. ^ Bunton R, Macdonald G (2002). Health promotion: disciplines, diversity, and developments (2nd ed.). Routledge. ISBN 978-0-415-23569-3.
  6. ^ Byrd N, Białek M (2021). "Your Health vs. My Liberty: Philosophical beliefs dominated reflection and identifiable victim effects when predicting public health recommendation compliance during the COVID-19 pandemic". Cognition. 212: 104649. doi:10.1016/j.cognition.2021.104649. PMC 8599940. PMID 33756152.
  7. ^ a b c d Minkler M (Spring 1989). "Health education, health promotion and the open society: an historical perspective". Health Educ Q. 16 (1): 17–30. doi:10.1177/109019818901600105. PMID 2649456. S2CID 10410928.
  8. ^ Lalonde M. A new perspective on the health of Canadians. A working document. Archived May 8, 2009, at WebCite Ottawa: Government of Canada, 1974.
  9. ^ Healthy people: the Surgeon General's report on health promotion and disease prevention. Archived January 31, 2009, at the Wayback Machine 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. Retrieved February 4, 2009.
  10. ^ a b "A discussion document on the concept and principles of health promotion". Health Promot. 1 (1): 73–6. May 1986. doi:10.1093/heapro/1.1.73. PMID 10286854.
  11. ^ a b Epp J (1986). "Achieving health for all. A framework for health promotion". Health Promot. 1 (4): 419–28. doi:10.1093/heapro/1.4.419. PMID 10302169.
  12. ^ a b The Ottawa Charter for Health Promotion. First International Conference on Health Promotion, Ottawa, 21 November 1986. Archived March 20, 2012, at the Wayback Machine Retrieved February 4, 2009.
  13. ^ Arizona State University (November 26, 2019). "Caring for family is what motivates people worldwide - International study including 27 countries shows people prioritize loved ones over everything else". EurekAlert!. Retrieved November 30, 2019.
  14. ^ Ko, Ahra, et al. (2020). "Family Matters: Rethinking the Psychology of Human Social Motivation". Perspectives on Psychological Science. 15 (1): 173–201. doi:10.1177/1745691619872986. PMID 31791196. S2CID 208611389. Retrieved November 30, 2019.
  15. ^ "WHO | The WHO Health Promotion Glossary". WHO. Archived from the original on January 20, 2022. Retrieved August 11, 2020.
  16. ^ "Healthy settings". World Health Organization (WHO) Health Promotion. October 28, 2023. Retrieved October 28, 2023.
  17. ^ "About us". HPH. Retrieved October 28, 2023.
  18. ^ Tones K, Tilford S (2001). Health promotion: effectiveness, efficiency and equity (3rd ed.). Cheltenham UK: Nelson Thornes. ISBN 978-0-7487-4527-2.
  19. ^ European Network for Workplace Health Promotion. Workplace health promotion. Archived November 18, 2007, at the Wayback Machine Retrieved February 4, 2009.
  20. ^ World Health Organization. Workplace health promotion. Benefits. Archived December 3, 2008, at the Wayback Machine Retrieved February 4, 2009.
  21. ^ World Health Organization. Workplace health promotion. The workplace: a priority setting for health promotion. Archived December 4, 2008, at the Wayback Machine Retrieved February 4, 2009.
  22. ^ a b c Byrne DW, Rolando LA, Aliyu MH, McGown PW, Connor LR, Awalt BM, Holmes MC, Wang L, Yarbrough MI (2016). "Modifiable Healthy Lifestyle Behaviors: 10-Year Health Outcomes From a Health Promotion Program". American Journal of Preventive Medicine. 51 (6): 1027–1037. doi:10.1016/j.amepre.2016.09.012. ISSN 1873-2607. PMID 27866595.
  23. ^ a b c d Journath G, Hammar N, Vikström M, Linnersjö A, Walldius G, Krakau I, Lindgren P, de Faire U, Hellenius ML (2020). "A Swedish primary healthcare prevention programme focusing on promotion of physical activity and a healthy lifestyle reduced cardiovascular events and mortality: 22-year follow-up of 5761 study participants and a reference group". British Journal of Sports Medicine. 54 (21): 1294–1299. doi:10.1136/bjsports-2019-101749. ISSN 1473-0480. PMC 7588408. PMID 32680841.
  24. ^ González-Dominguez ME, Romero-Sánchez JM, Ares-Camerino A, Marchena-Aparicio JC, Flores-Muñoz M, Infantes-Guzmán I, León-Asuero JM, Casals-Martín F (2017). "A Million Steps: Developing a Health Promotion Program at the Workplace to Enhance Physical Activity". Workplace Health & Safety. 65 (11): 512–516. doi:10.1177/2165079917705146. ISSN 2165-0969. PMID 28719762. S2CID 43473795.
