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To compare the use of health impact assessment (HIA) and the decision-making triangle (DMT) framework for evidence-informed, ethics-based decision-making and consider implications for practice. We compared HIA and the DMT approach with reference to: their use of evidence and theory; their application of ethical principles or values; and how they aid decision-making. A good fit between the HIA and DMT approaches was found. Ways in which they could be of benefit to each other were identified. The DMT approach and HIA are highly compatible: they are rooted in largely shared ethical principles or values; both involve appropriate use of evidence and theory; and both are concerned with enhancing the quality of decision-making in the interests of population health. The DMT approach and HIA are of potential value to each other: established HIA methods and tools can be of practical help in using the DMT approach; and the DMT framework provides insights to how HIA methods and processes could be improved and the vision of ‘impacts that matter’ widened. [ABSTRACT FROM AUTHOR]

Māori, the indigenous people of Aotearoa New Zealand, experience poorer health than non-Māori across a range of health measures. Interventions focused at an individual level have proved largely ineffective; ‘bottom-up’ approaches where communities determine their own priorities may be more sustainable than ‘top-down’ approaches where goals are determined by health authorities. The purpose of this paper is to illustrate an innovative health promotion programme aimed at improving Māori health and to discuss the importance of ownership and control of health initiatives by Māori. Evaluators conducted a comprehensive evaluation of a Healthy Eating Healthy Action programme in six small Māori health agencies, gathering information from programme managers and co-ordinators, participants and wider community members about what changes were occurring at individual, family and community levels. Effective interventions built on cultural values and practices and were delivered by Māori with close connections to the community. Changes in nutrition and physical activity made by participants also benefitted their wider families and community. The changes demonstrated subtle but important shifts in thinking about healthy eating and healthy activity that in the longer term could lead to more measurable change towards improved quality of life for people within communities. [ABSTRACT FROM AUTHOR]

The Nairobi Conference presaged a surge of interest in the development of health promotion in sub-Saharan Africa. A number of Africans have asserted that health promotion is underdeveloped in the continent, with the principles of the Ottawa Charter not widely adopted. This paper does not presume to say how health promotion could be developed in Africa, as that is for Africans to decide for themselves. Rather, it debates some issues which the international epistemic health promotion community could address in order to work in solidarity with African colleagues in taking forward the health promotion agenda in their continent. These issues include the Eurocentric nature of health promotion discourse, the different disease burden of Africa and the lack of training capacity in African universities. [ABSTRACT FROM AUTHOR]

The health and well-being benefits of access to green space are well documented. Research suggests positive findings regardless of social group, however barriers exist that limit access to green space, including proximity, geography and differing social conditions. Current public health policy aims to broaden the range of environmental public health interventions through effective partnership working, providing opportunities to work across agencies to promote the use of green space. Health Impact Assessment (HIA) is a combination of methods and procedures to assess the potential health and well-being impacts of policies, developments and projects. It provides a means by which negative impacts can be mitigated and positive impacts can be enhanced, and has potential application for assessing green space use. This paper describes the application of a HIA approach to a multi-agency project (Stepping Stones to Nature––SS2N) in the UK designed to improve local green spaces and facilitate green space use in areas classified as having high levels of deprivation. The findings suggest that the SS2N project had the potential to provide significant positive benefits in the areas of physical activity, mental and social well-being. Specific findings for one locality identified a range of actions that could be taken to enhance benefits, and mitigate negative factors such as anti-social behaviour. The HIA approach proved to be a valuable process through which impacts of a community development/public health project could be enhanced and negative impacts prevented at an early stage; it illustrates how a HIA approach could enhance multi-agency working to promote health and well-being in communities. [ABSTRACT FROM PUBLISHER]

The Community Health and the Built Environment (CHBE) project investigated the role of place in interventions for chronic disease prevention in order to identify contextual factors that may foster or inhibit intervention success. This paper presents a project model comprising objective-outsider and subjective-insider perspectives in a multi-method, community-based participatory research approach with an emphasis on knowledge exchange. The collaborative process generated valuable lessons concerning effective conduct of community-based research. The CHBE project model contributes a mechanism for investigating how place influences health behaviours and the outcomes of health promotion interventions. [ABSTRACT FROM PUBLISHER]

This paper reports on a complex environmental approach to addressing ‘wicked’ health promotion problems devised to inform policy for enhancing food security and physical activity among Māori, Pacific and low-income people in New Zealand. This multi-phase research utilized literature reviews, focus groups, stakeholder workshops and key informant interviews. Participants included members of affected communities, policy-makers and academics. Results suggest that food security and physical activity ‘emerge’ from complex systems. Key areas for intervention include availability of money within households; the cost of food; improvements in urban design and culturally specific physical activity programmes. Seventeen prioritized intervention areas were explored in-depth and recommendations for action identified. These include healthy food subsidies, increasing the statutory minimum wage rate and enhancing open space and connectivity in communities. This approach has moved away from seeking individual solutions to complex social problems. In doing so, it has enabled the mapping of the relevant systems and the identification of a range of interventions while taking account of the views of affected communities and the concerns of policy-makers. The complex environmental approach used in this research provides a method to identify how to intervene in complex systems that may be relevant to other ‘wicked’ health promotion problems. [ABSTRACT FROM PUBLISHER]

Health promotion addresses issues from the simple (with well-known cause/effect links) to the highly complex (webs and loops of cause/effect with unpredictable, emergent properties). Yet there is no conceptual framework within its theory base to help identify approaches appropriate to the level of complexity. The default approach favours reductionism—the assumption that reducing a system to its parts will inform whole system behaviour. Such an approach can yield useful knowledge, yet is inadequate where issues have multiple interacting causes, such as social determinants of health. To address complex issues, there is a need for a conceptual framework that helps choose action that is appropriate to context. This paper presents the Cynefin Framework, informed by complexity science—the study of Complex Adaptive Systems (CAS). It introduces key CAS concepts and reviews the emergence and implications of ‘complex’ approaches within health promotion. It explains the framework and its use with examples from contemporary practice, and sets it within the context of related bodies of health promotion theory. The Cynefin Framework, especially when used as a sense-making tool, can help practitioners understand the complexity of issues, identify appropriate strategies and avoid the pitfalls of applying reductionist approaches to complex situations. The urgency to address critical issues such as climate change and the social determinants of health calls for us to engage with complexity science. The Cynefin Framework helps practitioners make the shift, and enables those already engaged in complex approaches to communicate the value and meaning of their work in a system that privileges reductionist approaches. [ABSTRACT FROM PUBLISHER]

