Health promotion emerged in the 1990s as a unifying concept which brought together a number of separate, even disparate, fields of study and has become an essential part of the contemporary public health.
Regarded by some as the delivery vehicle or mechanism for public health, health promotion now forms an important part of the health services of most industrially developed countries and is the subject of a growing number of professional training courses and academic activities.
The implications of this growth have concerned many of those involved in health and health care delivery. Some of the initial momentum for its development sprang from dissatisfaction with what was typified as the bio-medical model of health associated with focus on disease, aetiology, and clinical diagnosis.
More recently, health promotion appears to be addressing the mainstream health care issues of the twenty-first century by contributing to newer approaches to health improvement, whole population programs, health impact assessment, investment for health projects, capacity building, community planning and involvement, and perhaps most importantly, evidence-based practice.
Less effort has been made, however, in considering the nature of this new form of knowledge and practice, its salient features and the likely constraints on, and possibilities for, its development. Such reflection continues to be useful for facilitating and development in the field.
Of course, the truth of the matter is that we have not survived without it any more than we have survived without attempts at medical care. It is just that throughout the long and tortuous history of the latter, health promotion has consistently been making its entries and exits to the stage, but well disguised and frequently anonymously.
To appreciate this, we must now consider what health promotion actually is. Indeed, since it has so often been well hidden, let us accomplish this by reflecting on what it is not.
Health Promotion and Related Policy
Health promotion professes to be centrally concerned with the social policy process and most definitions of health promotion place notions of social structure and policy process at the centre of concerns.
Building healthy public policy, for example, was one of the five means of health promotion action to achieve Health for all by the Year 2010 – along with creating supportive environments, strengthening community action, developing personal skills, and reorienting health services.
To promote health effectively, we need to be able to understand, analyze, and ultimately influence social and health policy. Social policy should have a substantial input to health promotion, taking health promotion on its own terms.
More than this, however, the study of social policy might contribute to our understanding of the emergence of health promotion itself. Health promotion has developed along with and in response to a social and political context particular to the late twentieth century. It has been described as lying at the forefront of social and cultural change (Beattie 1991).
Understanding this social and political policy context, and health promotion’s place within it, provides important reflection and self-awareness but also allows a better understanding of the limitations on and the possibilities for developing healthy public policy. Health promotion is itself a topic of interest to social policy analysts and is increasingly seen as an area of social policy.
Defining healthy public policy can be problematic because of variation in the use of the term and inherent conceptual ambiguity. Though a relatively new term, it is a direct descendant of the ‘old’ and the ‘new’ public health movements, and intimately linked to the development of World Health Organization programmes.
The conceptual grounding for healthy public policy came from the WHO Assembly’s resolution that health be the main social goal of government, including Health for all by the Year 2000.
A useful distinction has been made between healthy public policy and public health policy (Hancock 1982). The latter term refers to a narrower set of policies, more usually aimed at the system of caring for ill people. This distinction is a crucial one.
Healthy public policy self-consciously aims to go beyond the health care system and its more traditional hospital and physician-based care. Definitions of healthy public policy incorporate very broad visions of health, crossing traditional disciplinary, organizational, and governmental categories.
They refer to a concern for manipulating the social policy environment to create a healthy society, implicitly recognizing that the social environment is an important determinant of health.
Various sectors of society are understood to act in interdependence to regulate, enhance, or endanger health. Governmental sectors outside health are involved in engendering health, such as agriculture, education, transportation, energy, and housing, for example.
While the need for a health promotion approach has been strongly endorsed at international, national and provincial levels, the constraints upon translating the vision into reality cannot be overestimated.
This review of the evolution of community health services in U.K. has documented the gap between the principles of a health promotion approach and the traditional medical model that has dominated the pattern of service development. It has also documented some of the professional, organizational and political barriers that have militated against a shift to a more social model.