Basic knowledge for Health Promotion.

1. Health Promotion
And
Health Education
DR NATASHA K (MBBS, MPH, PHD FELLOW)
ASST PROF BUHS
DRNATASHA1976@GMAIL.COM

2. Topics
 Historical Background, Concept, Philosophy, Definition, Process,
Theory & Scope, Framework, Principles, Approaches & Aims, and
Objectives of Health Promotion.
 Ottawa Charter, Bangkok Charter and global development of
Health Promotion.
 Health promotion priority areas and strategies
2

3. Background of Health Promotion
 The world at the beginning of the 21st century is a world of change. Politically
economically, technically, socio-culturally and demographically, countries and
communities are in transaction.
 The world is significantly different today from some decades ago. New situations pose new
problems and at the same time present new opportunities.
 New health promotion approaches are required to match them. Health promotion has to
be justified against competing claims for the societies resources.
 We must strive to find even more effective ways of promoting supporting environments,
strengthening communities refocusing services and helping people acquire knowledge
and skills for health.
 We need to explore the strategies and methods for effectiveness of these activities.
3

4. Background cont…
 The information technology of today and tomorrow can enhance the ability of health promotion to
reach people everywhere. This however will require creativity and imitativeness, as well as commitment to
policy making. Achieving health for all, with the participation of all, based on the principles of equity and
solidarity, requires not only good management but a fresh approach.
 Over the past years stretching from Ottawa (1986), the first International Conference on Health Promotion
and which gave its name to Ottawa Chatter from Health Promotion, to the second conference in
Adelaide (1988) and the third in Sundsvall (1991), Health Promotion has carried its mission of giving health
a high position on the political agenda.
 Each of these conference has made a significant contribution to public health and to focusing our
attention to the necessity for a more holistic & comprehensive approach to addressing the determinants
of health. Jakarta conference is the fourth in a series of technical conferences on health promotion, all of
which have and continue to make major contributions to health promotion & public health.
4

5. History
 The “first and best known” definition of health promotion, declared by the American
Journal of Health Promotion since 1986 is
“the science and art of helping people change their lifestyle to move
toward a state of optimal health”
 Since then and even before there have been plenty of definitions for health promotion
 1974 Lalonde Report form Canada
 1979 Healthy People report of Surgeon general of united states
 1984 WHO
 1986 Canadian minister of national health and welfare
5
☼ Different conferences, important documentations and charters

6. 6
Health promotion is directed towards action on the determinants or causes of
health promotion, therefore, requires a close co-operation of sectors beyond
health services, reflecting the diversity of conditions which influence health.
Concept
Government at both local and national levels has a unique responsibility to act
appropriately and in a timely way to ensure that the ‘total’ environment,
which is beyond the control of individuals and groups, is conducive to health.

7. 7Concept

8. What is Health Promotion?
Today Health Promotion is more than
personal and population education.
Defined in a number of ways
“The process of enabling people to
increase control over and improve their
health”
(World Health Organisation 1986)
Health Promotion = health education x
healthy public policy.
(Tones and Tilford, 1994)
8

9. Phylosophy
 Through the involvement of
home, school and
community,
 including: the physical,
intellectual, emotional,
social and moral
development
Health promotion is any
combination of health, education, economic,
political, spiritual or organisational initiative
designed
to bring about positive attitudinal,
behavioural, social or environmental changes
conducive to improving
the health of populations.
9

10. DefinitionDefinition (learn this one)(learn this one)
Health promotion is the process
of enabling people to increase control over, and to
improve, their health. It is a positive concept
emphasising personal, social, political and institutional
resources, as well as physical capacities.
WHO (1990), Health Promotion Glossary
10

11. THE PROCESS OF HEALTH PROMOTIONTHE PROCESS OF HEALTH PROMOTION
FOCUS STRATEGIES IMPACT OUTCOMES
Individuals
Groups
Population
Education
couselling
Economic
change
Legislative
change
Policy or
organisation
change
Behavioural
educational
change
Social,
economic and
environment
change
Better
Health
Quality
of life
11

12. The scope of health promotion activity
Frameworks and Models are tools that help explain phenomena.
Many tools developed to explain the scope of health promotion.
1.Beattie’s (1991) model of health promotion
2.Tones and Tilford’s (1994) empowerment model of health promotion
3.Caplan and Holland’s (1990) Four perspectives on health promotion
4.Naidoo and Wills (2000) typology of health promotion
12

