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The health promotion best practices literature is imbued with hope for knowledge mobilization, enhanced practice, and improved population health. Given constrained medical care systems, health promotion is key to reducing the significant burden of chronic disease. However, we have seen little evidence of change. This article investigates facilitators of, and barriers to, three stages of health promotion practice in public health organizations, interagency coalitions, and volunteer committees. The article focuses not on what works but why it does or does not, drawing on five case studies within the Canadian Heart Health Initiative. Results indicate that the presence or absence of appropriately committed and/or skilled people, funds and/or resources, and priority and/or interest are the most common factors affecting all stages of health promotion practice. The article extends the literature on internal and external factors affecting health promotion and highlights strategic influences to consider in support of effective health promotion practice.
The centennial celebration of public health nursing is a strong reminder of the tradition and practice of public health nursing's commitment to communities. Partnerships with communities give public health nurses fiduciary responsibility to be actively involved in public health reform to advance health promotion and health protection. Public health nurses must rise to the challenge to build community capacity through facilitating community participation, enhancing community health services, and coordinating public policy to achieve core public health responsibilities of assessment, policy, and assurance. This paper explicates strategies for building community capacity for health promotion.
There is growing evidence that population health is influenced by broad socio-environmental factors that require population-focused health promotion strategies. The author reports on a study of the perspectives of public health nurses (PHNs) on the nature of their health promotion practice in the Canadian province of Manitoba, highlighting their perceptions about barriers to population-focused health promotion. A descriptive, exploratory research design was used to conduct standardized open-ended interviews with 24 PHNs in 3 geographically and demographically diverse health authorities. There were remarkable similarities in PHNs' perceptions about their practice. Three categories of barrier to population-focused health promotion were identified: barriers at the level of individual PHNs; organizational barriers (culture, policies, processes); and extra-organizational barriers at the level of the community or province. The results point to a gap between the theory that population-focused health promotion is at the heart of PHN practice and the experience of PHNs at the 3 sites. A concerted effort to address the barriers is needed so that PHNs in Manitoba can play a leadership role in creating a health-care system that truly invests in population health.
Achieving Health for All, a document released by Health and Welfare Canada, is a framework for nutrition in health promotion. Specific examples of the nutrition implications of the framework's challenges, mechanisms, and strategies are presented. Opportunities for involvement by individual dietitians/nutritionists as well as for The Canadian Dietetic Association are highlighted.
The differing concepts of health promotion are reviewed in their historical context and development, and a unified concept is proposed which encompasses general as well as specific causative factors in the social environment. The implications for health promotion strategies are discussed.
Employee health promotion programs typically involve one or more of the following: (1) education programs, (2) cholesterol, blood pressure, diabetes, or other similar screening programs, (3) smoking cessation programs, (4) drug/alcohol testing and counseling programs, (5) exercise facility or activity programs, and (6) recreational activity programs. The authors examine potential legal implications of these activities. This chapter is intended for those attempting to define and establish these programs or to focus and operate them without undue conflict or legal system involvement.
The European Network of Health Promoting School (ENHPS) program aims to foster healthy lifestyles for school populations by developing supportive teaching and learning environments conducive to promotion of health. Most European countries have joined the network since its organization in 1993. This paper describes how the European, national, and local aims of the ENHPS program have been realized in Finnish schools during the first year of the second triennium (1997-1999). Substantial development related to health promotion has occurred in the Finnish ENHPS schools. A safe school environment was emphasized, and networking with other schools was encouraged at the international and national levels. Attitudes toward the ENHPS program generally were positive. However, Finnish schools have emphasized developing "structures" for health promotion. In the future, efforts should concentrate on students' active participation in the activities of health promotion in everyday teaching and learning situations.
Health promotion programs (HPP) and employee assistance programs (EAP) are compared in terms of their structure and process. Two common themes are extracted: a belief that both are beneficial to both employers and employees, and a sense of 'mission'. The technology of HPP and EAP are examined and compared. EAPs' stimulation from Federal funding is contrasted with the more indigenous roots of HPPs. Examination of empirical data comparing organizations with EAPs which have and have not adopted HPPs indicate the former tend to be somewhat more 'caring' toward employees. An examination of program ingredients indicates much greater commonality of structural and processual ingredients within EAPs as compared to HPPs. The extent to which each program type has become more 'populist' in orientation and the implications of these changes for program technology are considered. Finally the paper describes differences in program evaluation stemming from target group definitions in the two types of programs.
Social disadvantage is an entrenched feature of contemporary New Zealand society and has a deleterious influence on health. Traditional health promotion activities, with their focus on the individual, have had only a limited impact. The World Health Organization is fostering a new approach to health promotion based on the Ottawa Charter, the two most important strategies being: building healthy public policy and strengthening community action. The new health promotion has great potential, especially with its emphasis on 'empowerment', but as yet only indirect evidence supports the effectiveness of this approach. Several current New Zealand community-based initiatives hold promise for the future and three of these are discussed. The greatest challenge is to ensure that the 'empowering' approach to health promotion continues to be developed by Area Health Boards and that this type of health promotion becomes a major priority at all levels of society. As social scientists, we need to support this approach and assist in the production of evidence to show whether it is capable of redressing the health effects of social disadvantage.
