Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health."
Scope The WHO's 1986 Ottawa Charter for Health Promotion and then the 2005 Bangkok Charter for Health Promotion in a Globalized World defines health promotion as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health". Health promotion is a multifaceted approach that goes beyond individual behavior change. It encompasses a wide range of social and environmental interventions aimed at addressing health determinants such as income, housing, food security, employment, and quality working conditions. It is important to distinguish between health education and health promotion. Health education refers to structured learning activities aimed at improving health literacy, while health promotion encompasses broader social and environmental interventions designed to support healthy behaviors and lifestyles. The World Health Organization distinguishes between these approaches, emphasizing that health promotion involves not only individual behavior change but also efforts to modify social determinants of health. Health promotion involves public policy that addresses health determinants such as income, housing, food security, employment, and quality working conditions. More recent work has used the term Health in All Policies (HiAP) to refer to the actions that incorporate health into all public policies. Health promotion is aligned with health equity and can be a focus of non-governmental organizations (NGOs) dedicated to social justice or human rights. Health literacy can be developed in schools, while aspects of health promotion such as breastfeeding promotion can depend on laws and rules of public spaces. One of the Ottawa Charter Health Promotion Action items is infusing prevention into all sectors of society, to that end, it is seen in preventive healthcare rather than a treatment and curative care focused medical model. There is a tendency among some public health officials, governments, and the medical–industrial complex to reduce health promotion to just developing personal skills, also known as health education and social marketing focused on changing behavioral risk factors. However, recent evidence suggests that attitudes about public health policies are less about personal abilities or health messaging than about individuals' philosophical beliefs about morality, politics, and science.
History This first publication of health promotion is from the 1974 Lalonde report from the Government of Canada, which contained a health promotion strategy "aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health". Another predecessor of the definition was the 1979 Healthy People report of the Surgeon General of the United States, which noted that health promotion "seeks the development of community and individual measures which can help... [people] to develop lifestyles that can maintain and enhance the state of well-being". At least two publications led to a "broad empowerment/environmental" definition of health promotion in the mid-1980s:
In the year 1984 the WHO Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health". In addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organizational change, community development and spontaneous local activities against health hazards" as health promotion methods. In 1986, Jake Epp, Canadian Minister of National Health and Welfare, released Achieving health for all: a framework for health promotion which also came to be known as the "Epp report". This report defined the three "mechanisms" of health promotion as "self-care"; "mutual aid, or the actions people take to help each other cope"; and "healthy environments". 1st International Conference on Health Promotion, Ottawa, 1986, which resulted in the "Ottawa Charter for Health Promotion". According to the Ottawa Charter, health promotion: "is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being" "aims at making... [political, economic, social, cultural, environmental, behavioural and biological factors] favourable through advocacy for health" "focuses on achieving equity in health" "demands coordinated action by all concerned: by governments, by health and other social organizations." The "American" definition of health promotion, first promulgated by the American Journal of Health Promotion in the late 1980s, focuses more on the delivery of services with a bio-behavioral approach rather than environmental support using a settings approach. Later the power on the environment over behavior was incorporated. The Health Promotion Glossary 2021 reinforces the international 1986 definition. The WHO, in collaboration with other organizations, has subsequently co-sponsored international conferences including the 2015 Okanagan Charter on Health Promotion Universities and Colleges. In November 2019, researchers reported, based on an international study of 27 countries, that caring for families is the main motivator for people worldwide.
Settings-based approach The WHO's settings approach to health promotion, Healthy Settings, looks at the settings as individual systems that link community participation, equity, empowerment, and partnership to actions that promote health. According to the WHO, a setting is "the place or social context in which people engage in daily activities in which environmental, organizational, and personal factors interact to affect health and wellbeing." There are 11 recognized settings in this approach: cities, villages, municipalities and communities, schools, workplaces, markets, homes, islands, hospitals, prisons, and universities.
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