Challenges and Changing Context in the 21st Century for Health Promotion and Education

1. Changing Health Burden, and Complex Determinants of Health:

Both developing and developed countries are confronting a developing extent of elderly population and a population with more chronic conditions and non-communicable diseases. In addition, many developing countries are still facing with infectious diseases, and gradually more injuries and violence as their economies grow. Changing lifestyle brings more stress, and along these lines a threat to mental health of those in both developed and developing countries alike. With extensive population mobility, international travel, no country is safe from potential major communicable diseases outbreaks such as SARS or human influenza or even not-yet-known emerging diseases. Environmental changes are influencing an extensive number of nations either through sweeping worldwide climatic changes or geographically related natural disasters, such as tsunami, storm causing thousands of deaths by one stroke. Fundamentally all countries are facing numerous, rather than single type of health burden, the basic causes of which are highly pertinent for actions in health promotion.

2. Inequity and Health:

In most countries, health is improving. In some countries the trend is reverse, e.g. due to HIV/AIDS, war and civil unrest, and excessive alcohol consumption. Widening health gaps between and within countries is a global concern.

3. The Communication Revolution:

Access to dependable information about what determines health and appropriate channels to communicate health needs of the communities should be a public commodity that is to be available for all.

4. Expanding and Increasing Democratization in Countries around the Globe:

Such changes and concerns make another setting that ought to legitimately drive activities in health promotion, especially with regards to creating healthy public policies, and community empowerment. The two areas still need to be further developed in many countries.

5. Globalization and Urbanization:

The dynamics of globalization and urbanization influence health in many ways: physical and cultural environment, trade, transports, tourism, economic transactions, production of goods and working environment.

6. The Threat of War and Terrorism: 

The definitive threat to good health is the perilous condition made by war and violence.

International Union for Health Promotion and Education (IUHPE)

IUHPE is an independent and proficient association for individuals and organizations committed to improving the health and well-being of the people through education, community action, and the development of healthy public policy.

The mission, goals and objectives of IUHPE are as follows:

Mission: To promote global health and to achieve equity in health between and within countries

Goals:

• Greater equity in health of populations between and within countries of the world
• Effective alliances and partnership for health
• Accessible evidence-based knowledge and practical experience in health promotion
• Excellence in policy and practice for effective, quality health promotion
• High levels of capacity in individuals, organizations and countries to undertake health promotion activities

Objectives:

• Increase investments in health promotion
• Increase in organizational, governmental and intergovernmental policies and practices favoring health and equity
• Improvements in policy and practice of governments at all levels influencing determinants of health
• Strong alliances and partnerships among all sectors based on agreed ethical principles
• Activities that contribute to the development, translation and exchange of knowledge and practice that advance the field of health promotion 

The priority areas of IUHPE are as follows:

• Social determinants of health
• Health promotion in sustainable development
• Non-communicable diseases prevention and control
• Health promotion system

Reference:
http://www.iuhpe.org/index.php/en/

Global Conferences on Health Promotion

1. Ottawa Charter for Health Promotion, 1986

In 1986, the Ottawa Charter for Health Promotion was introduced. This was the first global conference on Health promotion which was held in Ottawa, Canada, in November 1986. It defined health promotion as “the process of enabling people to increase control over, and to improve their health.’

The Ottawa Charter conceptualized health as-

• A fundamental right
• Equal access of opportunities
• Individual and collective responsibility
• An essential element of social and economic development.

The Charter identified five health promotion action areas:

a. Build healthy public policy: It is about putting health on the agenda of policy makers at all levels and includes legislation, economic measures, taxation and organisational change.

b. Create supportive environments: refers to living and working conditions that are safe, stimulating, satisfying, enjoyable and provide a positive benefit to health.

c. Strengthen community action: deals with empowering communities to exert ownership, control and action over their own activities and destinies.

d. Develop personal skills: covers providing information, education for health and enhancing life skills.

e. Reorient health services: acknowledges that health services need to focus more on prevention than simply treatment and cure. The responsibility for health is shared amongst individuals, the community, government, institutions and other organisations.

The strategies were:

• Advocate: Advocacy for health
• Enable: enable all people to achieve their fullest health potential.
• Mediate: mediate between differing interests in society for the pursuit of health

2. Adelaide Recommendations on Healthy Public Policy, 1988

It was held in Adelaide, South Australia on April 1988. It gave more priority to healthy public policy seeing the action areas of Ottawa Charter are interdependent. The main aim of health public policy is to create a supportive environment to enable people to lead healthy lives.