Clarifying the contours of research in health promotion (HP) is an ongoing challenge. Research in this action-oriented field has traditionally been developed based on values such as participation and empowerment. Consequently, many forms of participatory research have emerged throughout the years, and participatory research has positioned itself as a core competency of HP and public health. This paper argues that participation as a normative stance guiding methodology, or as value, is a fragile posture upon which to position research practices. The argument is based on a realist–constructionist perspective of science and specifically uses Law and Latour's notion of inscription device and Callon's actor-network theory to suggest that participation is an epistemological necessity and that participatory research practices may be considered as inscription devices. These theoretical notions help clarify the consequences of participation on knowledge production. Finally, the article refers to Stengers's work to propose an ecology of research practices that defines obligations and exigencies for HP with respect to knowledge production and that are more consistent with the field's values of social justice and equity. [ABSTRACT FROM PUBLISHER]

This paper provides an overview of five key internationally recognized health promotion frameworks and assesses their consideration of gender. This analysis was conducted as part of the Promoting Health in Women project, a Canadian initiative focused on generating a framework for effective health promotion for women. To date, no review of health promotion frameworks has specifically focused on assessing the treatment of gender. This analysis draws on a comprehensive literature review that covered available literature on gender and health promotion frameworks published internationally between 1974 and 2010. Analysis of five key health promotion frameworks revealed that although gender was at times mentioned as a determinant of health, gender was never identified and integrated as a factor critical to successful health promotion. This superficial attention to the role of gender in health promotion is problematic as it limits our capacity to understand how gender influences health, health contexts and health promotion, as well as our ability to integrate gender into future comprehensive health promotion strategies. [ABSTRACT FROM AUTHOR]

Research with Pride (RwP) was a community–student collaborative initiative to promote and build capacity for community-based research exploring health and wellness in lesbian, bisexual, trans and queer (LGBTQ) communities. The event took place at University of Toronto's Dalla Lana School of Public Health (DLSPH) in September 2009, and engaged over 100 students, community members and academic researchers in a full day of discussion, learning and networking. RwP was initiated by a group of graduate students in Health Promotion who identified a gap in resources addressing LGBTQ health, facilitating their further learning and work in this area. By engaging in a partnership with a community service organization serving LGBTQ communities in downtown Toronto, RwP emerges as a key example of the role of community–student partnerships in the pursuit of LGBTQ health promotion. This paper will describe the nature of this partnership, outline its strengths and challenges and emphasize the integral role of community–student partnerships in health promotion initiatives. [ABSTRACT FROM AUTHOR]

In many places extreme heat causes more deaths than floods, cyclones and bushfires. However, efforts to manage the health implications of heat and increase the adaptive capacity of vulnerable populations are in their infancy, requiring urgent attention from research and policy. This paper presents a case for research exploring the influence of social and contextual factors on vulnerable populations’ capacity to adapt to heat in the context of climate change. We argue such research is imperative given current prioritization of short-sighted policy solutions such as installation and use of greenhouse-intensive domestic air-conditioners as moderators of heat stress. Globally, vulnerability to heat stress is most often assessed by epidemiological analysis of past morbidity and mortality data; yet a range of other factors need to be accounted for in interpreting and understanding these patterns of ill-health and loss of life, and further in determining how vulnerability is created, exacerbated and alleviated by broader societal conditions. Such factors include: the cooling technologies and infrastructures available to householders, practical knowledge about how to moderate heat stress, and social and cultural understandings of comfort and vulnerability. To investigate these factors, new methodologies are required. Social practice theory, which conceptualizes the dynamic interactions between individuals and wider systems of power, infrastructure, technologies, society and culture as components of practices such as household cooling, is presented as a way forward. The development of a practice-based methodology and conceptual framework to understand adaptation to heat will provide a multidimensional, systems-oriented understanding of how vulnerability can potentially be reduced. [ABSTRACT FROM AUTHOR]

This paper has contributed to confirming the link between education and health in developed countries. The analysis is based on 11 European Union countries. We estimate country-specific health functions, where the dependent variable is self-reported health status and the education attainment is one of the main inputs. All eight waves (1994–2001) of the European Community Household Panel are deployed. A random effects ordered probit is estimated in order to control, to a given extent, for unobserved heterogeneity. Explanatory variables are both time invariant (education attainment and gender) and time varying (gross wages, hours of work, age and living alone). Results confirm the positive impact of secondary education on health in most cases and tertiary education in all cases, even after controlling for other inputs in the health function and taking unobserved heterogeneity into account. Secondary education has an impact on health in all countries in the sample except for The Netherlands and UK. The effect does not differ between secondary and tertiary education in France, Ireland and Greece. The correlation between education and health is interpreted in different but complementary ways by diverse approaches and we may not disentangle the precise mechanism that connects health with education from our results. Anyway, it seems clear that better coordination is needed between education and health policies to effectively improve health literacy. Other relevant results from our study are that women register poorer health than men, age contributes to worsening health status and wages contribute positively to health. [ABSTRACT FROM AUTHOR]

In spite of improvements in global health over the 20th century, health inequities are increasing. Mounting evidence suggests that reducing health inequities requires taking action on the social determinants of health (SDOH), which include income, education, employment, political empowerment and other factors. This paper introduces an alternative health education curriculum, developed by the US-based non-profit organization Just Health Action, which teaches critical health literacy as a step towards empowering people to achieve health equity. Critical health literacy is defined as an individual's understanding of the SDOH combined with the skills to take action at both the individual and the community level. Prior to describing our curricular framework, we connect the recommendations of the World Health Organization Commission on the SDOH with the objectives of the Ottawa Charter for Health Promotion by arguing that achieving them is reliant on critical health literacy. Then we describe our four-part curricular framework for teaching critical health literacy. Part 1, Knowledge, focuses on teaching the SDOH and the paradigm of health as a human right. Part 2, Compass, refers to activities that help students find their own direction as a social change agent. Part 3, Skills, refers to teaching specific advocacy tools and strategies. Part 4, Action, refers to the development and implementation of an action intended to increase health equity by addressing the SDOH. We describe activities that we use to motivate, engage and empower students to take action on the SDOH and provide examples of advocacy skills students have learned and actions they have implemented. [ABSTRACT FROM AUTHOR]

