Health promotion

Introduction

Health promotion involves improving a population's health through improvement of their lifestyle (or behaviour), environment, and health policy.  The Ottawa Charter set out in 1986 the WHO's vision of the role of health promotion.

Common areas in which health promotion is practised

Common areas addressed by health promotion specialists include:

• smoking
• alcohol
• diet/obesity/exercise
• sexual health - including STIs, family planning
• mental health - including suicide prevention

All these areas contribute considerably to the burden of disease in the UK. 

Health promotion methods

Many of the more visible health promotion activities are lifestyle campaigns aimed at dissuading individuals from taking part in behaviour likely to damage their health if continued.  This is sometimes called health education.

In concert with such campaigns there will often be attempts to influence local or national policies relating to health or environmental factors impinging on the disease, such as introducing legislation to ban smoking in public places, or a voluntary proof-of-age card scheme to discourage under-age drinking.  It has therefore been suggested health promotion can be summarised by the formula:

health promotion = health education x healthy public policy

(Tones K, Health promotion, health education and the public health. p833. In: Oxford Textbook of Public Health 4ed. 2002)

National campaigns

Many national campaigns take place each year, with the aim of co-ordinating activities and improving uptake and awareness of advice by the public.  The current vogue is to have a day or week dedicated to a particular cause, e.g. World AIDS Day, or National Epilepsy Week.  Most of these events were listed on the DH health promotion calendar, which unfortunately appears to have been discontinued. Helpfully, though, Equip (part of NHS West Midlands) provides what seems to be a reliable alternative for 2008:

Health Events Calendar 2008 (Equip, 2008)
DH Health Events Calendar 2007  (DH, now discontinued)

Cost-effectiveness and policy

The costs involved in preventing or reducing the impact of many diseases (such as those mentioned above) are often much lower than those associated with the treatment of the full disease.  Despite this, the funding of health promotion - usually a primary care activity - has traditionally taken a back seat to acute (secondary) care activities.

However, recent government support for health promotion has increased with the publication in late 2004 of the 'Choosing Health' White Paper, and legislation on smoking in public places and extended alcohol licensing laws have recently been in the media spotlight.  Since 1 December 2005 the WHO no longer accepted applications for work from individuals who smoke.

‘Choosing Health’ White Paper

Although there are some concerns about the practical implementation of the 'Choosing Health'  recommendations - in particular the money allocated for this purpose - the bulk of the Paper sets out bold plans to improve the public's health through health promotion and increasing individuals' own sense of responsibility for their health and a healthier lifestyle.

DH Choosing Health pages | Main White paper (DH, Nov 2004) | Delivery Plan (DH, March 2005)

Smoking cessation health equity audit

There is overwhelming evidence that tobacco use causes significant morbidity and mortality (e.g. Doll, Peto et al, 2004, BMJ DOI: 10.1136/bmj.38142.554479.AE [?]), and smoking cessation schemes are an important way of trying to reduce smoking prevalence.  When I was working at Slough PCT (now part of Berkshire East PCT) I was asked with a colleague to undertake a 'health equity audit' (HEA) of smoking cessation services in East Berkshire, to determine how well the services are distributed in comparison with estimated need.

HEA of smoking cessation services in East Berkshire - executive summary (PDF, 60kb, September 2006)

Please contact me if you would like further information on the HEA or would like to request a copy of the full report.

Related resources

Please note there are hundreds of Health Promotion resources available on the internet - this is just a small selection.

Alcohol

The Portman Group

Diet & obesity

Food Standards Agency | National Diet & Nutrition Survey
Obesity: the new frontier of Public Health law (Mello et al, NEJM 354: 2601-2610)

Drug abuse

Talk to Frank

Health promotion in schools & prisons

Health promoting schools
Healthy Living Blueprint for Schools (DfES, 2004)
Health promoting prisons (PSI 24/2002): a shared approach (DH, 2002

Mental health

Mentality
NeLH Mental Health promotion

Road safety including drink-driving

THINK! Road safety | Drink-driving campaign

Sexual health

Terrence Higgins Trust
Playing Safely
British Association for Sexual Health and HIV (BASHH)

Smoking/Tobacco control

NHS stop smoking campaign
ASH (Action on Smoking and Health) | Smokefree action

General

DH Healthy Living
Health Promotion Agency NI Resources page
Patient.co.uk patient information leaflets
NICE Public Health intervention guidance
Society of Health Education and Health Promotion Specialists
Social marketing strategy - It's Our Health (NSMS, June 2006)