13. Health promotion theories
 There are many different theories that guide health promotion interventions
 Most theories are based in the social sciences including sociology, education,
psychology and policy studies
 Different approaches to health promotion tap into different theoretical
perspectives and academic disciplines
 We will examine 4 contrasting models
13

14. Niandoo & Wills 2005
Models of health promotion may help to:
 Conceptualize or map the field of health promotion
 Interrogate and analyze existing practice
 Plan and chart the possibilities for interventions
14

15. Beattie’s model of Health Promotion
Individual
Authoritative
Collective
Negotiated
Health persuasion
Needs to focus on
why behaviour is
happening
Legislative
Action
Focus
Act
Resources
Policy
Community
Development
Empowerment
community level
Skills
Personal Counselling
Greater control
15

16. Beattie’s model applied
Key features
Examines 2 axis
i) type of approach used top down (authoritarian) or bottom up (negotiated or
owned by clients)
ii) size of approach
Categorises 4 types of activities
a)Personal Counselling eg working with dietician on food and physical individual
personal plans and goals
b)Health persuasion eg Campaign of eating 5 fruit and vegetables a day on TV
c)Legislative action eg laws that subsidise the price of healthy food stuff
d)Community development eg communities producing and distributing food
themselves
16

17. Tones and Tilford’s (1994) model of health promotion
Key features
States interaction between two main sets of processes for health improvement
i)development and implementation of healthy public policy
ii) health education in which people are empowered to take control of their life.
Example attempts of Jamie’s School Diners campaign where school meals was brought
into public consciousness and lead to standards for meals and an increase in the budgets
for school meals.
Only when these two approaches work in parallel can the conditions for living and
individuals behavioural aspects of health be addressed
17

18. Caplan and Holland’s model of health promotion (1990)
Key features
More complex and theoretically driven
Attempts to unpick what determines health and ill-health and
therefore what activities can be used to address health issues.
One axis refers to a theory of knowledge and how knowledge
is generated in relation to health
The other axis refers to how society is constructed and how this
impacts on health.
18

19. TANNAHILL’S MODEL OF HEALTH PROMOTION (DOWNIE et al – 1990)
Health education
Prevention
Health
protectio
n
1
2
3
4
5
7
6
1. Preventive services, e.g..
immunization, cervical screening,
hypertension case finding,
developmental surveillance, use of
nicotine chewing gum to aid
smoking cessation.
2. Preventive health education, e.g..
smoking cessation advice and
information.
3. Preventive health protection, e.g..
fluoridation of water.
4. Health education for preventive
health protection, e.g.. lobbying for
seat belt legislation.
5. Positive health education, e.g. life
skills with young people.
6. Positive health
protection, e.g..
workplace smoking
policy.
7. Health education aimed
at positive health
protection, e.g.. pushing
for a ban on tobacco
advertising.
19

20. TANNAHILL’S MODEL OF HEALTH PROMOTION
(DOWNIE et al – 1990) (cont.)
 Shows how these different approaches relate to each other in an
all-inclusive process termed health promotion.
 Health education- communication to enhance well being and
prevent ill health through influencing knowledge and attitudes.
 Prevention- reducing or avoiding the risk of diseases and ill health
primary through medical interventions.
 Health protection safeguarding population health legislative, fiscal
or social measures.
20

21. A FRAMEWORK FOR HEALTH PROMOTION ACTIVITIESA FRAMEWORK FOR HEALTH PROMOTION ACTIVITIES
AREAS OF
HEALTH
PROMOTION
ACTIVITY
Preventive health
services(Primary,
secondary, tertiary
Preventive health
services(Primary,
secondary, tertiary
Community-based
work
Community-based
work
Organisation
development
Organisation
developmentHealthy
Public Policy
Healthy
Public Policy
Environmental
health measures
Environmental
health measures
Economic and
regulatory
activities
Economic and
regulatory
activities
Health education
programmes
Health education
programmes
21