The Conference identified four key areas as priorities for health public policy for immediate action:

• Supporting the health of women: Women empowerment and develop women's healthy public policy
• Creating supportive environments for health
• Tobacco and alcohol: policy to reduce tobacco growing and alcohol production 
• Food and nutrition: elimination of hunger and malnutrition

3. Sundsvall Statement on Supportive Environments for Health, 1991

It was held in Sundsvall, Sweden on June 1991. It majorly focus on making the environment - the physical environment, the social and economic environment, and the political environment - supportive to health.

The Conference highlighted four aspects of supportive environments:

• The economic dimension, which requires re-channeling the resources for the achievement of Health for All and sustainable development.
• The social dimension, which includes the ways in which norms, customs and social processes affect health.
• The political dimension, which requires governments to assure democratic participation in decision-making and the decentralization of responsibilities and resources.
• The need to recognize and use women's skills and knowledge in all sectors.

The proposed strategies to promote the creation of supportive environments at community level were:

•  Building alliances for health and supportive environments
•  Strengthening advocacy through community action
•  Enabling communities and individuals to take control over their health
•  Mediating between conflicting interests in society

4. Jakarta Declaration on Leading Health Promotion into the 21st Century

The Fourth International Conference on Health Promotion is the first to be held in a developing country, and the first to involve the private sector in supporting health promotion. It was held in Jakarta, Indonesia on July 1997. Its main slogan was “Health promotion is a key investment”. The Jakarta Declaration on Health Promotion offered a vision and focus for health promotion to next century. It reviewed the determinants of health and explored the widest possible range of resources to tackle health determinants in the 21st century.

The declaration set priorities for health promotion in the 21st Century, they were:

•  Promote social responsibility for health
•  Secure an infrastructure for health promotion
•  Consolidate and expand partnerships for health
•  Increase community capacity and empower the individual
•  Increase investments for health development

In the declaration, global health promotion alliance formation was endorsed. The goal of this alliance was to advance the priorities for action in health promotion set out in this Declaration.

• Priorities for the alliance include:
• Raising awareness of the changing determinants of health
• Promoting solidarity in action
• Supporting the development of collaboration and networks for health development
• Fostering transparency and public accountability in health promotion
• Mobilizing resources for health promotion
• Enabling shared learning 
• Accumulating knowledge on best practice

5. Global Conference on Health Promotion: Bridging the Gap, Mexico City, 2000

The fifth Global conference on Health promotion was held in Mexico on June, 2000. This conference mainly focused on bridging the gap in equity after the failure of Health for all by 2000. The actions set in this conference are as follows:

• Health promotion should be a fundamental priority in local, regional, national and international policies and programmes.
• Support the preparation of country’s plans of action for promoting health
• Establish or strengthen national and international networks
• Active participation of all sectors and civil society, in the implementation of health promoting actions
• Advocate that UN agencies be accountable for the health

6. The Bangkok Charter for Health Promotion in a Globalized World, 2005

This was the sixth global conference on health promotion which was held in Bangkok, Thailand on August, 2005. It identified major challenges, actions and commitments needed to address the determinants of health in a globalized world by reaching out to people, groups and organizations. It identified various changing context since the development of the Ottawa Charter like increasing inequalities within and between countries, commercialization, global environmental change, etc.

The conference set various actions for health promotion in a globalized world:

• Advocate for health based on human rights and solidarity
• Regulate and legislate to enable equal opportunity for health and well-being for all people
• Build capacity for policy development
• Invest in sustainable policies, actions and infrastructure to address the determinants of health
• Partner and build alliances with public, private, nongovernmental and international organizations.

7. Seventh Global Conference on Health Promotion, Nairobi, 2009

The seventh global conference on Health Promotion was held in Nairobi, Kenya on October, 2009. This conference identifies key strategies and commitments that is immediately required for closing the implementation gap in health and development through health promotion.

There are three major gaps identified in this conference:

• the gap in health programmes 
• the gap in policy-making and intersectoral partnerships 
• the gap in health systems

To address these gaps, the following strategies and actions were identified as:

• Building capacity for health promotion, 
• Strengthening health systems, 
• Partnerships and intersectoral action, 
• Community empowerment, and
• Health literacy and health behaviours. 

8. Eighth Global Conference on Health Promotion, Helsinki, 2013

The eighth global conference on Health Promotion was held in Helsinki, Finland on June, 2013. This conference was co-hosted by WHO and the Ministry of Social Affairs and Health, Finland. The main theme of the conference was “Health in All Policies” (HiAP) and its focus was on implementation, the “how-to”. It was structured around six themes.

Health in All Policies is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. It improves accountability of policymakers for health impacts at all levels of policy-making. It includes an emphasis on the consequences of public policies on health systems, determinants of health and well-being. It can provide a framework for regulation and practical tools that combine health, social and equity goals with economic development, and manage conflicts of interest transparently.

