Health promotion - Downie, Fyfe & Tannahill's model

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(This is a sub-page of the main health promotion page.)


Downie, Fyfe & Tannahill's overlapping spheres

“Health promotion comprises efforts to enhance positive health and prevent ill-health, through the overlapping spheres of health education, prevention, and health protection.”[1] Downie, Fife & Tannahill's overlapping spheres

Health education

Health education (e.g. education of schoolchildren about health consequences of smoking) is an activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health. Health education remains an important component of health promotion, although it is nevertheless a subset.

Disease prevention

Disease prevention (e.g. seat belts) involves specific interventions aimed at avoiding contact with disease producing risk factors or, where this is not possible, treatment aimed at minimising the harmful consequences of the disease process. It is commonly divided into three levels: primary, secondary, and tertiary prevention. See Disease prevention for more details.

Health protection

Health protection involves collective activities directed at factors which are beyond the control of the individual. Tannahill has given the following definition:

“Legal or fiscal controls, other regulations or policies, or voluntary codes of practice aimed at the prevention of ill-health or the positive enhancement of well-being.”[2]

NB - note that, since the creation of the Health Protection Agency, the meaning of health protection has changed to mean what the Agency (which has since become part of Public Health England) did. The Agency was invented quite some time after Downie, Fyfe & Tannahill's seminal paper. The HPA considered its role to be '"to protect the community (or any part of the community) against infectious diseases and other dangers to health" (HPA Act).' It goes on to refer to its 'role in reducing the dangers to health from infections, chemical and radiation hazards...'.[3]


  1. Downie RS, Fyfe C & Tannahill A. Oxford: Oxford University Press, 1990.
  2. Tannahill A. What is health promotion? Health Education Journal 1985;44(4):167-8.
  3. Health Protection Agency. What the Health Protection Agency Does. (last updated 12 April). Last viewed 22 June.