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This chapter discusses the range of factors that influence our health and examines how the readers define and implement health promotion in the 21st century. It argues that health promotion is an integral part of public health and plays a central role in advancing the health of the population. The chapter focuses on planning and evaluating health promotion approaches in a systematic and sustainable manner to improve population health outcomes. Graduates in health promotion must have highly developed conceptual skills, technical skills in needs assessment, planning and evaluation, and 'radar detection' to manage 'upwards' within their organisation and 'outwards' to a digitally informed environment to harness patients/consumers' capacities for self-care and advocacy in addressing the social and environmental determinants of health. Alcohol consumption would be moderated through the use of an identification card to purchase a maximum quantity of alcohol per week to ensure safe levels of consumption for all Australians.

This chapter draws together and articulates the challenges and opportunities facing health promotion in the 21st century. It asks the reader to think about global, national and local challenges facing the promotion of health, and about health challenges, many of which are outside the health system. The inextricable links between the health of the planet and the health of human society is a core focus of health promotion. Continuing to measure cost-effectiveness and use health economic strategies will be important for building an evidence-base for health promotion. The recognition of growing urbanisation combined with the impact of the local environment on population health brings strong recommendations for healthy cities approaches to be part of the future of health promotion. A healthy cities approach embraces systems thinking, addresses fundamental social, economic and environmental determinants, enables participation, is supported by policy and supports health through good governance and guidance.

In this chapter, the authors discuss what an interconnected partnership approach means and why it is important for health promotion. Federal governments have played a role in coordinating federally funded organisations, such as Divisions of General Practice, Medicare Locals and Primary Health Networks. Aside from government in Australia, the role of non-government and community based organisations, settings-based organisations and so on is crucial to supporting and improving the health of our communities. Given variations in capacity and funding for health promotion across Australia, working collaboratively with organisations and sectors that impact the social and environment determinants of health seems like the logical way forward. The authors also discuss other organisations such as not-for-profit bodies, and their role in advancing health promotion. They explore some examples of a systems approach and systems thinking. They conclude with a discussion of the implications and opportunities for health promotion into the future.

The role of local government in improving public health has been given legislative recognition in some Australian states. There is growing evidence of the positive role this statutory recognition has given to align local government efforts with state government health policy. Health in All Policies (HiAP) is a comprehensive approach to integrating public health, promoting components into a range of traditional local policies such as those relating to housing, transport and water. While much of the work internationally in HiAP has focused on urban populations, we argue that there are opportunities for rural and remote Australian local governments to use HiAP to respond to disparities in health outcomes amongst rural and remote Australian communities. We examine the Australian experiences with HiAP, the role for local governments and the future challenges and opportunities around the use of a HiAP approach to improve community health outcomes in rural and remote Australian communities.

BACKGROUND: There is little published research about managers’ views about implementing and embedding workplace health promotion interventions. OBJECTIVE: To shed light on research-to-practice challenges in implementing workplace health promotion interventions in the Australian road transport industry. METHODS: In this Participatory Action Research project, managers from small-to-midsized companies in the Australian road transport industry were asked their views about enablers and barriers to implementing nutrition and physical activity interventions in their workplace. RESULTS: Managers identified practical assistance with resources, ideas, and staffing as being key enablers to implementation. Barriers included time restraints, worker age and lack of interest, and workplace issues relating to costs and resources. CONCLUSION: Manager perspectives add new insights about successful implementation of workplace health promotion. A Participatory Action Research approach allows managers to develop their own ideas for adapting interventions to suit their workplace. These findings add to a small body of knowledge about managers’ views regarding implementing workplace health promotion in small-to-midsized road transport companies – a relatively unexplored group. Managers highlight the importance of time constraints and worker availability when designing interventions for the road transport industry. Managers require a good understanding of the workplaces’ socio-cultural context for successful health promotion and health behaviour change.

In this chapter, the authors provide an overview of what settings are; identify and discuss global directions and trends in healthy settings; and look at some examples of healthy settings. They discuss the challenges associated with the settings approach and introduce concepts related to healthy settings and the future. The health-promoting settings approach has much support globally as a strategy to help combat rising risk factors for chronic diseases. Fortune, K. and colleagues recognise the challenges associated with evaluating and 'proving' the effectiveness of a healthy settings approach. This can be difficult because of the number of agencies or organisations that can be involved in a healthy settings approach. The authors describe what we consider to be a health promotion setting and present a global perspective on settings and discuss a range of health promotion settings as examples of how a settings approach could be implemented.

In this chapter, the author begins with a reminder that evaluation and considerations of attainability are the keys to planning and implementation. The author discusses planning and implementation principles, provides example through theories, models and frameworks, and discusses the need to be flexible and nimble as the project or program grows. A word on innovation: one of the challenges, or perhaps what is sometimes seen as time constraining in health promotion projects or programs, can be grappling with the issue of evidence-based practice versus innovation. Integrating evaluation throughout the innovation process helps to build evidence, which is useful for the particular project or program as well as informing broader health promotion practice. Planning for health promotion is an essential process. It can be guided by planning frameworks theories and tools, and adapted to suit local needs.

This chapter provides an overview of sustainability in its several forms. It includes governance and sustainability along with project or program sustainability for health promotion. Sustaining programs and health promotion approaches also enables the development of greater synergies towards long-term risk factor improvement. Drawing on international approaches, Torres and colleagues conducted a study using an analytical grid of a health promotion approach. The phases of the approach are: analysis and planning; implementation; evaluation; sustainability; and empowerment. Identifying the concepts of sustainability can take significant research and review of existing health promotion approaches. This process also sometimes seeks the opinions and input of experts in the field, or those who have been involved in health promotion or related activities. The toolkit includes the application of a series of the modules that discuss the need for communities to develop a sustainability plan.

How should we invest precious health resources? At a time when chronic illness is increasing, inequality persists and climate change is starting to impact our health, how can health promotion improve health outcomes across the whole population? Health Promotion in the 21st Century offers a systematic introduction to the principles of health promotion today, and effective planning, implementation and evaluation. The authors review the global, regional and local issues that affect health in Australia, and show how social, economic, political and educational elements in society contribute to population health and wellbeing. Throughout, the authors emphasise that health promotion needs multiple solutions, and that health professionals should seek out strategic opportunities and partnerships. They consider the issues facing vulnerable groups - such as Aboriginal and Torres Strait Islander people, those with mental health issues, and the aged - and suggest a variety of innovative tools for working with particular populations. They also focus on strategies to ensure programs remain vibrant and sustainable in the longer term. With case studies and activities in each chapter, Health Promotion in the 21st Century is an essential resource for anyone seeking to build a career in health promotion.