Green and Kreuter (1991) define health promotion as “any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health” (p. 2). Parse (1990) states that health promotion is that which is motivated by the desire to increase well-being and to reach the best possible health potential. Jamie exemplifies this motivation to stay in her best health, at least at first glance. Let’s look further into Jamie’s health history.

When it comes to health practices, Jamie is a study in contradictions. Jamie’s father had a myocardial infarction (MI) at the age of 48 years and died of an MI at the age of 50 years. Many of Jamie’s paternal relatives have died of heart disease. Jamie’s mother and one maternal aunt each had breast cancer diagnosed in their early 50s. Though she has an annual physical by her family doctor and monitors her blood cholesterol and triglycerides, Jamie has never been screened for cardiac disease. Jamie takes the flu vaccine every year but has not had a tetanus-diphtheria vaccine booster in 14 years; though she sees her gynecologist yearly, she has had only one mammogram, 3 years ago.

In skipping annual mammograms and in not pursuing cardiac screening despite her high risk, Jamie is neglecting an important step in maintaining her health—health protection. Health protection is those behaviors in which one engages with the specific intent to prevent disease, to detect disease in the early stages, or to maximize health within the constraints of disease (Parse, 1990). Immunizations and cervical cancer screening are examples of health protection activities.

In discussing health promotion, it is helpful to define what is meant by health. An early definition defines health as “being sound in body, mind, and spirit: freedom from physical disease or pain” (Merriam-Webster, 2009). As health promotion has become an important strategy to improve health, the way health is defined has shifted from a focus on the curative model to a focus on multidimensional aspects such as the social, cultural, and environmental facets of life and health (Benson, 1996). The well-known definition by the World Health Organization (WHO) states that health is “a state of complete physical, mental and social well-being, and not merely the absence of disease” (WHO, 2009). WHO also states that health is the extent to which an individual or group is able to realize aspirations, to satisfy needs, and to change or to cope with the environment. In this aspect, health is viewed not only as an important goal but as a resource for living (WHO, 1986).

Healthy People 2020 is the health promotion initiative for the nation. Developed through a consortium and managed by the U.S. Department of Health and Human Services (USDHHS), Healthy People 2020 “challenges individuals, communities, and professionals, indeed all of us to take specific steps to ensure that good health, as well as long life, are enjoyed by all” (USDHHS, 2009).

The broad goals of Healthy People 2020 are to attain high quality, longer lives free of preventable disease, disability, injury, and premature death; achieve high equity, eliminate disparities and improve the health of all groups; create social and physical environments that promote good health for all; and promote quality of life, healthy development, and healthy behaviors across all life stages. Objectives toward achieving these goals are organized into 38 topic areas with corresponding priorities for action for each objective. Leading health indicators, or determinants of health, in each topic area help track progress toward meeting the goals of Healthy People 2020. A list of leading health indicators common across most of the topic areas is found in Table 4-1. Figure 4-1 illustrates the relationships among the determinants of health. The home page for Healthy People 2020 can be accessed at www.healthypeople.gov/Default.htm.