What is Health Promotion?

Health promotion refers to any activity that promotes health. It is usually differentiated from health information and health education (which teaches people about what is healthy) by prompting behavioural change. In other words, it is not enough to educate people about the dangers of smoking to their health, we need them to cease smoking. The WHO (2005) defined health promotion as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health".  

Before the provider/commissioner spilt in the NHS, health promotion managers were quite commonplace and health promotion was integral part of the work of a Primary Care Trust (PCT) based public health specialist team. Around 2006/7 health promotion work became submerged into health improvement teams which largely went into community services provider trusts whilst the remainder of public health teams became focused on public health commissioning or supporting commissioning of health care. For example, public health teams weren't actively involved in promoting health eating and physical exercise but instead commissioned a health improvement service from the local community health services to do so. In some instances, community health services and community pharmacies may have been commissioned to deliver a number of health promotion campaigns per year - such as stop smoking, alcohol consumption, improving oral health of children, mental health promotion etc. Public health teams may have still been involved however in working with PCT communications teams to provide healthy messages via press releases to the media.

Since April 2013, local authorities have the remit for health promotion and health improvement of their local populations. Local public health teams that are based in local authorities may find that health promotion work is part of their role and responsibilities along with the commissioning of public health services. Health promotion can now be viewed as a term to encompass a wide range of approaches of improving health of people, communities and populations such as organisational development (working with organisations to be more health promoting e.g. schools), community development, strategy development, partnership development, personal development (working with lay and professional people to maximise their own health and be enabled to 'signpost' or advise) and developing ways to impart health information.

Doing Health Promotion

• Understand the different perspectives and theories about health. This includes lay perspectives, lifestyle approaches.
• Understand the social determinants of health - housing, education, social-economic factors etc.
• Know the models of health promotion (see below)
• Know the different health behaviour change models (see below)
• Know the key stages in developing health promotion interventions: 
  • approach to be taken
  • barriers/challenges
  • mobilising resources, building alliances and raising public awareness
  • monitoring and evaluation

Models of Health Promotion

There are many different models of health promotion but the most commonly used is Beattie (1991). Beattie sets out 4 main strategies for health promotion: 

• Health Persuasion: Interventions directed at individuals and led by professionals (e.g. a community nurse or midwife encouraging a pregnant woman to stop smoking)
• Personal Counselling: Interventions that are client led and encourage individuals to make their own choices (e.g. helping young people to identify their own health concerns and working with them to develop their own confidence and skills)
• Community Development: Interventions that take place within a defined community to identify local health issues and working with local people to take action on those concerns (for example, residents on a housing estate organising local walks) 
• Legislative Action: Interventions that are led by professionals or experts but are intended to protect the health of the community they serve (e.g. smoke-free public places, monitoring of food hygiene in eating establishments 

Health Behaviour Change Models

• Health Beliefs Model (Becker)
• Theory of Planned Behaviour (Azen)
• Stages of Changing Behaviours (Prochasha, Di Clemente & Norcross (1992)
• Health Action Model (Tones, 1987)

Writing a Health Promotion Strategy

1. Needs Assessment - How big is the problem locally? Who are the key target groups?
2. Resource Mapping - Who is doing what at the moment? How much is each partner agency contributing?
3. Priorities for Action - What are the most important and effective interventions and/or service to initiate or strengthen?
4. Strategies for Change - How can each partner agency contribute? What service model will be deployed? What are the standards and milestones? How should policies, programmes and practice be modified in order to achieve standards and milestones?
5. Service Developments - What change is needed to be made to structures, volumes or quality aspects of service? How should these be translated into service agreements and contracts? What are the resource requirements? Who will lead on the agreed changes? What is the timetable for these changes? 
6. Audit, Monitoring and Performance Assessment

Measuring the Effectiveness of Health Promotion

Measuring the effectiveness of a health promotion initiative is difficult. Changes in health status are not immediate and the influences on health are so diverse that it can be hard to attribute change in outcomes to one health intervention. It is possible to evaluate the output of a health promotion initiative or campaign (be careful that you don't end up describing the process or action taken). It will depend on the aims and the objectives. If the initiative is to promoting more exercise at the workplace, participants in the scheme could be asked at the start what their current level of exercise is and then again at the end of the scheme (before/after study design). They could then be asked again at 6 months to see if they continued their change. For campaigns, a survey may be able to tell you how many people saw the campaign and whether it had any effect on their behaviours and attitudes. It is good practice to decide how you will evaluate your initiative when you are designing the initiative. Have a look on Medline, etc for examples of health promotion activities that are similar to what you are proposing and how they evaluated the effectiveness.