22. A FRAMEWORK FOR HEALTH PROMOTION ACTIVITIESA FRAMEWORK FOR HEALTH PROMOTION ACTIVITIES
CLASS
AGE
GENDER
ETHNICITY
Housing tenure
Environment
Regional location
Access to health
services
Access to leisure
facilities
Nutrition
Smoking
Physical
activity
Psychosocial
factors, e.g.
stress
Cholesterol
Blood
pressure
Obesity
KEY SOCIAL
STRATIFICATION
FACTORS
ENVIRONMENT
FACTORS
LIFESTYLE
FACTORS
PHYSIOLOGICAL
FACTORS
C
H
D
22

23. 23
The five key principles of health promotion as determined by
WHO are as follows:
1.Health promotion involves the population as a whole in the context
of their everyday life, rather than focusing on people at risk from
specific diseases.
2.Health promotion is directed towards action on the determinants or
causes of health therefore, requires a close co-operation of sectors
beyond health services, reflecting the diversity of conditions which
influence health
PRINCIPLES OF HEALTH PROMOTION

24. 24
PRINCIPLES OF HEALTH PROMOTION contd
3. Health promotion combines diverse, but complementary methods or approaches
including communication, education, legislation, fiscal measures, organisational
change, community change, community development and spontaneous local
activities against health hazards.
4. Health promotion aims particularly at effective and concrete public participation.
This requires the further development of problem-defining and decision-making life
skills, both individually and collectively, and the promotion of effective participation
mechanisms.
5. Health promotion is primarily a societal and political venture and
not medical service, although health professionals have an important role
in advocating and enabling health promotion.

25. Main approaches to health promotion
 Medical or preventative
 Behavioral change
 Educational
 Empowerment
 Social change
25

26. Aims
 Reduce morbidity and premature mortality
 Target: whole populations or high risk groups
 Promotion of medical intervention to prevent ill-health
26The medical or preventative approach

27. Aims
 Encourages individuals to adopt healthy behaviors which improve health
 Views health as a property of individuals
 People can make real improvements to their health by choosing to change lifestyle
 It is people’s responsibility to take action to look after themselves
 Involves a change in attitude followed by a change in behavior
27Behavior change approach

28. Aims  To enable people to make an informed choice about their health
behavior by
 providing knowledge and information
 developing the necessary skills
 Not similar the behavioral approach, it does NOT try to persuade or
motivate change in a particular direction
 OUTCOME is client’s voluntary choice which may be different from
the one preferred by health promoter
28The educational approach

29. Empowerment approach 29
WHO defined health promotion as “enabling people to gain control over their lives” (empowerment)
Aims
 Helps people identify their own concerns and gain the skills and confidence necessary to
act upon them
 This is the only approach to use a ‘bottom-up’ (rather than ‘top-down’) approach
 Empowerment may involve both self-empowerment and community empowerment
 Self-empowerment:
 Based on counseling
 Uses non-directive ways
 Increase person’s control over his/her own live

30. Aims (Cont.)
 For people to be empowered they need to:
1. Recognize and understand their powerlessness
2. Feel strongly enough about their situation to want to change it
3. Feel capable of changing the situation by having information,
support and life skills
30

31. Aims
 Radical approach which aims to change society not individual behavior
 Aims to bring changes in the physical, economic and social environment
 Healthy choice to become the easier choice in terms of cost, availability and accessibility
 Targeted towards groups and populations
31Social change approach

32. These approaches have different
objectives
 To prevent disease
 To insure that people are well informed and are able to make
health choices
 To help people acquire the skills and confidence to take greater
control over their health
 To change polices and environments in order to facilitate healthy
choices
32

33. TOP-DOWN VS. BOTTOM-UP
 Priorities set by health promoters
who have the power and
resources to make decisions and
impose ideas of what should be
done
 Priorities are set by people
themselves identifying issues they
perceive as relevant
33

34. THE FIVE APPROACHES
EXAMPLES RELATED TO SMOKING
Based on Ewles and Simnet (1992: 36)
34

35. The medical approach
 AIM: Free from lung disease, heart disease and other smoking
related disorders
 ACTIVITY: Encourage people to seek early detection and treatment
of smoking related disorders
35

36. Behavioral change approach
 AIM: Behavior changes from smoking to not smoking
 ACTIVITY: Persuasive education to
– prevent non-smokers from starting to smoke
– persuade smokers to stop
36

