Health Promotion: History and International Efforts

1. Health Promotion: History and International Efforts

2. Health Promotion • Health promotion has been defined by the World Health Organization's (WHO) 2005 Bangkok Charter for Health Promotion in a Globalized World as: "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"

3. Health Promotion • There is a tendency among public health officials and governments (especially in Canada and the USA) to reduce health promotion to health education and social marketing. • The health promotion is then focused on changing behavioral risk factors.

4. Health Promotion: History • The best known definition of health promotion came in 1986 and was coined by the American Journal of Health Promotion: "the science and art of helping people change their lifestyle to move toward a state of optimal health“ • This definition was derived 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".

5. Health Promotion: History • 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".

6. Health Promotion: History • At least two publications led to a "broad empowerment/environmental" definition of health promotion in the mid-1980s: • World Health Organization, 1984 • Epp report, 1986

7. WHO, 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.

8. Epp Report, 1986 • In 1986, Jake Epp the 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 (the actions people take to help each other cope) • healthy environments.

9. International Conferences on Health PromotionThe WHO, in collaboration with other organizations, has co-sponsored international conferences on health promotion: • 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”

10. International Conferences on Health Promotion • 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” • Seventh GCHP Nairobi, Kenya 2009, Resulted in the • “Nairobi Call to Action” • Eighth GCHP Helsinki Finland, 2013 • “Health in all Policies”

11. The Ottawa Charter for Health PromotionFirst International Conference on Health Promotion, Ottawa 1986 • They presented this CHARTER for action: “to achieve Health for All by the year 2000 and beyond.” • Building healthy public policy. • Create supportive environment. • Strengthening community action. • Developing personal skills. • Re-orientating health care services toward prevention of illness and promotion of health.

12. Eighth Global Conference on Health Promotion, Helsinki, 2013 Call on Governments to: • Commit to health and health equity as a political priority • Ensure effective structures, processes and resources • Strengthen the capacity of Ministries of Health to engage other sectors of government • Build institutional capacity and skills • Adopt transparent audit and accountability mechanisms • Establish conflict of interest measures • Include communities, social movements and civil society

13. Health Promotion: History • The WHO, in collaboration with other organizations, has co-sponsored these international conferences on health promotion. • Altogether, the documents produced by conference attendees emphasized "investing in health promotion beyond an individual, disease-oriented, behaviour-change model".

14. International Efforts • Government agencies around the world have made substantial efforts in the area of health promotion. • There are also non-governmental organizations that have made efforts to promote health.

15. International Efforts • The WHO and its regional offices (such as the Pan American Health Organization) are influential in health promotion around the world. • The International Union for Health Promotion and Education (based in France) holds international, regional, and national conferences on health promotion.

16. Australia • The Australian Health Promotion Association (started in 1988). • The Victorian Health Promotion Foundation from the state of Victoria, is the first health promotion foundation to be funded by a tax on tobacco.

17. New Zealand • The Health Promotion Forum of New Zealand is the national umbrella organization with more than 150 organizations promoting health.

18. Norway • The Research Centre for Health Promotion and Resources (www.rchpr.org) was established in 2010. • The Centre takes part in the scientific exploration of health and tries to promote, sustain, and restore good health in individuals.

19. United Kingdom • In 2008, the Royal Society for the Promotion of Health merged with the Royal Institute of Public Health to form the Royal Society for Public Health. • In 2009 the website: www.HealthcarePromotions.co.uk was created to provide healthcare professionals with free and easy access to health promotion resources.

20. United States • Government agencies in the U.S. concerned with health promotion include: • Centers for Disease Control and Prevention • United States Army Center for Health Promotion and Preventive Medicine • Nongovernmental organizations in the U.S. include: • American Public Health Association • The Wellness Council of America

21. Canada • Ontario appointed a health promotion minister to lead its Ministry of Health Promotion in 2005. • The Ministry’s vision is to enable Ontarians to lead healthy, active lives and make the province a healthy, prosperous place to live, work, play, learn and visit.

22. British Columbia • The BC Coalition for Health Promotion is a voluntary non-profit society dedicated to the advancement of health promotion in BC. • www.vcn.bc.ca/bchpc/

23. British Columbia • In May 2011, Premier Christy Clark announced a new $68.7-million Healthy Families BC Strategy aimed at creating a healthier population. • www.healthyfamiliesbc.ca

24. Population Health and Public Policy

25. Current Situation in Canada • Each year in Canada, more than two-thirds of deaths result from four groups of chronic diseases – cardiovascular, cancer, type 2 diabetes and respiratory disease. • These chronic diseases share common preventable risk factors (physical inactivity, unhealthy diet and tobacco use).

