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Defining health promotion

The Health Promotion Forum has been striving to encapsulate the discipline of health promotion in a few words.  This is a challenge that has vexed the profession since it first emerged several decades ago.   It is widely acknowledged that we need a clear definition of health promotion to effectively communicate its purpose and value to others. Below is our definition, which we invite health promoters around the country – and the world – to adopt.

Health promotion is both a discipline and a process.  It focuses on empowering people and communities to take control of their health and wellbeing.  Ranging from action at a community level to developing policies, it is founded on the principle that health and wellbeing begins in the settings of everyday life.
Health Promotion Forum of New Zealand
Runanga Whakapiki Ake i te Hauora o Aotearoa
April 2014
  At HPF the discussions around defining health promotion have covered  a wide range of topics.  Our conclusions – on some of these topics – have been:
  1. There are three perspectives on health promotion relevant to the Aotearoa New Zealand setting.
  2. Health promotion is a unique discipline and is distinct from public health and health education.
  3. Health promotion is one of the disciplines that together work towards optimising population health.
Three equally important perspectives on health promotion In Aotearoa New Zealand, health promotion is primarily based on two foundation documents: Te Tiriti o Waitangi and the Ottawa Charter, a global framework of the World Health Organisation[i]. There are at least three major perspectives of health promotion in New Zealand – Western, Māori, and Pasifika. While they have many things in common, each has its own unique elements and distinct source, history and strengths.
  1. From a Western perspective, health promotion is a public health discipline. It is the process of enabling peoples and communities to take greater control of their health[ii].
  2. From a Māori view point, health promotion is the enabling of Māori to take greater control of the determinants of their health and therefore their future[iii].
  3. From a Pasifika perspective, health promotion is the empowering of Pasifika peoples to control their wellbeing and their future[iv].
All three are ever-evolving systems of knowledge.  All require equal respect and acknowledgement in our collective learning and enrichment: as fellow human beings with equal rights and responsibilities. HPF acknowledges that all three perspectives have merits and strengths to contribute.  We respect the need to provide space for the respective autonomy of each.  At the same time, where our perspectives overlap, we encourage collaborative effort and partnership for the collective wellbeing of society at all levels. Health promotion is a unique discipline – distinct from public health and health education “Health promotion is a discipline with its own ideology and ordered field of study.”  That is the conclusion of John Kenneth Davies, Professor of International Health Promotion (HPF) at the University of Brighton, England, in a paper commissioned by the Health Promotion Forum, November 2013. Some people see health promotion as a strategy for achieving public health.  Others see it as a form of health education: encouraging behavioural change. Davies disagrees with both beliefs.  He asserts that health promotion’ uniqueness is founded in its work to tackle the determinants of health (the ‘causes of the causes’), and that it is distinct from public health by virtue of its more holistic approach. “Health promotion has a unique and specialised role within a wider multidisciplinary approach to maintaining and improving health,” says Prof Davies in his paper Health Promotion: A Unique Discipline? He quotes Wills and Douglas (2008) as saying it is “a moral and political project and is fundamentally values-based.” The discussion on health promotion and population health In an attempt to tease out the distinction between population health and health promotion, HPF Senior Health Promotion Strategist Karen Hicks posed a question to a professional group on LinkedIn.  Over 60 contributions from 15 members gave rise to a sometimes heated discussion on the topic. While some people hold a clear view about the distinction between health promotion and population health, for many there is still much confusion.  The majority of people who took part in Karen’s LinkedIn discussion see health promotion as a way of moving towards improved population health.  However there were differing views on how this is achieved.  Some see health promotion as individually focused behavioural change.  Others see it as a strategic approach to health inequities and the underlying social determinants of health. Karen suggests that, perhaps a way to see health promotion is as one of the disciplines – along with public health and social development – that, together, work towards improving overall population health? Further she suggests we might see health promotion as a continuum:  health promotion practitioners work at the community level, implementing programmes to improve hauora, while health promotion strategists work at the national and global policy level; aiming to improve the social determinants of health and address health inequities.
We look forward to continuing discussions around this complex question.

[i] World Health Organization. 1986.  Ottawa Charter, Geneva  
[ii] World Health Organization 1986. Ottawa Charter, Geneva  
[iii] Mihi Ratima, M. 2010.  Māori health promotion – a comprehensive definition and strategic considerations, Health Promotion Forum, Auckland  
[iv] Tu’itahi, S. & Lima, I. 2014. Pacific health promotion, a chapter soon to be published in textbook of health promotion, Otago University Press.  
    April 2014 By Jo Lawrence-King, Karen Hicks and Sione Tu’itahi Edited by Jo Lawrence-King