CHAPTER 10 Health promotion
Health promotion encompasses action to prevent ill-health and promote wellness and is fundamental to the work of the Australian health system. Relative to expenditure on treatment of disease, the investment of health sector resources in this area remains small, yet it has contributed much to reducing Australia’s burden of disease and injury. Successes have been achieved where there has been strong leadership, often from within the health sector, and partnerships that have successfully engaged sectors outside of the traditional health arena. Advocacy by a diverse range of organisations and interest groups has also helped to usher in the healthy public policy that has been necessary to achieve population level health improvements.
Initiatives to prevent disease and injury have been an aspect of the work of Australian health services and agencies for many decades. In the latter stages of the 20th century, and from the 1980s in particular, these efforts were transformed in scale and sophistication, corresponding to the rise of the field of health promotion.
The emergence of health promotion has come about as a result of progress in international thinking about how to tackle the health challenges facing populations. The World Health Organization (WHO) has been central to these developments. Together with the United Nations Children’s Fund (UNICEF), WHO convened the International Conference on Primary Health Care in the Kazakh city of Alma-Ata in 1978 (see also Chapters 4 and 9). At this meeting it was agreed by delegates that health is closely linked to social and economic development, that communities have a right to participate in planning and implementing actions to address their needs, that coordination across diverse sectors (e.g. education, housing, agriculture) is needed to achieve national health goals, and that redressing health inequalities should be a priority (WHO and UNICEF 1978). There was a call for Health For All By The Year 2000, which was a mission subsequently adopted by the World Health Assembly.
Following the landmark gathering at Alma-Ata, WHO held the First International Conference on Health Promotion in the Canadian city of Ottawa in 1986 to develop a charter of action for achieving Health for All. The Ottawa Charter (WHO 1986), as it was called, is recognised as the foundational document of modern health promotion. Health promotion is defined here as the process of enabling people to increase control over, and to improve, their health. It was understood that the field is not just concerned with producing improvements in health status, but more fundamentally with enabling people to participate fully in society and to exercise control over the circumstances that affect their health. Five primary areas of action were identified as central to empowering people for health, namely:
The Ottawa Charter also articulated values that continue to guide health promotion priorities and practice. A holistic perspective was adopted that recognised the physical, mental and social dimensions of health, determined by diverse factors (behavioural, social, cultural, environmental, economic and political). The goal of social justice was evident in the emphasis given to reducing differences in health status related to unequal access to societal resources and opportunities. As indicated above, empowerment of individuals and communities was positioned as central to the purpose of health promotion. Principles of practice that were embraced included community participation, working in partnerships, undertaking action at multiple levels to address health determinants, and engaging diverse sectors in policy and program development.
In Australia there was a series of significant developments during the 1980s and 1990s that reflected the growth of this field. The Australian Health Promotion Association was established in 1988, and the Health Promotion Journal of Australia commenced publication in 1991. Several major strategic documents were published that recognised the role of health promotion in tackling national priority issues; the National Aboriginal Health Strategy (National Aboriginal Health Strategy Working Party 1989), the first National HIV/AIDS Strategy (Commonwealth of Australia 1989), and Goals and Targets for Australia’s Health in the Year 2000 and Beyond (Commonwealth Department of Human Services and Health 1994). The National Public Health Partnership was established in 1996 to coordinate national action on priority health promotion issues, including nutrition, physical activity, mental health, injury, and Indigenous health.
Pause for reflection
Health promotion is often identified as a central goal in the mission statements of departments of health in Australia, yet funding for this area remains only a fraction of that directed towards the treatment of disease and injury (bio-medical model of health). Why do you think this is the case, and what might bring about an increase in the allocation of resources towards health promotion?
Australian health promotion policy and programs are enacted across multiple levels of the health system, engaging government, statutory, non-government and private sector organisations. Indeed, it has been the combination of advocacy by non-government organisations, policy development by state, territory and Commonwealth government departments, and project implementation by health promotion agencies and front-line health care workers that has led to many of the successes that have so far been achieved in population health.
The range of health organisations that are major contributors in Australian health promotion efforts are shown in Figure 10.1. The contribution that these make are described in broad terms below, although in practice the roles of various organisations are not neatly delineated and vary according to the issues and population groups which are the focus of action.