Population health is shaped by more than local or national influences—the global matters. Health promotion practitioners and researchers increasingly are challenged to engage with upstream factors related to the global economy, such as global prescriptions for national macroeconomic policies, debt relief and international trade. This paper identifies 10 books (A Brief History of Neoliberalism, Bad Samaritans: The Myth of Free Trade and the Secret History of Capitalism, The World is Not Flat: Inequality and Injustice in Our Global Economy, Globalization and its Discontents, The Debt Threat: How Debt is Destroying the Developing World, Global Woman: Nannies, Maids, and Sex Workers in the New Economy, A Race Against Time, Globalization and Health: An Introduction, Global Public Goods for Health: Health Economics and Public Health Perspectives, Trade and Health: Seeking Common Ground) and several key reports that we found to be particularly useful for understanding the global economy's effects on people's health. We draw attention to issues helpful in understanding the present global financial crisis. [ABSTRACT FROM AUTHOR]

Aboriginal people in Canada suffer ill-health at much higher rates compared with the rest of the population. A key challenge is the disjuncture between the dominant biomedical approach to health in Canada and the holistic and integrative understandings of and approaches to health in many Aboriginal cultures. More fundamentally, colonization is at the root of the health challenges faced by this population. Thus, effective approaches to health promotion with Aboriginal people will require decolonizing practices. In this paper, we look at one case study of a health promotion project, the Urban Aboriginal Community Kitchen Garden Project in Vancouver, Canada, which, guided by the teachings of the Medicine Wheel, aims to provide culturally appropriate health promotion. By drawing on Aboriginal approaches to healing, acknowledging the legacy of colonization and providing a context for cultural celebration, we suggest that the project can be seen as an example of what decolonizing health promotion could look like. Further, we suggest that a decolonizing approach to health promotion has the potential to address immediate needs while simultaneously beginning to address underlying causes of Aboriginal health inequities. [ABSTRACT FROM PUBLISHER]

Community-based interventions are an important component of obesity prevention efforts. The literature provides little guidance on priority-setting for obesity prevention in communities, especially for socially and culturally diverse populations. This paper reports on the process of developing prioritized, community-participatory action plans for obesity prevention projects in children and adolescents using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. We combined stakeholder engagement processes, the ANGELO Framework (scans for environmental barriers, targeted behaviours, gaps in skills and knowledge) and workshops with key stakeholders to create action plans for six diverse obesity prevention projects in Australia (n = 3), New Zealand, Fiji and Tonga from 2002 to 2005. Some sites included sociocultural contextual analyses in the environmental scans. Target groups were under-5-year-olds (Australia), 4–12-year-olds (Australia) and 13–18-year-olds (all four countries). Over 120 potential behavioural, knowledge, skill and environmental elements were identified for prioritization leading into each 2-day workshop. Many elements were common across the diverse cultural communities; however, several unique sociocultural elements emerged in some cultural groups which informed their action plans. Youth were actively engaged in adolescent projects, allowing their needs to be incorporated into the action plans initiating the process of ownership. A common structure for the action plan promoted efficiencies in the process while allowing for community creativity and innovation. The ANGELO is a flexible and efficient way of achieving an agreed plan for obesity prevention with diverse communities. It is responsive to community needs, combines local and international knowledge and creates stakeholder ownership of the action plan. [ABSTRACT FROM PUBLISHER]

This paper aimed to explore the contribution of a micro grant financing scheme to community action in terms of residential health-promoting initiatives, interorganizational collaboration and public participation. The scheme was two-fold, consisting of (i) micro grants of 500-3500 Euros, which were easily obtainable by local organizations and (ii) neighbourhood health panels of community and health workers, functioning as a distributing mechanism. Data were collected using three methods: (i) observations of the neighbourhood-based health panels, (ii) in-depth interviews with policy-makers and professionals and (iii) analyses of documents and reports. This study demonstrated the three-fold role of micro grants as a vehicle to enable community action at an organizational level in terms of increased network activities between the local organizations, to set an agenda for the 'health topic' in non-traditional health agencies and to enable a number of health-promoting initiatives. Although these initiatives were attended by small groups of residents normally considered hard to reach, the actual public participation was limited. In their role as a distributing mechanism, the health panels were vital with regard to the achieved impact on the community action. However, certain limitations were also seen, which were related to the governance of the panels. This case study provides evidence to suggest that micro grants have the potential to stimulate community action at an organizational and a residential level, but with the prerequisite that grants be accompanied by increased investments in infrastructure. [ABSTRACT FROM AUTHOR]

The objective of this paper is to measure health literacy in a representative sample of the Australian general population using three health literacy tools; to consider the congruency of results; and to determine whether these assessments were associated with socio-demographic characteristics. Face-to-face interviews were conducted in a stratified random sample of the adult Victorian population identified from the 2004 Australian Government Electoral Roll. Participants were invited to participate by mail and follow-up telephone call. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA) and Newest Vital Sign (NVS). Of 1680 people invited to participate, 89 (5.3%) were ineligible, 750 (44.6%) were not contactable by phone, 531 (32%) refused and 310 (response rate 310/1591, 19.5%) agreed to participate. Compared with the general population, participants were slightly older, better educated and had a higher annual income. The proportion of participants with less than adequate health literacy levels varied: 26.0% (80/308) for the NVS, 10.6% (51 33/310) for the REALM and 6.8% (21/309) for the TOFHLA. A varying but significant proportion of the general population was found to have limited health literacy. The health literacy measures we used, while moderately correlated, appear to measure different but related constructs and use different cut offs to indicate poor health literacy, [ABSTRACT FROM AUTHOR]