37. Educational approach
 AIM: Clients understand effects of smoking on health and will make
a decision whether to smoke or not and act on their decision
 ACTIVITY: Giving information to clients about effects of smoking
 Helping them explore their values and attitudes and come to a
decision
 Helping them learn how to stop smoking if they want to
37

38. The empowerment approach
AIM: Anti-smoking issue is considered only if clients identify it as a
concern
ACTIVITY: Clients identify what, if anything, they want to know and do
about it
38

39. Social change approach
 AIM: Make smoking socially unacceptable so it is easier not to
smoke than to smoke
 ACTIVITY
– No smoking policy in all public places
– Cigarette sales less accessible
– Promotion of non-smoking as a social norm
– Limiting and challenging tobacco advertisements and sports
sponsorships
39

40. Models
1. The medical model
2. The behaviour change model
3. The educational model
4. The empowerment model
5. The social change model
40

41. Break
… BACK TO THE ‘BACK’…..AGAIN
41

42. Alma Ata Declaration, 1978
 On Primary Health Care: Essential health care that’s practical,
scientifically sound and social acceptable methods and
technology made UNIVERSALLY accessible and affordable to
individuals and families in the community.
 It expressed the need for urgent action by all governments, all
health and development workers, and the world community to
protect and promote the health of all the people of the world.
42

43. Important Policy Documents 43
 First ICHP Ottawa, Canada 1986 Resulted in the “Ottawa Charter for Health Promotion”
 Second ICHP Adelaide, Australia 1988 Resulted in the “Adelaide Recommendations on Healthy Public
Policy”
 Third ICHP Sundsvall, Sweden 1991 Resulted in the “Sundsvall Statement on Supportive Environments for
Health”
 Fourth ICHP Jakarta, Indonesia 1997 Resulted in the “Jakarta Declaration on Leading Health Promotion
into the 21st
Century”
 Fifth GCHP Mexico City, Mexico 2000 Resulted in the “Mexico Ministerial Statement for the promotion of
health”
 Sixth GCHP Bangkok, Thailand 2005 Resulted in the “Bangkok Charter for Health Promotion in a
Globalized World”
 7th Global Conference on Health Promotion: Nairobi 2009
 8th Global Conference on Health Promotion: Helsinki 2013

44. Ottawa Charter (1986)
Health promotion should be a part of public policy, documents and measures.
Health promotion should be a part of a community policy and practice.
Environment should enable and promote health.
People should be able to gain information, knowledge and skills enabling
development of health.
Health services should more orient on health promotion and support.
44

45. THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
 Healthy public policy is a pre-requisite for successful health promotion.
 A Healthy Public Policy is characterized by a concern for health and equity and
an accountability for health impact.
 Health should be made a priority item on the agenda of policy-makers in all
sectors.
 Policy-makers should be made aware of the health consequences of their
decisions. They should create pro-health policies, whether in the area of
development, legislation, taxation etc.
1. Healthy Public Policy
45

46.  Healthy public policy covers a combination of diverse but complementary
measures and approaches such as legislation, taxation, fiscal incentives and
disincentives, policy analysis and review, and organizatioanl change
 Joint action by all sectors will contribute to achieving safer and healthier goods
and services, healthier public services, and cleaner and more healthy
environment.
 The aim is to make the healthier choice the easier choice for all people.
 HPP should lead to the creation of a supportive environment to enable people to
lead healthy live
1. Healthy Public Policy
46
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)

47.  According to the Adelaide Conference (1988), “The main aim of HPP is to
create a supportive environment to enable the people to lead healthy lives.
Healthy choices are thereby made possible and easier for citizens”.
 All relevant government sectors like agriculture, trade, education, industry and
finance need to give important consideration to health as an essential factor
during their policy formulation.
1. Healthy Public Policy
47
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)

48.  A supportive environment is essential for health.
 Supportive environments cover the physical, social, economic, and political
environment.
 Supportive environments encompass where people live, work and play. This
is what is envisaged by the “settings” approach.
 Everyone has a role in creating supportive
environments for health.
2. Create Supportive Environment
48
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)

49.  According to the Ottawa Charter, “health promotion works through concrete and
effective community action in setting priorities, making decisions, planning
strategies and implementing them to achieve better health”.
 There are many ways of defining community. Factors used are geography, culture
and social stratification.
 Community action is any activity undertaken by a community in order to effect
change (including voluntary and self-help services).
3. Strengthen Community Action: Community Participation
49
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)