The actions set in this conference are as follows:

• Commit to health and health equity as a political priority 
• Establish conflict of interest measures
• Ensure effective structures, processes and resources 
• Build institutional capacity and skills 
• Adopt transparent audit and accountability mechanisms 
• Strengthen the capacity of Ministries of Health to engage other sectors of government
• Include communities, social movements and civil society in development, implementation and monitoring

9. Ninth Global Conference on Health Promotion, Shanghai 2016

The ninth Global Conference on Health Promotion was held in Shanghai, China, 2016. The Conference is entitled “Promoting health in the Sustainable Development Goals: Health for all and all for health”. The main goal of this conference was to highlight the critical links between promoting health and the 2030 Agenda for Sustainable Development.

The main themes of the conference were:

• Healthy cities: ensure that people are living in healthy and liveable cities
• Health literacy: ability of individuals to gain access to, understand and use information in ways which promote and maintain good health
• Good governance in favor of health
• Healthy China: It is a Chinese Government’s agenda for health and development that has the potential of huge benefits for the rest of the world. For e.g. strengthening China’s health science and technology innovation

Reference:

www.who.int/healthpromotion/conferences/en/

History of Health Promotion

Health promotion was rooted in much earlier shifts within public health that stretch back to the nineteenth century and beyond. The history can briefly be highlighted in the following chronological order:

• 19th century: A notion to improve environment and sanitation, believing poor environment, bad smell was the cause of disease (miasma theory).
• Towards the end of 19th century: Environmental understandings of public health were pushed in more specific direction (e.g. works of Louis Pasteur)
• 1900 – 1970: Social hygiene was concerned with the social influence on individual and public health, and aimed to encourage a focus on preventive medicine.
• 1930s – 1940s: Development of social medicine which helped to change the focus of public health in other ways too, particularly by bringing social sciences into health studies.
• By mid – 20th century: Role of preventing diseases and promoting good health was given much importance in many Western countries. National Health Service (NHS) was established in 1948.
• 1974: A New perspective on Health of Canadians (the Lalonde Report) acknowledged the importance of improving living standards and public health measures.
• Following the Lalonde Report, health promotion began to emerge as a recognizable part within public health. There were series of initiatives introduced by WHO in late 1970s and 1980s that stressed the importance of promoting good health as well as combating disease.
• 1977: WHO implemented “Health for All by The Year 2000”
• 1978: Declaration of Alma Ata advocated a multidimensional approach to health and socioeconomic development and urged active community participation in health care and health education at every level, with a particular focus on primary health care.
• 1986 – 2016: Global Conferences on Health Promotion

1. 1986: Ottawa Charter for Health Promotion: First International Conference on health promotion which was held in Ottawa, Canada. This Charter defined health promotion as “the process of enabling people to increase control over, and to improve their health”.
2. 1988: Adelaide Recommendation on Healthy Public Policy
3. 1991: Sundsvall Statement on Supportive Environments for Health
4. 1997: Jakarta Declaration on Leading Health Promotion into the 21st Century: The Fourth International Conference on Health Promotion is the first to be held in a developing country, and the first to involve the private sector in supporting health promotion.
5. 2000: Global Conference on Health Promotion: Bridging the Gap, Mexico City
6. 2005: The Bangkok Charter for Health Promotion in a Globalized World
7. 7)2009: Seventh Global Conference on Health Promotion, Nairobi: Closing the implementation gap in health and development through health promotion.
8. 2013: Eighth Global Conference on Health Promotion, Helsinki: The main theme of the conference was “Health in All Policies” (HiAP)
9. 2016: Ninth Global Conference on Health Promotion, Shanghai: The main goal of this conference was to highlight the critical links between promoting health and the 2030 Agenda for Sustainable Development.

Foundations of Health Education

There are mainly three foundations of health education, they are:

• Health Sciences
• Psycho-social Behavioral Science
• Educational Science

1. Health Sciences:

 Health Sciences are the applied sciences which address the use of science, technology, engineering or mathematics in the delivery of healthcare. Health education is drawn from various disciplines which come under health sciences like environmental science, physical science, biological science, etc. which makes health sciences as one of the foundations of health education.

2. Psycho-social Behavioral Science:

Psycho-social Behavioral Science deals with the study of human behavior at the level of own self, other individuals, family, and community members. It includes the traits of Social Psychology which influences the behavior of individuals. It also includes the theories and models such as Health Belief Model, Theory of Reasoned Action/Theory of Planned Behavior, etc. which explains the readiness of individuals to change the behavior or adopt change. 

3. Educational Science:

Educational Science is closely related to pedagogy, which is the process of teaching. More specifically, it is considered to be the study of improving the teaching-learning process. Its field can include the research of different teaching methods and how a group of students receive these methods as well as the process of improving the teaching methodologies.