Promoting the health of communities has been the rallying cry (now renewed) from the nation's top public health officials. Public health nurses have always stressed community health promotion, not only in their work but also in the educating of future public health nurses. Facilitating the shift from focusing primarily upon secondary and tertiary prevention, individual, and disease-oriented processes is a constant challenge, given the current health care and reimbursement systems. The objectives of this paper are: to give a brief historical review of the nation's health objectives, other recent pertinent documents, and early public health nursing's emphases regarding community health promotion; to give a selected overview of recent community health promotion programs implemented by community and public health nurses in nursing education and practice; and to focus on present challenges to nursing in implementing community health promotion.
This paper reports the results of a study undertaken to explain levels of implementation of heart health promotion activities observed in Ontario public health agencies in 1997. Organizational-level data were collected by surveying all 42 health departments in 1994, 1996 and 1997 as part of the Canadian Heart Health Initiative Ontario Project. Guided by social ecological and organizational theories, the model examines relationships between implementation and four sets of possible determinants of activity: (1) the predisposition of agencies to undertake heart health promotion activities, (2) their capacity to undertake these activities, (3) internal organizational factors and (4) external system factors. A small set of five variables explains almost half of the variance in implementation (R2 = 0.46): organizational capacity (beta = 0.40), priority given to heart health (beta = 0.36), coordination of programs (beta = 0.19), use of resource centers (beta = 0.12) and participation in networks (beta = 0.09). The results suggest that models integrating organizational and socio-ecological theories can help us understand the implementation of community-based heart health promotion activities by public health agencies. Implications for future research, policy and practice are discussed.
The cultural aspects of health promotion are important in policy development as well as in assessing effectiveness of health promotion activities. The discourses on promoting health and well-being in journalism reflect the health promotion culture in society. This article illustrates how health promotion is portrayed by 147 newspaper items from the two Finnish quality dailies during the period 2002-2004 and introduces a semiotic Actantial Model of Health Promotion (AMHP) for studying health promotion cultures. The most popular news themes on health promotion were physical and social environment, welfare services, nutrition and obesity, and mental well-being. The actants (actors, actions and abstract factor) of health promotion were identified and the AMHP with seven key actants (generator, health-object, public, tool, executor, threat and obstacle) was constructed. The model sheds light on two sides of health promotion discourses in journalism. The dominant culture of health promotion was represented by policy actions, information, education and scientific research, which were defined by health experts, decision-makers and researchers. Representations of the opposite culture--'the otherness' of health promotion included external harmful factors and unhealthy behaviours, mentalities opposed to being health-oriented, rationally uncontrolled living, disorder, disharmony and insecurity. The opposing factors were presented by people and institutions lacking the will, ability or motivation for a health-oriented life. To understand better the values of health promotion, it is necessary to assess the characteristics of the opposite side of health promotion culture, because the current dominant values can be described more clearly by the boundaries--by 'otherness'. The study argues that the AMHP can be used as a semiotic method to identify the value dimensions and the boundaries between the dominant and the opposite discourses of health promotion in various communications such as advertising and health education. Also, it provides a tool for the analysis of the media's role in 'victimization' or 'heroization' of various population groups.
The Family Health Leader (FHL) Project was initiated in 1997 to encourage self-care and health promotion. Since then, there has been no retraining. This study aimed to strengthen the FHLs' capability to sustain community-based health promotion and network establishment. The study, of a quasi-experimental design, was conducted in a village in Phan Thong district, Chon Buri Province, Thailand. The intervention emphasized enhancing the FHLs' knowledge, ability, leadership and motivation to advance health promotion activities. Before implementing the main intervention, 5 community health workers were trained as facilitators to strengthen 36 FHL capabilities. The curriculum and manual for training facilitators and FHLs were also developed. The intervention for strengthening FHLs' capabilities lasted for 7 months using participatory training. A within-subject repeated ANOVA was used to measure changes in the main outcome variables immediately, and at three and six months after the intervention. A qualitative methodology was utilized to assess network establishment. The results indicate that the FHLs' knowledge of self-care and health promotion, ability, leadership and motivation had increased significantly after the intervention (p < 0.001). The FHLs also sought to extend their network by involving both the community committee and the local authorities. The intervention appeared to be successful in strengthening the FHLs' capabilities to sustain health promotion within the community, and it established networks vertically and horizontally. The FHLs were the key persons to bring good health to family members. Periodical participatory learning and group empowerment are recommended for encouraging the FHLs to maximize their potential for family self-care and health promotion.
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