26. Current Situation in Canada • According to the World Health Organization, over 90% of type 2 diabetes and 80% of coronary heart disease could be avoided or postponed with good nutrition, regular physical activity, the elimination of smoking and effective stress management. • The estimated total cost in Canada of illness, disability and death attributable to chronic diseases amounts to over $80 billion annually.

27. Current Situation in Canada • The number of Canadians who are overweight or obese has steadily increased over the last 25 years. • Today, nearly one-quarter (23.1%) of adult Canadians, 5.5 million people aged 18 or older, are obese. • An additional 36.1% (8.6 million) are overweight, bringing the total number of adult Canadians who are overweight or obese to over 59%.

28. Current Situation in Canada • Of even greater concern, 28% of Canadian children and adolescents aged 2 to 17 are overweight or obese (9% are obese). • For children aged 6 to 11 and adolescents aged 12 to 17, the likelihood of being overweight or obese tends to rise with the time spent watching TV, playing video games or computer use.

29. Current Situation in Canada • Physical inactivity costs the Canadian health care system at least $2.1 billion annually in direct health care costs, and the estimated annual economic burden is $5.3 billion. • For the majority of Canadians, current physical activity patterns are not optimal for health.

30. Current Situation in Canada • People over 45 use more of the per capita share of health care resources than their younger counterparts. • Canada's population is aging and health-care costs both for the country as a whole and for business in regard to benefit costs will increase with the population.

31. Community Action Program for Childrenwww.phac-aspc.gc.ca • CAPC is a community-based children’s program delivered by the Public Health Agency of Canada. It was established in 1993 and is jointly managed with the provinces and territories. There are 440 CAPC sites across Canada. • CAPC provides long term funding to community coalitions to deliver programs that address the health and development of children (0-6 years) who are living in conditions of risk. • It recognizes that communities have the ability to identify and respond to the needs of children and places a strong emphasis on partnerships and community capacity building.

32. KidSportwww.kidsportcanada.ca • KidSport was established in 1993 by Sport BC. • KidSport is a community based sport-funding program that provides grants for children ages 6 – 18 to remove financial barriers that prevent them from playing organized sport.. • There are over 30 community chapters in BC and over 177 chapters across Canada. • With the help from dedicated corporate partners, KidSport works to fulfill its mission of eliminating the financial barriers to sport participation, ‘So ALL Kids Can Play!’

33. Integrated Pan-Canadian Healthy Living Strategy • The strategy seeks to obtain a 20% increase in the proportion of Canadians who are physically active, eat healthily and are at healthy body weights. • By 2015, increase by 20% the proportion of Canadians who participate in regular physical activity based on 30 minutes/day of moderate to vigorous activity.

34. Policy and Program • Improve physical activity and healthy eating patterns, behaviours and choices among Canadians. • Improve access to, and the affordability of, healthy food choices and physical activity opportunities. • Reduce the gap in physical activity levels that exists at different age, sex, education and income levels. • Enhance collaboration and planning across health and “non-health” sectors.

35. Timeline • 2015 is the first marker, with ongoing monitoring and evaluation undertaken in order to assess progress and allow for adjustments.

36. Anticipated ResultsShort-term results (6-18 months) Promoting: • Increased knowledge of health information by individuals and population. • Increased access to health information and health-promoting programs. • Enhanced collaboration and integration of healthy living approaches that address high priority health issues.

37. Medium-term results (18-60 mo) Facilitating: • Increased access to health-supporting physical and social environments in rural, remote and northern communities. • Increased capacity of communities to create health-promoting social and physical environments. • Increased proportion of populations engaging in healthy behaviours.

38. Long-term results (5 years plus) Contributing to: • Reduction in health disparities • Reduced human and economic burden of disease • Improved health outcomes • Improved quality of life for Canadians.

39. Provincial Government Strategies and Investments • In 2011 there was a collective goal declared by federal, provincial and territorial Ministers responsible for Sport, Physical Activity and Recreation to increase physical activity levels by 2015. • This was done to provide an impetus to reinforce provincial strategies and investments in improving physical activity. POLICY

40. Sport, Physical Activity and Recreation Ministers: 2015 National Physical Activity Targets By 2015, for children and youth aged 5 to 19 years: • To increase, by seven percentage points the proportion of children and youth who participate in 90 minutes of moderate-to-vigorous physical activity each day • To increase the average number of steps taken by all children and youth from 11,500 steps to 14,500 steps per day, which is equivalent to an increase of 30 minutes of physical activity per day. POLICY

41. Industry, Philanthropic and Research Investments • There has been an increase in support from philanthropic, research and industry funding sources in the area of physical activity – continued engagement and enhanced involvement of these sectors is critical to further facilitating behaviour change POLICY