50.  Community participation covers a spectrum of activities
 At the low end, it may be token participation in the form of consultation or
endorsing plans drawn up by the health authorities. At the high end, it may
be in the form of ‘people power’ where they have full say in identifying needs,
setting priorities, planning strategies and activities and implementing the
programme.
50
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
3. Strengthen Community Action: Community Participation

51.  Full community participation occurs when communities participate in equal
partnership with health professionals as stakeholders in setting the health
agenda.
 Community participation is a social process whereby groups with shared
needs living in a defined geographic area actively pursue identification of their
needs, take decisions and establish mechanisms to meet these needs
3. Strengthen Community Action: community Participation
51
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)

52.  According to the Jakarta Declaration (1997), “health promotion improves both
the ability of individuals to take action, and the capacity of groups,
organizations or communities to influence the determinants of health”.
 Empowerment is an important strategy, based on the notion that health is
significantly affected by the extent to which one has control or power over
one’s life.
3. Strengthen Community Action: Community Participation
52
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)

53.  Strategies for empowering the community include leadership training, learning
opportunities for health, and access to resources including material and
funding
 Empowerment helps people to identify their own needs and concerns, and gain
the power, skills and confidence to act upon them. It is a bottom-up strategy
which requires the health promoter to act as a facilitator and catalyst for
change.
4. Develop Personal Skills
53
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)

54.  Skills which can promote an individual’s health include those pertaining to
identifying, selecting and applying healthy options in daily life.
 Health education is life-long, so that people can develop the relevant skills to
meet the health challenges of all stages of life, and to be able to cope with
chronic illness and disabilities.
 Health education should be conducted in all settings.
4. Develop Personal Skills
54
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)

55.  Shift of emphasis from provision of curative services.
 Health care system must be equitable and client-centered.
 May necessitate reengineering and organizational change, especially in
the areas of professional education and training, management, recruitment
and deployment of health personnel, and planning, development and
delivery of services,
5. Reorient Health Services
55
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)

56. 56
Building a
healthy public
policy
Creating
supportive
environments
Developing
personal skills
Strengthening
community
action
Reorientating
health services
IMPORTANT AREAS FOR CONSIDERATION IN HEALTH
PROMOTION

57. Adelaide Recommendations on Healthy Public Policy
Second International Conference on Health Promotion, Adelaide, South Australia, 5-9 April 1988
The Conference strongly recommends that the World Health Organization
continue the dynamic development of health promotion through the five
strategies described in the Ottawa Charter. It urges the World Health
Organization to expand this initiative throughout all its regions as an
integrated part of its work.
Support for developing countries is at the heart of this process.
Healthy Public Policy
57

58. Sundsvall Statement on Supportive Environments
for Health
Third International Conference on Health Promotion, Sundsvall,
Sweden, 9-15 June 1991
The Sundsvall Conference has again demonstrated that the issues
of health, environment and human development cannot be
separated.
Development must imply improvement in the quality of life and
health while preserving the sustainability of the environment. Only
worldwide action based on global partnership will ensure the
future of our planet
Supportive environment for Health
58

59. Jakarta Declaration on Leading Health Promotion
into the 21st Century
The Fourth International Conference on Health Promotion: New
Players for a New Era - Leading Health Promotion into the 21st
Century, Jakarta, Indonesia, 21-25 July 1997
The Jakarta Declaration included Five Priorities for Health Promotion in
21st
Century
1. “Promote Social Responsibility for health”
2. “Increase investments for health development”
3. “Consolidate and expand partnerships for health”
4. “Increase community capacity and empower the individual”
5. “Secure an infrastructure for health promotion”
59

60. The participants endorsed the formation of a Global health promotion
alliance
Priorities for the alliance include:
• Raising awareness of the changing determinants of health
• Supporting the development of collaboration and networks for health
development
• Mobilizing resources for health promotion
• Accumulating knowledge on best practice
• Enabling shared learning
• Promoting solidarity in action
• Fostering transparency and public accountability in health promotion
60