Despite the proposed ecological and systems-based perspectives of the settings-based approach to health promotion, most initiatives have tended to overlook the fundamental nature of ecosystems. This paper responds to this oversight by proposing an explicit re-integration of ecosystems within the healthy settings approach. We make this case by focusing on water as an integrating unit of analysis. Water, on which all life depends, is not only an integral consideration for the existing healthy settings (schools, hospitals, workplaces) but also highlights the ecosystem context of health and sustainability. A focus on catchments (also know as watersheds and river basins) exemplifies the scaled and upstream/downstream nature of ecosystems and draws into sharp focus the cross-sectoral and transdisciplinary context of the social and environ- mental determinants of health. We position this work in relation to the converging agendas of health promotion and ecosystem management at the local, regional and global scales-and draw on evidence from international initiatives as diverse as the WHO Commission on Social Determinants of Health, and the Millennium Ecosystem Assessment. Using water as a vehicle for understanding the systemic context for human wellbeing, health promotion and disease prevention draws inevitable attention to key challenges of scale, intersectoral governance and the complementary themes of promoting resilience and preventing vulnerability. We conclude by highlighting the importance of building individual and institutional capacity for this kind of integration-equipping a new generation of researchers, practitioners and decision- makers to be conversant with the language of ecosystems, capable of systemic thought and focused on settings that can promote both health and sustainability. [ABSTRACT FROM AUTHOR]

In 2007, the World Health Organization, together with United Nations and international organization as well as experts, met to draw upon existing evidence and practical experience from regions, countries and individual schools in promoting health through schools. The goal of the meeting was to identify current and emerging global factors affecting schools, and to help them respond more effectively to health, education and development opportunities. At the meeting, a Statement was developed describing effective approaches and strategies that can be adopted by schools to promote health, education and development. Five key challenges were identified. These described the need to continue building evidence and capturing practical experience in school health; the importance of improving implementation processes to ensure optimal transfer of evidence into practice; the need to alleviating social and economic disadvantage in access to and successful completion of school education; the opportunity to harness media influences for positive benefit, and the continuing challenge to improve partnerships among different sectors and organizations. The participants also identified a range of actions needed to respond to these challenges, highlighting the need for action by local school communities, governments and international organizations to invest in quality education, and to increase participation of children and young people in school education. This paper describes the rationale for and process of the meeting and the development of the Statement and outlines some of the most immediate efforts made to implement the actions identified in the Statement. It also suggests further joint actions required for the implementation of the Statement. [ABSTRACT FROM AUTHOR]

Data from the European School Survey Project on Alcohol and other Drugs have shown that adolescent sub- stance use is a growing problem in western and particularly Eastern European countries. This paper describes the development, implementation and results of the Icelandic Model of Adolescent Substance Use Prevention. The Icelandic Model is a theoretically grounded, evidence-based approach to community adolescent substance use prevention that has grown Out of collaboration between policy makers, behavioural scientists, field-based practitioners and community residents in Iceland. The intervention focuses on reducing known risk factors for substance use, while strengthening a broad range of parental, school and community protective factors. Annual cross-sectional surveys demonstrate the impact of the intervention on substance use among the population of 14- to 16-year-old Icelandic adolescents. The annual data from two cohorts of over 7000 adolescents (>81% response rate) show that the proportions of those who reported being drunk during the last 30 days, smoking one cigarette or more per day and having tried hashish once all declined steadily from 1997 to 2007. The pro- portions of adolescents who reported spending time with their parents and that their parents knew with whom they were spending their time increased substantially. Other community protective factors also showed positive changes. Although these data suggest that this adolescent substance use prevention approach successfully strengthened a broad range of parental, school and community protective factors, the evidence of its impact on reducing substance use needs to be considered in light of the correlational data on which these observations are based. [ABSTRACT FROM AUTHOR]

The field of men's health has grown markedly over the past few decades. Increased activity specifically relating to men's health promotion in both Australia and the UK has been noted during this period. There has, however, been a reticence to critically examine men's health promotion work within a broader discourse relating to gender and gender relations. Indeed, the vast majority of health-related gender discussion to date has been focused on women's health experiences and their health practices. In this paper, we argue that grounding men's health within this broad gender discourse is important for building an evidence base in, and advancing, men's health promotion work at a range of levels. We specifically explore the research, practice and policy contexts relating to men's health in Australia and the UK, and describe the facilitators for, and barriers to, promoting men's health. We conclude by suggesting that a critical gender lens ought to be applied to current men's health promotion work and provide strategies for researchers, practitioners and policy makers to move towards this new frontier. [ABSTRACT FROM AUTHOR]

In this paper, we analyse Canadian health promotion discourse past and present, in the context of selected federal and provincial government policy initiatives. Principally, we examine the health promotion discourse articulated in A New Perspective on the Health of Canadians, Achieving Health for All: A Framework for Health Promotion, the Ottawa Charter for Health Promotion, Improving the Health of Canadians, and Canada Health Action: Building on the Legacy-Volume II-Synthesis reports and Issue papers. We argue that the health promotion lessons of the past 30 years contained within these reports have largely been forgotten, overlooked or disregarded in policy implementation. We conclude, as have many before us, that successful health promotion policy needs to reflect a collectivist rather than individualist ethos where responsibility for the health of Canadians is concerned. Moreover, it needs to be one that addresses the social determinants of health, including inequity, via the coordination of healthy public policy. [ABSTRACT FROM AUTHOR]

Twenty years have passed since the philosophy and principals were formulated in the Ottawa Charter for health promotion. A critical reflection of the content and success of the Ottawa Charter was published before the IUHPE World Conference in Vancover in June 2007. This paper contextualizes and discusses Salutogenesis and Antonovsky in the development of health promotion practice and research and, further, relates the salutogenic concept Sense of Coherence (SOC) to the Ottawa Charter. An overview of the development of health pro- motion and the salutogenic theory of health is presented. In addition, this is illustrated in a new way using the metaphors of 'health in the river of life' and 'SOC in a life course perspective'. Health promotion, including the Ottawa charter, lacks a clear theoretical foundation. The results of a systematic review of salutogenic research are used to demonstrate how the salutogenic framework could support the philosophical and practical intentions of the OC. The salutogenic model contributes to the maintenance and development of health and quality of life (QoL), i.e. the process and outcome of the principles of the OC. The metaphor of the river and the life cycle are new ways of demonstrating the paradigm shift provided by the Salutogenesis and health promotion in relation to public health and medicine. The salutogenic theory is an important contribution to the theory base of health promotion research and practice. [ABSTRACT FROM AUTHOR]

