Health Promotion: Concepts and Determinants

Introduction to Health Promotion

Health promotion is a central concept in personal health, focusing on enabling individuals and communities to increase control over and improve their health. It integrates multiple determinants and approaches to foster wellbeing and prevent disease.

• Definition: Health promotion is the process of enabling people to increase control over, and to improve, their health (WHO, Ottawa Charter, 1986).

• Key Determinants: Health Canada identifies determinants such as income, social status, education, employment, social environments, physical environment, personal health practices, healthy child development, biology/genetics, health services, gender, and culture.

• Wellbeing Approach: Integrates Western and Indigenous frameworks, focuses on strengths, considers current and future generations, and facilitates intersectoral actions.

• Measurement: Wellbeing is measured by indicators such as perceived health, mental health, sense of belonging, and environmental quality.

Social Determinants of Health (SDOH)

The social determinants of health are the conditions in which people live that affect their current and future health. These determinants are crucial for understanding health disparities and guiding health promotion strategies.

• Examples: Income, education, employment, social support, physical environment, personal health practices, healthy child development, biology/genetics, health services, gender, and culture.

• Impact: These factors influence health outcomes and contribute to health inequities.

Principles and Levels of Health Promotion

Principles of Health Promotion

Health promotion is guided by principles that emphasize empowerment, community participation, and addressing determinants of health.

• Empowerment: Providing information and skills to help individuals feel control resides within them.

• Community Participation: Involving the population as a whole in everyday life contexts.

• Complementary Approaches: Combining diverse strategies to address health determinants.

Levels of Prevention

Health promotion operates at three levels of prevention: primary, secondary, and tertiary. Each level targets different stages of health and disease.

• Primary Prevention: Measures to prevent illness before it occurs, including health promotion and specific protection. Strategies can be active (individual involvement) or passive (recipient).

• Secondary Prevention: Early identification and treatment of health problems to prevent worsening (e.g., breast screening, developmental screening).

• Tertiary Prevention: Measures to reduce severity, minimize disability, and restore function (e.g., rehabilitation).

Changing Views of Healthcare

Medical, Behavioural, and Socioenvironmental Approaches

The healthcare system has evolved from a medical model to more holistic approaches that consider behavioural and socioenvironmental determinants.

• Medical Approach: Health equated with quality of medicine and acute care hospitals; limited impact on population health and costly.

• Behavioural Approach: Focuses on individual behaviours and lifestyle choices (Lalonde Report).

• Socioenvironmental Approach: Considers social determinants and broader factors beyond the individual.

Milestones in Health Promotion

Several key reports and conferences have shaped health promotion policy and practice in Canada and globally.

• Lalonde Report (1974): Introduced a holistic perspective, recognizing human biology, environment, lifestyle, and health care organization as key areas.

• WHO/UNICEF Alma Ata (1978): Called for urgent action to protect and promote health worldwide.

• Shifting Paradigm Conference (1980): Emphasized self-responsibility and the impact of social structures.

• Beyond Health Care Conference (1984): Introduced healthy public policy and healthy cities/communities projects.

• Epp Report (1986): Identified challenges in health care and the need for community support.

• Ottawa Charter (1986): Influential document outlining five strategies for health promotion.

Ottawa Charter for Health Promotion

Five Strategies for Health Promotion

The Ottawa Charter identifies five key strategies to achieve health for all:

• Building Healthy Public Policy

• Creating Supportive Environments

• Strengthening Community Action

• Developing Personal Skills

• Reorienting Health Services

Healthy Public Policy

Definition and Importance

Healthy public policy refers to government rules, laws, and decisions across all sectors that create supportive environments to improve living conditions and address economic, social, and environmental factors.

• Purpose: Makes it easier for everyone to lead healthier lives by addressing broader determinants.

• Application: Policies in housing, employment, environment, and social support contribute to health promotion.

Summary Table: Levels of Prevention

Key Equations and Concepts

• Health Promotion Equation:

• SDOH Impact Equation:

Additional info: Academic context was added to clarify the principles, levels, and milestones of health promotion, as well as the social determinants of health and the Ottawa Charter strategies.