61. Mexico Ministerial Statement for the
Promotion of Health: From Ideas to Action
Fifth Global Conference on Health Promotion,
Health Promotion: Bridging the Equity Gap,
Mexico City, 5-9 June 2000
The attainment of the highest possible standard of health is a
positive asset for the enjoyment of life and necessary for social
and economic development and equity.
8 Statements and 6 Actions where signed by 88 Countries world
wide.
61

62. The ‘Bangkok Charter for Health Promotion in a
globalized world’
It has been agreed to by participants at the 6th Global
Conference on Health Promotion held in Thailand from 7-11
August, 2005
1. Make the promotion of health central to the global development agenda.
2. Make the promotion of health a core responsibility for all of government.
3. Make the promotion of health a key focus of communities and civil society.
4. Make the promotion of health a requirement for good corporate practice.
62

63. Basic Strategies for Health Promotion
 Advocate
 Enable
 Mediate
63

64. Advocate
 Good health is a major resource for social,
economic and personal development and an
important dimension of quality of life. Political,
economic, social, cultural, environmental,
behavioral and biological factors can all favor
health or be harmful to it. Health promotion
action aims at making these conditions
favorable through advocacy for health.
64

65. Enable
Health promotion focuses on achieving equity in health.
Health promotion action aims at reducing differences in
current health status and ensuring equal opportunities
and resources to enable all people to achieve their
fullest health potential. This includes a secure foundation
in a supportive environment, access to information, life
skills and opportunities for making healthy choices.
People cannot achieve their fullest health potential
unless they are able to take control of those things which
determine their health. This must apply equally to women
and men.
65

66. Mediate
 The prerequisites and prospects for health cannot be ensured by
the health sector alone. More importantly, health promotion
demands coordinated action by all concerned: by governments,
by health and other social and economic sectors, by
nongovernmental and voluntary organization, by local authorities,
by industry and by the media. People in all walks of life are involved
as individuals, families and communities. Professional and social
groups and health personnel have a major responsibility to mediate
between differing interests in society for the pursuit of health.
 Health promotion strategies and programmes should be adapted
to the local needs and possibilities of individual countries and
regions to take into account differing social, cultural and economic
systems.
66

67. 6 Major Elements
 Better Health policy.
 Physical environment.
 Social environment.
 Community relationships.
 Personal health skills.
 Health services
67

68. Prerequisites for Health
The fundamental conditions and resources for health are:
peace,
shelter,
education,
food,
income,
a stable eco-system,
sustainable resources,
social justice, and equity.
68

69. HEALTH PROMOTION: WHERE DO WE START?
 From disease/conditions.
 From issues eg. Safety, environment, tobacco control.
 From lifestyles.
 From settings eg. workplace
home
schools
clinics
69

70. SETTINGS FOR HEALTH
 This approach to health promotion arose from the Ottawa Charter:
“Health is created and lived by people within the settings of their
everyday life; where they learn, work, play and love”.
70

71. WHY SETTINGS?
 Human health behaviour is determined by the physical and social forces which are present and interacting
in any setting.
 Involves the target population as a whole in the context of their everyday life and in their unique
environment.
 Holistic and comprehensive approach.
71

72. SETTINGS FOR HEALTH
 The Settings For Health approach in concerned with creating health in our different settings.
 Examples of Healthy Setting are:
 Healthy Cities
 Healthy Villages
 Healthy Islands
 Health Promoting Hospitals
 Health Promoting Schools
72

73. CONCLUSION
 The concept of health promotion is positive, dynamic and
empowering which makes it rhetorically useful and politically
attractive.
 By considering the recommended principles, subject areas,
policy priorities and dilemmas it is hoped that future activities in
the health promotion field can be planned, implemented and
evaluated more successfully.
 Further development work is clearly required and this will be an
ongoing task of the WHO Regional Office for Europe.
73

74. References
Online
www.who.int/topics/health_promotion
www.healthpromotionjournal.com
www.iuhpe.org
ped.sagepub.com
Books
1.A Text Book of Health Education (Philosophy and Principles) by Hari Bhakta Pradhan,
Educational Resources for Health, Kathmandu, Nepal.
2.Foundations and Principles of Health Education by Nicholas Galli, University of Illinois,
Illinois
3.Education For Health A Manual.. WHO
4.Theory in a Nutshell : A practical guide to HP Theories…Don Nutbeam and Elizabeth Harris
5.HP.. Bedworth
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