Body dissatisfaction, dieting, eating disorders and exercise disorders are prevalent among male and female university students worldwide. Male students are also increasingly adopting health-damaging, body-image-related behaviors such as excessive weight lifting, body building and steroid abuse. Given the severity and difficulty of treating eating disorders, prevention of these problems is a recognized public health goal. Health promotion and health education programs have been conducted in the university setting since the mid 1980s, but few have achieved significant improvements in target health attitudes and behaviors. In this paper, 27 large, randomized and controlled health promotion and health education programs to improve body dissatisfaction, dieting and disordered eating and exercise behaviors of male and female college students are reviewed. In general, health education programs to improve body image and prevent eating disorders in the university setting have been limited by small sample sizes and the exclusion of male students. The majority of studies were conducted among either female undergraduate psychology students or women that were recruited using on-campus advertising. The latter reduces the ability to generalize results to the whole university population, or the general community. In addition, there has been a paucity of longitudinal studies that are methodologically sound, as only 82% (22/2 7) of interventions included in the review used random assignment of groups, and only 52% (n = 14) included follow-up testing. Information-based, cognitive behavioral and psycho- educational approaches have been the least effective at improving body image and eating problems among university students. Successful elements for future initiatives are identified as taking a media literacy- and dissonance-based educational approach, incorporating health education activities that build self-esteem, and using computers and the internet as a delivery medium. A newly designed program for Australian university students is described. [ABSTRACT FROM AUTHOR]

The paper draws on qualitative data collected in focus groups with primary school pupils in years three and five (ages 7-11 years), carried out as part of a wider study evaluating the Primary School Free Breakfast Initiative in Wales. A total of 16 focus groups were carried out across eight schools to examine pupil's perceptions of food and food related behaviour. A key finding was the way in which control over choice of food and access to healthy! unhealthy food options differed between younger and older pupils across home, school and eating out settings. While older participants experienced and valued high levels of control over food choice in all three settings, this was not the case for younger participants. Pupils in year three had little choice, particularly at home and school, with other factors (such as security, structure and meal-time companionship) being more important to them than ability to choose what they ate. All participants in the study expressed a general preference for unhealthy as opposed to healthy food items, even when acknowledging health consequences and engaging in some compensatory strategies. The authors suggest that interventions should aim to educate and encourage food providers, such as parents/carers, schools, and food outlets, to produce a range of healthy options, and encourage informed food choice among children at a younger age. [ABSTRACT FROM AUTHOR]

This paper reports on expectations for and community members' experience in the development of community indicators in a healthy communities initiative (HCI) in Alberta, Canada. The HCI process involved community visioning, the creation of action plans to further the vision by addressing key health priorities and/or community capacity building activities and the development of indicators to monitor and report on progress towards goals. Nineteen semi-structured interviews were conducted with community participants to discuss definitions of success in the HCI and participant experience in developing indicators. Three themes emerged: the formal indicators lacked relevance to community members; the community did not own the HCI indicators and participants instead drew upon measures of success which were largely experiential in nature. The study provides a critically reflective, candid account of on-the-ground work with communities. The findings reveal limitations in the process of developing community indicators in this HCI, which we attribute in part to skills and discontinuities on the staffing side of the health authority and in part to failure to recognize and fully appreciate 'different ways of knowing' between communities and agencies. [ABSTRACT FROM AUTHOR]

This paper describes the Model for Outcome Classification in Health Promotion and Prevention adopted by Health Promotion Switzerland (SMOC, Swiss Model for Outcome Classification) and the process of its development. The context and method of model development, and the aim and objectives of the model are outlined. Preliminary experience with application of the model in evaluation planning and situation analysis is reported. On the basis of an extensive literature search, the model is situated within the wider international context of similar efforts to meet the challenge of developing tools to assess systematically the activities of health promotion and prevention. [ABSTRACT FROM AUTHOR]

Al Gore's movie An Inconvenient Truth and the British government's Stern Review of the economics of climate change have provided heightened awareness of how humans are over-stretching the Earth's life support systems. The health of human populations and the health of global ecosystems are inextricably linked and the need for fundamental changes in how we live is becoming impossible to ignore. While not the complete answer, education must be a part of imagining and transforming our patterns of living. Learning embedded in educational systems derived from worldviews that replicate unhealthy and unsustainable lifestyles and environments is not a part of the solution but a significant part of the problem. In Australia, two internationally implemented whole-school reform movements, health promoting schools (HPS) and sustainable schools (SS)--seek to provide ways of operationalizing transformative educational processes. Both movements aim to build resilience and optimism, use action-oriented teaching and learning approaches, and have a focus on the future. While these two approaches to educational and social change have much in common, currently there is virtually no conversation between their proponents and advocates. This paper makes a case for HPS and SS to work together--both theoretically and practically--with the ultimate goal being the emergence of schools that are both green and healthy. Such integration would make an important educational contribution to the creation of a healthy, sustainable world. [ABSTRACT FROM AUTHOR]

Governments and other public health agencies have become increasingly interested in evidence-informed policy and practice. Translating research evidence into programmatic change has proved challenging and the evidence around how to effectively promote and facilitate this process is still relatively limited. This paper presents the findings from an evaluation of a series of evidence-based health promotion resources commissioned by the Victorian Department of Human Services. The evaluation used qualitative methods to explore how practitioners for whom the resources were intended, viewed and used them. Document and literature review and analysis, and a series of key informant interviews and focus groups were conducted. The findings clearly demonstrate that the resources are unlikely to act as agents for change unless they are linked to a knowledge management process that includes practitioner engagement. This paper also considers the potential role of knowledge brokers in helping to identify and translate evidence into practice. [ABSTRACT FROM AUTHOR]

This paper reports results of a study that explored the relationship between the local environmental actions of Healthy Cities programs and the adverse health impacts of climate change. The analysis is primarily based on a limited literature review of climate change and health, with particular attention to the relationships between Healthy Cities and climate change, and on documentary analysis of information from organization reports and website content associated with Healthy Cities programs in Europe and Australia. Four semi-structured interviews with key people in two Healthy Cities programs in Europe and Australia were conducted to provide information to supplement and complement the published information and to verify theme identification. The main findings of this study are that, although there is no explicit connection between the local activities of Healthy Cities programs and the potential (or actual) adverse health impacts of climate change, Healthy Cities programs are involved in many local environmental actions and some of these actions, for example, those relating to improving air quality and reducing pollution, are linked implicitly to the health impacts of climate change. Through their local relationships and their participation in regional networks, Healthy Cities are able to make connections between local environmental actions and the health impacts of climate change. Furthermore, expanding Healthy Cities to include eco-social sustainability as a central aim not only has the potential to strengthen the links between local environmental actions and climate change, but also presents a relevant health development setting for exploring the social and environmental sustainability of cities. [ABSTRACT FROM AUTHOR]

