For debate: a new wave in public health improvement

Promotion & Education, 2007

2007

Over the last fifty years, a change has emerged in the way health researchers and practitioners understand the factors that prevent chronic disease and lead to good health. Before that, it was largely considered a matter of bio-medical cause and effect, coupled with negative life style choices. Health professionals began to see that good health and disease prevention is a lot more than that. In 1948, the World Health Organization declared that, more than the absence of disease, health is "a state of complete physical, mental and social well being and not merely the absence of disease or infirmity." And later in 1986, the Ottawa Charter for Health Promotion declared that health is "created and lived by people within the settings of their everyday life; where they learn, work, play and love." As you see from these declarations, a large number of social factors and conditions, including income, employment, education, and others lead to healthy people and communities. In 1998, Health Canada developed a comprehensive list of those factors, calling them the Determinants of Health: income, social support, education and literacy, employment and working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender, and culture. These factors come together like streams to form a flowing river to help us reach a state of complete physical, mental, and social well being. But we realize that many people in our society cannot exploit the determinants of health in their everyday lives. They may lack access because of poverty, homelessness, distance, or related reasons. They may be denied access because of racism, discrimination, or related reasons. This can create health inequities, leaving those who are left out not as well equipped to achieve their full health. Because of that, we promote inclusion, so that everyone can gain access to the 'streams' that lead to health. Primer to Action is for health professionals, lay workers, volunteers and activists. It's for you and your organization, but also for your family, and your community. We will focus on six key determinants of health: income, education, employment, housing, food, and inclusion. Primer to Action will show you 1) where you can find more information about each of the determinants, 2) how you can work on the determinants in your agency, 3) who you can learn from, with examples and models; and 4) what you can do in your community to bring everyone into the flowing river of health.

Australian Health Review, 2006

There is now unequivocal evidence that the health status of individuals and of whole communities is socially and economically determined, as are many other aspects of our lives. This suggests, as advocates of public health and population health approaches argue, that our efforts in managing our health and wellbeing should focus much more on early intervention and prevention programs than has been the case to date. However, although this ideology of social and economic determinism is generally accepted, practice does not reflect such values. Indeed, as increasing demand at the critical end of health service provision sees us spending more and more of our limited health care resources on acute and chronic illness, less resources are devoted to constructing and maintaining health-creating communities and environments. Paradoxically, while most of our leaders, academics and policy makers have themselves been nurtured in a sound understanding of cause and effect in the world, they are ig...

Journal of Public Health Research, 2015

New scenarios are emerging in the European and worldwide context: the ageing of society, the climate changes, the increasing of health inequalities and the financial crisis. In this context, the scientific community and the decision-makers agree on the role of health in all policies (HiAP) strategy in improving the population's health. The HiAP takes into account factors not strictly related to health but with important health consequences. To bring public health in all policies a change is needed, but there are some obstacles to overcome: for instance, the lack of evidence regarding the governance tools and frameworks for HiAP, the difficulty of convincing stakeholders and producing a cultural change in the political positioning of decision-makers. Consequently, it is necessary: i) to implement stronger and responsible decision-support approaches, such as health impact assessment and health technology assessment; ii) to encourage and coordinate all relevant sectors in playing their part in reducing health gaps within the European Union; iii) to strengthen cooperation and make better use of existing networks and existing public health and related institutions. The final aim will be to monitor the impact of the health determinants in order to promote the effective implementation of HiAP approach.

