Health promotion

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Models of health promotion


Criticised for victim-blaming, not addressing social issues.


Developed from educational model:

  • knowledge and concepts
  • clarification of attitudes and values
  • development of decision-making skills
  • informed choices in health-related behaviour
  • development of life-skills for personal and social development (assertiveness, communication skills)
  • enhancement of self esteem

Radical political

Knowledge, attitudes, practice

Model started after W.W.II in USA. Not too successful, and from it arose the Health Belief Model, in which attitudes (cognitive, affective and conative [action]) were thought to be the key components determining behaviour, as opposed to knowledge.

The model developed in the 1950s to include individuals’ perceptions of susceptibility and severity; and cues for action.

Downie, Fyfe & Tannahill’s model

“Health promotion comprises efforts to enhance positive health and prevent ill-health, through the overlapping spheres of health education, prevention, and health protection.” (Downie RS, Fyfe C & Tannahill A. Oxford: Oxford University Press, 1990.) See Health promotion - Downie, Fyfe & Tannahill's model for more details.

Determinants of health

1. General socio-economic, cultural and environmental conditions.
2. Living and working conditions.
3. Social and community influences.
4. Individual lifestyle factors.
5. Age, sex, and hereditary factors.

Ottawa charter

Five principles, based on a WHO report. See Ottawa Charter for Health Promotion, 1986 for details.

Building healthy public policy

Ensuring that policy decisions have a positive impact on peoples’ lives.

Creating a supportive environment

Ensuring that peoples’ living and working conditions are safe, satisfiying, stimulating and enjoyable.

Strengthening community action

Recognising that real changes can be achieved if people in communities are involved in setting priorities, planning strategies and implementing them in the pursuit of health.

Developing personal skills

Ensuring that people have enough information and education about health and develop life skills to ensure increased self-esteem and increased control over factors that affect their own health.

Reorienting health services

Promoting a health care system committed to the pursuit of health beyond its responsibility for providing clinical and curative services.


See screening articles.

Health promotion Planning structure

  • Diagnostic stage - establish (health) needs, knowing what’ been done elsewhere and what works, local sensitivities… (National and local prevalence etc. statistics; literature review; surveys, etc.).
  • Reaching the target group - approaches, settings, interventions.
  • Identifying and collaborating with appropriate agencies/¬services
  • Set agreed aims and objectives - decide priorities, establish milestones/¬targets
  • Process
  • Personnel involved. (Who’s in direct contact with target group; who trains educators…)
  • Action taken and outcomes
  • Resource implications
  • Barriers and enabling factors
  • Evaluation

Pros and cons of target-setting for health promotion

Pros Cons
  • Highlights priorities
  • Monitoring tool
  • Stimulates data collection
  • Converts policies into programmes
  • Spurious priorities
  • Oversimplifies
  • Unrealistic
  • Poor data presently

Pros and Cons of settings and methods for health promotion

Setting Pros Cons
  • Access to most children to age 16 - get them before it’s too late!
  • Health education is cross curricular theme (some in most subjects)
  • Still open to influence; key period of adolescence occurs while at school
  • School can be a health promoting environment
  • Staff generally motivate; teachers have credibility and possess skills and competencies
  • Potential for influencing parents and community.
  • No single philosophy (preventive goal not the only goal).
  • Pressures of national curriculum, exams, etc.
  • Health education low status/¬priority
  • ?Pupils not all willing to believe authority figures.
Health services (primary care, hospitals)
  • GPs have access to a large proportion of the population.
  • Hospitals more limited, but contact is at a crucial time at which receptive.
  • Health education based on preventive medical model
  • GPs most trusted source of information
  • Potential competence in health care teams to deliver health education (knowledge, skills - but educational skills might be lacking).
  • Preventive medicine has low status
  • Communication and educational skills may be poor
  • Work overload: immediate treatment takes priority
  • Shortness of consultations a barrier
  • Access to adult population in well-defined surroundings
  • People of working age difficult to reach through other settings
  • The development of health promoting working environments can support changes in lifestyle.
  • Aims not principally concerned with health or education
  • Occupational health service provision patchy
  • Skilled health educators may not be available.
Mass media
  • Reaches a large number of people simultaneously
  • Need for large numbers of staff eliminated
  • Results are “visible” (good for politicians!)
  • Difficult to target specific groups effectively (important when dealing with sensitive health issues like substance abuse)
  • No immediate feedback, so message and its delivery can’t be tailored, therefore has less influence
  • High costs of national media (local media cheaper).

Accident prevention matrix - example

Example of a road accidents prevention matrix

Human Vehicle Environment
Pre-event Eyesight Alcohol level Road-worthiness (tyres, brakes…) Road surface and markings.
Event Seat belt wearing Crash resistance of car Crash barriers
Post-event Excellence of trauma services Rigidity of passenger compartment, ability to open doors Response and access to ambulance and casualty services.

"Health for all" - Alma Ata declaration 1978

Alma Ata declaration in 1978 preceded by 30th World Health Assembly in 1977, at which it was stated that:

The main social target of WHO in the coming decades would be the attainment by all the citizens of the world by the year of a level of health that will permit them to lead a socially and economically productive life.

The full document is available here.

Principles of Alma Ata declaration

  • 1978, in Alma Ata (USSR)
  • Health is a human right
  • Inequalities in health are unacceptable
  • Health promotion and protection are an essential part of economic development
  • It is the individual’s right and duty to participate
  • Governments are responsible for health and should aim for health for all by the year
  • The basis for the achievement of HFA is primary health care
  • Primary health care reflects and evolves from the social conditions of the community
  • Plans, policies and strategies need to be produced by governments an implemented by them in a co-ordinated way
  • International co-operation is needed.
  • Resources are needed: a possible source of these is the current spending on armaments

Subsequent Alma Ata declaration predicated on the principles that:

  • health is not an end in itself, but a means to an end;
  • lifestyles conducive to good health should be encouraged through the empowerment of individuals and their communities;
  • social, political and physical environments which are conducive to good health should be encouraged through community participation, and multisectoral and international collaboration;
  • the resources directed at improving health should be distributed equitably so that the unacceptable inequalities in health should be reduced.

CHIMPE (revision aid)

Community participation Health promotion International co-operation Multisectoral co-operation Primary health care Equity

UK health promotion bodies

Once upon a time there was the Health Education Authority (HEA). This was founded in 1987 as a special health authority, and was largely funded by the UK government's Department of Health.[1][2] This kept banging on about inequalities and deprivation as a cause of ill-health, which annoyed the UK's Conservative government; so it was abolished in 1993. Some of its functions went to the Health Development Agency (HDA). The Health Development Agency was a special health authority established or was it 1993? to develop the evidence base to improve health and reduce health inequalities. It "worked in partnership with professionals and practitioners across a range of sectors to translate that evidence into practice". As a result of the Department of Health's review of its "arms length bodies", the functions of the HDA were transferred to NICE on 1 April.[3]

With the implementation of the Health and social care act much of the role of health promotion in England moved into public health departments in local government authorities.


  1. Copy of page from the HEA web site. Last viewed 12 November.
  2. The National Archives. Health Education Authority: minutes and papers. Updated; Accessed: (27 May).
  3. Information about the HDA from the NICE web site. Last viewed 12 November.