Contemporary health promotion is now a well-defined discipline with a strong (albeit diverse) theoretical base, proven technologies (based on program planning) for addressing complex social problems, processes to guide practice and a body of evidence of efficacy and increasingly, effectiveness. Health promotion has evolved principally within the health sector where it is frequently considered optional rather than core business. To maximize effectiveness, quality health promotion technologies and practices need to be adopted as core business by the health sector and by organizations in other sectors. It has proven difficult to develop the infrastructure, workforce and resource base needed to ensure the routine introduction of high-quality health promotion into organizations. Recognizing these problems, this paper explores the use of organizational theory and practice in building the capacity of organizations to design, deliver and evaluate health promotion effectively and efficiently. The paper argues that organizational change is an essential but under-recognized function for the sustainability of health promotion practice and a necessary component of capacity-building frameworks. The interdependence of quality health promotion with organizational change is discussed in this paper through three case studies. While each focused on different aspects of health promotion development, the centrality of organizational change in each of them was striking. This paper draws out elements of organizational change to demonstrate that health promotion specialists and practitioners, wherever they are located, should be building organizational change into both their practice and capacity-building frameworks because without it, effectiveness and sustainability are at risk. [ABSTRACT FROM AUTHOR]

Large segments of the population in poor countries continue to suffer from a high level of unmet health needs, requiring macro-level, broad-based interventions. Healthy public policy, a key health promotion strategy, aims to put health on the agenda of policy makers across sectors and levels of government. Macro-economic policy in developing countries has thus far not adequately captured the attention of health promotion researchers. This paper argues that healthy public policy should not only be an objective in rich countries, but also in poor countries. This paper takes up this issue by reviewing the main macro-economic aid programs offered by international financial institutions as a response to economic crises and unmanageable debt burdens. Although health promotion researchers were largely absent during a key debate on structural adjustment programs and health during the 1980s and 1990s, the international macro-economic policy tool currently in play offers a new opportunity to participate in assessing these policies, ensuring new forms of macro-economic policy interventions do not simply reproduce patterns of (neoliberal) economics-dominated development policy. [ABSTRACT FROM AUTHOR]

The discourse of the 2005 Bangkok Charter for Health Promotion in a Globalized World represents a radical departure from that of the Ottawa Charter that, in 1986, staked a place for the health promotion field in mainstream public health. Via a critical analysis of the discourse in these two Charters, this paper illustrates a shift from a 'new social movements' discourse of ecosocial justice in Ottawa to a 'new capitalist' discourse of law and economics in Bangkok. The Bangkok Charter's content may identify 'actions, commitments and pledges required to address the determinants of health in a globalized world through health promotion', but this paper shows how its discourse works to naturalize and perpetuate many of detrimental determinants associated with 'globalization'. [ABSTRACT FROM AUTHOR]

Increasingly, researchers are exploring alternative ways of assessing the impact of 'Health Promoting School' (HPS) initiatives, in recognition of the model's emphasis on achieving change that is both enduring and far-reaching. However, it is still assumed that initiatives will lead to immediate change at the individual level. This paper challenges that view and argues that potential markers of success associated with process need to be identified earlier as a means of supporting schools and teachers. Notwithstanding differences in the way the HPS is conceptualized and implemented, four themes are highlighted that have relevance beyond any one school or country. These were drawn from a process evaluation of a European Network of HPSs Project in Scotland. They highlight the ways in which schools were able to successfully adopt HPS principles and the conditions that need to be in place for the HPS concept to flourish. Such indicators need to be given greater recognition as HPS outcomes if schools are to progress beyond the early stages of project implementation. [ABSTRACT FROM AUTHOR]

This paper was presented as a technical background paper at the WHO sixth Global Conference on Health Promotion in Bangkok Thailand, August 2005. It describes what we know about the effectiveness of four of the Ottawa Charter health promotion strategies from eight reviews that have been conducted since 1999. The six lessons are that (i) the investment in building healthy public policy is a key strategy; (ii) supportive environments need to be created at the individual, social and structural levels; (iii) the effectiveness of strengthening community action is unclear and more research and evidence is required; (iv) personal skills development must be combined with other strategies to be effective; (v) interventions employing multiple strategies and actions at multiple levels are most effective; (vi) certain actions are central to effectiveness, such as intersectoral action and interorganizational partnerships at all levels, community engagement and participation in planning and decision-making, creating healthy settings (particularly focusing on schools, communities, workplaces and municipalities), political commitment, funding and infrastructure and awareness of the socio-environmental context. In addition, four case studies at the international, national, regional and local levels are described as illustrations of combinations of the key points described earlier. The paper concludes that the four Ottawa Charter strategies have been effective in addressing many of the issues faced in the late 20th century and that these strategies have relevance for the 21st century if they are integrated with one another and with the other actions described in this paper. [ABSTRACT FROM PUBLISHER]

This paper reviews approaches to the mapping of resources needed to engage in health promotion at the country level. There is not a single way, or a best way to make a capacity map, since it should speak to the needs of its users as they define their needs. Health promotion capacity mapping is therefore approached in various ways. At the national level, the objective is usually to learn the extent to which essential policies, institutions, programmes and practices are in place to guide recommendations about what remedial measures are desirable. In Europe, capacity mapping has been undertaken at the national level by the WHO for a decade. A complimentary capacity mapping approach, HP-Source.net, has been undertaken since 2000 by a consortium of European organizations including the EC, WHO, International Union for Health Promotion and Education, Health Development Agency (of England) and various European university research centres. The European approach emphasizes the need for multi-methods and the principle of triangulation. In North America, Canadian approaches have included large- and small-scale international collaborations to map capacity for sustainable development. US efforts include state-level mapping of capacity to prevent chronic diseases and reduce risk factor levels. In Australia, two decades of mapping national health promotion capacity began with systems needed by the health sector to design and deliver effective, efficient health promotion, and has now expanded to include community-level capacity and policy review. In Korea and Japan, capacity mapping is newly developing in collaboration with European efforts, illustrating the usefulness of international health promotion networks. Mapping capacity for health promotion is a practical and vital aspect of developing capacity for health promotion. The new context for health promotion contains both old and new challenges, but also new opportunities. A large scale, highly collaborative approach to capacity mapping is possible today due to developments in communication technology and the spread of international networks of health promoters. However, in capacity mapping, local variation will always be important, to fit variation in local contexts. [ABSTRACT FROM PUBLISHER]