The world was different when the Ottawa Charter for Health Promotion was released 30 years ago. Concerns over the environment and what we now call the 'social determinants of health' were prominent in 1986. But the acceleration of ecological crises and economic inequalities since then, in a more complex and multi-polar world, pose dramatically new challenges for those committed to the original vision of the Charter. Can the 2015 Sustainable Development Goals (SDGs), agreed to by all the world's governments, offer a new advocacy and programmatic platform for a renewal of health promotion's founding ethos? Critiqued from both the right and the left for, respectively, their aspirational idealism and lack of political analysis, the SDGs are an imperfect but still compelling normative statement of how much of the world thinks the world should look like. Many of the goals and targets provide signals for what we need to achieve, even if there remains a critical lacuna in articulating how this is to be done. The fundamental flaw in the SDGs is the implicit assumption that the same economic system, and its still-present neoliberal governing rules, that have created or accelerated our present era of rampaging inequality and environmental peril can somehow be harnessed to engineer the reverse. This flaw is not irrevocable, however, if health promoters – practitioners, researchers, advocates – focus their efforts on a few key SDGs that, with some additional critique, form a basic blueprint for a system of national and global regulation of capitalism (or even its transformation) that is desperately needed for social and ecological survival into the 22nd century. Whether or not these efforts succeed is a future unknown; but that the efforts are made is a present urgency. Citation: Labonté R. Health promotion in an age of normative equity and rampant inequality. Int J Health Policy Manag. 2016;5(x):x–x.

Social Science & Medicine, 1999

Policymakers in many countries seek to contain health care costs over the long range by promoting health and more eective health behavior. Such eorts can be directed at entire populations, at members of a health plan, at de®ned risk groups or single individuals at risk. Many health risks are associated with socio-economic status and social inequalities but these are often dicult to address because of social and political con¯icts. Health, also, is often a product of culture and other social circumstances. Health may be promoted through non-health interventions or through more targeted health eorts seeking to eect behavior change. Preventive screening is of growing importance but such eorts often out-pace evidence of ecacy or cost-eectiveness. Many opportunities exist to build on new clinician±patient partnerships to make patients better informed and to eect positive health behavior. New technologies, and particularly the internet, oer new ways to promote health and more constructive illness behaviors. #

Canadian journal of public health. Revue …, 1999

The ACTION-FOR-HEALTH project aims to improve the health and quality of life of European citizens by tackling health inequalities through health promotion and Structural Funds. The project connects partners from 10 EU countries including: National Center of Public Health and Analysis-NCPHA (Bulgaria), Institute of Public Health of Međimurje county-ZZJZ MŽ (Croatia), Estonian-Swedish Mental health and Suicidology Institute (Estonia), National Institute for Health and Development-OEFI (Hungary), Institute of Hygiene-HI (Lithuania), CBO (Netherlands), University of Trnava-TU ( Slovakia), University de la Laguna-ULL (Spain), University of Brighton-UoB (United Kingdom) and the Institute of Public Health Murska Sobota-ZZV MS (Slovenia) as the project co-ordinator.

Asia-pacific Journal of Public Health, 2000

Journal of Urban Health, 2007

The social and physical environments have long since been recognized as important determinants of health. People in urban settings are exposed to a variety of health hazards that are interconnected with their health effects. The Millennium Development Goals (MDGs) have underlined the multidimensional nature of poverty and the connections between health and social conditions and present an opportunity to move beyond narrow sectoral interventions and to develop comprehensive social responses and participatory processes that address the root causes of health inequity. Considering the complexity and magnitude of health, poverty, and environmental issues in cities, it is clear that improvements in health and health equity demand not only changes in the physical and social environment of cities, but also an integrated approach that takes into account the wider socioeconomic and contextual factors affecting health. Integrated or multilevel approaches should address not only the immediate, but also the underlying and particularly the fundamental causes at societal level of related health issues. The political and legal organization of the policy-making process has been identified as a major determinant of urban and global health, as a result of the role it plays in creating possibilities for participation, empowerment, and its influence on the content of public policies and the distribution of scarce resources. This paper argues that it is essential to adopt a long-term multisectoral approach to address the social determinants of health in urban settings. For comprehensive approaches to address the social determinants of health effectively and at multiple levels, they need explicitly to tackle issues of participation, governance, and the politics of power, decision making, and empowerment.