  25. ^ Bezzina B A, Ashton L, Watson T, James CL (2023). "Health and wellness in the Australian coal mining industry: An analysis of pre-post findings from the RESHAPE workplace health promotion program". PLOS ONE. 18 (7): e0288244. Bibcode:2023PLoSO..1888244B. doi:10.1371/journal.pone.0288244. ISSN 1932-6203. PMC 10328312. PMID 37418458.
  26. ^ Huang SJ, Hung WC, Shyu ML, Chou TR, Chang KC, Wai JP (2023). "Field Test of an m-Health Worksite Health Promotion Program to Increase Physical Activity in Taiwanese Employees: A Cluster-Randomized Controlled Trial". Workplace Health & Safety. 71 (1): 14–21. doi:10.1177/21650799221082304. ISSN 2165-0969. PMID 35657298. S2CID 249313373.
  27. ^ Franco E, Urosa J, Barakat R, Refoyo I (March 8, 2021). "Physical Activity and Adherence to the Mediterranean Diet among Spanish Employees in a Health-Promotion Program before and during the COVID-19 Pandemic: The Sanitas-Healthy Cities Challenge". International Journal of Environmental Research and Public Health. 18 (5): 2735. doi:10.3390/ijerph18052735. ISSN 1660-4601. PMC 7967464. PMID 33800372.
  28. ^ Mache S, Vitzthum K, Groneberg DA, Harth V (2019). "Effects of a multi-behavioral health promotion program at worksite on smoking patterns and quit behavior". Work (Reading, Mass.). 62 (4): 543–551. doi:10.3233/WOR-192889. ISSN 1875-9270. PMID 31104040. S2CID 159039058.
  29. ^ Ornek OK, Esin MN (November 4, 2020). "Effects of a work-related stress model based mental health promotion program on job stress, stress reactions and coping profiles of women workers: a control groups study". BMC Public Health. 20 (1): 1658. doi:10.1186/s12889-020-09769-0. ISSN 1471-2458. PMC 7641806. PMID 33148247.
  30. ^ Walker L, Smith N, Delon C (2021). "Weight loss, hypertension and mental well-being improvements during COVID-19 with a multicomponent health promotion programme on Zoom: a service evaluation in primary care". BMJ Nutrition, Prevention & Health. 4 (1): 102–110. doi:10.1136/bmjnph-2020-000219. ISSN 2516-5542. PMC 7887868. PMID 34308117.
  31. ^ Prevention Cf. "CDC - Workplace Health - Implementation - Physical Activity". Archived from the original on October 17, 2015. Retrieved September 27, 2015.
  32. ^ Engbers LH, van Poppel MN, Chin A, Paw MJ, van Mechelen W (July 2005). "Worksite health promotion programs with environmental changes: a systematic review". Am J Prev Med. 29 (1): 61–70. doi:10.1016/j.amepre.2005.03.001. PMID 15958254.
  33. ^ Pelletier KR (October 2005). "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. 47 (10): 1051–8. doi:10.1097/ PMID 16217246. S2CID 30828898.
  34. ^ Chapman LS (2005). "Meta-evaluation of worksite health promotion economic return studies: 2005 update" (PDF). Am J Health Promot. 19 (6): 1–11. doi:10.4278/0890-1171-19.4.TAHP-1. PMID 16022209. S2CID 208067183. Archived (PDF) from the original on December 7, 2010.
  35. ^ Kuoppala J, Lamminpää A, Husman P (November 2008). "Work health promotion, job well-being, and sickness absences—a systematic review and meta-analysis". J. Occup. Environ. Med. 50 (11): 1216–27. doi:10.1097/JOM.0b013e31818dbf92. PMID 19001948. S2CID 7330866.
  36. ^ Martin A, Sanderson K, Cocker F (January 2009). "Meta-analysis of the effects of health promotion intervention in the workplace on depression and anxiety symptoms". Scand J Work Environ Health. 35 (1): 7–18. doi:10.5271/sjweh.1295. PMID 19065280.
  37. ^ Goetzel RZ, Ozminkowski RJ (2008). "The health and cost benefits of work site health-promotion programs". Annu Rev Public Health. 29: 303–23. doi:10.1146/annurev.publhealth.29.020907.090930. PMID 18173386.
  38. ^ Pega F, Nafradi B, Momen N, Ujita Y, Streicher K, Prüss-Üstün A, Technical Advisory Group (2021). "Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury". Environment International. 154: 106595. doi:10.1016/j.envint.2021.106595. PMC 8204267. PMID 34011457.

Further reading

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Health promotion
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