This paper discusses what is meant by ‘global health promotion’ and the extent to which global governance architecture is emerging, enabling people to increase control over, and to improve, their health within an increasingly global context. A review of selected initiatives on breast-milk substitutes, healthy cities, tobacco control and diet and nutrition suggests that existing institutions are uneven in their capacity to tackle global health issues. The strategic building of a global approach to health promotion will draw on a broad range of governance instruments, give careful attention to implementation in the medium to longer term, reflect on the nature and appropriateness of partnerships and develop fuller understanding of effective policies for harnessing the positive influences of globalization and countering the negatives. [ABSTRACT FROM PUBLISHER]

This paper explores the importance for health promotion of the rise of public health as a foreign policy issue. Although health promotion encompassed foreign policy as part of ‘healthy public policy’, mainstream foreign policy neglected public health and health promotion's role in it. Globalization forces health promotion, however, to address directly the relationship between public health and foreign policy. The need for ‘health as foreign policy’ is apparent from the prominence public health now has in all the basic governance functions served by foreign policy. The Secretary-General's United Nations (UN) reform proposals demonstrate the importance of foreign policy to health promotion as a core component of public health because the proposals embed public health in each element of the Secretary-General's vision for the UN in the 21st century. The emergence of health as foreign policy presents opportunities and risks for health promotion that can be managed by emphasizing that public health constitutes an integrated public good that benefits all governance tasks served by foreign policy. Any effort to harness globalization for public health will have to make health as foreign policy a centerpiece of its ambitions, and this task is now health promotion's burden and opportunity. [ABSTRACT FROM PUBLISHER]

This paper advocates that mental health promotion receive appropriate attention within health promotion. It is of great concern that, in practice, mental health promotion is frequently overlooked in health promotion programmes although the WHO definitions of health and the Ottawa Charter describe mental health as an integral part of health. It is suggested that more attention be given to addressing the determinants of mental health in terms of protective and risk factors for both physical and mental conditions, particularly in developing countries. Examples of evidence-based mental health programmes operating in widely diverse settings are presented to demonstrate that well designed interventions can contribute to the well-being of populations. It is advocated that particular attention be given to the intersectorial cooperation needed for this work. [ABSTRACT FROM PUBLISHER]

Facilitating community action is a key goal of health promotion. This paper describes a public health advocacy framework. It then presents a case study of its application for planning community action by a community alliance concerned about increased heavy traffic on roads through a small regional city in the South West region of Western Australia. The case study illustrates defining the public health problem, the solution and the target for action; and the implementation of a comprehensive range of strategies including a media advocacy strategy to attract public attention, to reframe media messages, and to provide a policy alternative to government and industry. The campaign was evaluated in terms of process and outcomes, and was successful in putting pressure on key stakeholders and achieving the alliance's two main goals. The case study demonstrates the value of a well-planned campaign and including public health advocacy in public health practice, as an important strategy to facilitate the creating of healthy environments through healthy public policy. [ABSTRACT FROM AUTHOR]

The worksite is one of the key channels for the delivery of interventions to reduce chronic diseases among adult populations. It provides easy and regular access to a relatively stable population and it encourages sustained peer support. This paper reports a 2-year follow-up of the impact of a worksite health promotion programme on serum cholesterol and dietary changes among employees in a city in Malaysia. A quasi-experimental study was conducted among Malay-Muslin male security guards, with those working in a public university in Kuala Lumpur comprising the intervention group, and those working in the teaching hospital of the same university as the comparison group. They were comparable in socio-demographic characteristics. The intervention group received intensive individual and group counselling on diet, physical activity and quitting smoking. The comparison group was given minimal education on the same lifestyle changes through mail and group counselling. The intervention group showed a statistically significant reduction in their mean total cholesterol levels as compared with the comparison group, with an intervention effect of -0.38 (95% Cl = -0.63, -0.14) mmol/l. The intervention group also reported a reduction in the amount of cigarettes smoked. The worksite was shown to be an effective channel for health promotion. The adoption of the new lifestyle behaviours should be supported and sustained through modification of work policies. [ABSTRACT FROM AUTHOR]

The World Health Organization makes a case for the importance of voluntary organizations in promoting health at local levels. The purpose of this paper is to contribute to understanding which factors explain local voluntary associations (LVAs) participation in health promotion in local contexts. It does so through (i) identifying indicators that represent determinants of health promotion action which were reported by LVAs and by (ii) comparing their actions with these determinants. The data reported are from a questionnaire survey of all registered LVAs in four municipalities in Finland. Principal component analysis revealed four determinants of health promotion action. Four factors in the final multivariate model explained over half of the variance of LVAs engagement in health promotion action: competence, values 'healthy' and also opportunities and municipality. There is some evidence to support a model of health promotion action which has not been tested empirically in relation to these types of organization. More detailed studies of determinants of health promotion action are needed to shape strategies in local communities. [ABSTRACT FROM AUTHOR]

This paper examines the factors that have enabled the Healthy Cities Noarlunga (HCN) initiative to be sustainable over 18 years (1987-2005). Sustainability related to the ability of the initiative to continue to operate continuously in a manner that indicated its existence was accorded value by the community and local service providers. The analysis is based on a narrative review of 29 documents related to HCN, including a number of evaluations. Nine factors emerged as important to ensuring sustainability: strong social health vision; inspirational leadership; a model that can adapt to local conditions; ability to juggle competing demands; strongly supported community involvement that represents genuine engagement; recognition by a broad range of players that Healthy Cities is a relatively neutral space in which to achieve goals; effective and sustainable links with a local university; an outward focus open to international links and outside perspectives; and, most crucial, the initiative makes the transition from a project to an approach and a way of working. These sustainability factors are likely to be relevant to a range of complex, community-based initiatives. [ABSTRACT FROM AUTHOR]

