This article intends to shed some light on health promotion as described by the Ottawa Charter on Health Promotion. In addition, some related concepts will be discussed.

Background Information:

Primary prevention of disease refers to actions aimed at ensuring that individuals do not develop disease. This may be focused against a single disease, or may be aimed at a group of diseases sharing similar risk factors.

Secondary prevention of disease refers to actions taken after disease has occurred in an individual so that complications of that disease do not occur.

Tertiary prevention of disease refers to actions taken after complications of a disease have occurred and intend to restore individuals to better health or limit the effects of the complication(s).

Modes of intervention refer to the specific activities or approaches undertaken for the prevention of disease(s). The modes of intervention are specific for each level of prevention- primary/secondary/tertiary prevention.

Health Promotion is one of two modes of intervention described under primary prevention, with the other being specific protection. Specific protection refers to precise actions taken to protect against the development of particular disease conditions, and includes vaccination, chemoprophylaxis, etc.

The modes of intervention under secondary prevention are Early diagnosis, and appropriate treatment; while those under tertiary prevention are disability limitation, and rehabilitation.

While most of the modes of intervention are fairly intuitive and easy to understand for the general public, health promotion sounds like a vague concept, and is often equated with health education.

Key Messages:

Health education is the “process of assisting individuals to make informed decisions about matters affecting their personal health and that of others”.

Health promotion is the “process of enabling people to increase control over, and to improve, their health .. a commitment to dealing with the challenges of reducing inequities, extending the scope of prevention, and helping people to cope with their circumstances to create environments conducive to health, in which people are better able to take care of themselves”.

Clearly, health promotion is much wider in scope than health education, and emphasizes voluntary, informed behaviour changes.

Health behaviour refers to any activity undertaken by an individual for the purpose of promoting, protecting, or maintaining health, regardless of whether such behaviour is actually effective in doing so.

Two types of health behaviour have been described:

1. Health-directed behaviour: Performed primarily to prevent disease
2. Health-related behaviour: Behaviours that may have health implications but are not undertaken with any specific health outcome in mind

Health promotion behaviours are those that promote health and combat health problems, for example:

• Consuming a healthy diet
• Engaging in regular physical activity

In contrast to health promotion behaviours, health risk behaviours are associated with increased susceptibility to particular disease(s) or ill-health, for example:

• Sexual promiscuity/ unsafe sexual practices
• Harmful use of alcohol
• Consumption of tobacco

Thus, while health education merely seeks to enable health related decision making, health promotion seeks to empower people to voluntarily make informed behaviour changes to promote, protect, and maintain health. Naturally, behaviour change is harder to bring about than prescribing medications or providing prosthetics. It is also more time-consuming than other modes of intervention. This explains the relative lack of health promotion programs compared to other health interventions.

An excellent example of a health promotion project is the North Karelia project that was originally launched in North Karelia, Finland to reduce cardiovascular deaths in the region (1972-77), but was then extended to include the entire country.

The graph clearly shows the dramatic decrease in mortality after the project began, with an 84% decline in North Karelia, and an 82% decline in mortality in Finland between 1972 and 2011.

Useful Links:

Link to the Ottawa Charter on Health Promotion:

https://www.euro.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charter.pdf

Link to an article describing the North Karelia Project:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444010/pdf/10.1177_1559827620910981.pdf

Link to a previous article on Health Promotion:

https://communitymedicine4all.com/2016/08/27/understanding-health-promotion/