More than 20 years have passed since the American-Israeli medical sociologist Aaron Antonovsky introduced his salutogenic theory 'sense of coherence' as a global orientation to view the world, claiming that the way people view their life has a positive influence on their health. Sense of coherence explains why people in stressful situations stay well and even are able to improve their health. The origin of salutogenesis derives from the interviews of Israeli women with experiences from the concentration camps of the Second World War who in spite of this stayed healthy. Sixty years after the Holocaust this paper aim to shed light on the salutogenic theory in the context of public health and health promotion. In addition, other approaches with salutogenic elements for the explanation of health are considered. A potential direction for public health of the early 21st century is proposed. The historical paradox is to honour the victims of the Holocaust and see the birth of post-modern public health and the salutogenic framework through the experience of its survivors in the ashes of Modernity. [ABSTRACT FROM AUTHOR]

This paper starts by briefly reviewing the history, theory and practice of the settings approach to promoting public health—highlighting its ecological perspective, its understanding of settings as dynamic open systems and its primary focus on whole system organization development and change. It goes on to outline perceived benefits and consider why, almost 20 years after the Ottawa Charter advocated the approach, there remains a relatively poorly developed evidence base of effectiveness. Identifying three key challenges—relating to the construction of the evidence base for health promotion, the diversity of conceptual understandings and real-life practice and the complexity of evaluating ecological whole system approaches—it suggests that these have resulted in an ongoing tendency to evaluate only discrete projects in settings, thus failing to capture the 'added value' of whole system working. It concludes by exploring the potential value of theory-based evaluation and identifying key issues that will need to be addressed in moving forward—funding evaluation within and across settings; ensuring links between evidence, policy and practice; and clarifying and articulating the theories that underpin the settings approach generically and inform the approach as applied within particular settings. [ABSTRACT FROM AUTHOR]

The context in which public health programmes operate can play an important role in influencing their implementation and effectiveness. An intervention that has been shown to be effective in one setting may turn out to be ineffective somewhere else, even supposing it can be implemented there. Therefore, systematic reviews of public health interventions should appraise the applicability of the intervention process and the transferability of the intervention effectiveness to other localities. However, applicability and transferability appraisal is seldom reported in systematic reviews of public health and health promotion interventions. This paper aims to introduce an innovative approach to bridging this gap. A list of attributes that may impact on applicability and transferability can be developed, based on knowledge of the proposed intervention. Then the applicability and transferability of the intervention to the local setting can be rated, and given a score, based on knowledge of the local setting. This approach provides a useful tool for evaluating public health interventions and provides a reliable basis for informed decision making in resource-poor settings, where rigorous primary studies are lacking and where very limited resources put a high demand on evidence-based approaches to health promotion. [ABSTRACT FROM AUTHOR]

Whilst urban-dwelling individuals who seek out parks and gardens appear to intuitively understand the personal health and well-being benefits arising from 'contact with nature', public health strategies are yet to maximize the untapped resource nature provides, including the benefits of nature contact as an upstream health promotion intervention for populations. This paper presents a summary of empirical, theoretical and anecdotal evidence drawn from a literature review of the human health benefits of contact with nature. Initial findings indicate that nature plays a vital role in human health and well-being, and that parks and nature reserves play a significant role by providing access to nature for individuals. Implications suggest contact with nature may provide an effective population-wide strategy in prevention of mental ill health, with potential application for sub-populations, communities and individuals at higher risk of ill health. Recommendations include further investigation of 'contact with nature' in population health, and examination of the benefits of nature-based interventions. To maximize use of 'contact with nature' in the health promotion of populations, collaborative strategies between researchers and primary health, social services, urban planning and environmental management sectors are required. This approach offers not only an augmentation of existing health promotion and prevention activities, but provides the basis for a socio-ecological approach to public health that incorporates environmental sustainability. [ABSTRACT FROM AUTHOR]

Systematic reviews of public health interventions are fraught with challenges. Complexity is inherent; this may be due to multi-component interventions, diverse study populations, multiple outcomes measured mixed study designs utilized and the effect of context on intervention design, implementation and effectiveness. For policy makers and practitioners to use systematic reviews to implement effective public health programmes, systematic reviews must include this information, which seeks to answer the questions posed by decision makers, including recipients of programmes. This necessitates expanding the traditional evaluation of evidence to incorporate the assessment of theory, integrity of interventions, context and sustainability of the interventions and outcomes. Unfortunately however, the critical information required for judging both the quality of a public health intervention and whether or not an intervention is worthwhile or replicable is missing from most public health intervention studies. When the raw material is not available in primary studies the systematic review process becomes even more challenging. Systematic reviews, which highlight these critical gaps, may act to encourage better reporting in primary studies. This paper provides recommendations to reviewers on the issues to address within a public health systematic review and, indirectly, provides advice to researchers on the reporting requirements of primary studies for the production of high quality systematic reviews. [ABSTRACT FROM AUTHOR]

A sustained scaled up response to global public health challenges such as HIV/AIDS will require a functioning and efficient health system, based on the foundation of strong primary healthcare. Whilst this is necessary, it is not sufficient. Health promotion strategies need to be put into place to better engage and support families and communities in preventing disease, optimize caring, creating the demand for services and holding service providers to account. There will have to be a move away from the traditional model whereby the problem of HIV/TB/malaria is to be solved by merely increasing resources to a centralized bureaucracy that tries to increase the supply of services including health promotion messages. Development projects and programs that succeed are based on understanding of local practice and preferences, rather than on internationally 'generalized models' of how people or villages should behave and what they should want. This paper will first briefly review different approaches to scaling up health promotion interventions, some of the key obstacles in scaling up and then suggest some possible solutions with a focus on a human rights based approach. This approach changes the emphasis from the content of the message to the characteristics of a community's organisations and institutions. Scaling up occurs as a process of association between state actors and civil society that is planned strategically and involves a sharing of experience and a strong learning process among the association partners. A human rights-based approach can facilitate such an approach through developing a common vision, delineating roles and responsibility and facilitating communication channels for the most vulnerable. But this will require health development agencies to pursue a more overt political agenda. [ABSTRACT FROM AUTHOR]