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In this chapter you will learn about health promotion and study health promotion initiatives related to Australia's health priorities. You will investigate the principles of social justice and analyse the importance of the action areas of the Ottawa Charter.

Health promotion based on the five action areas of the Ottawa Charter

Over the last 20 years there has been a rapid growth in the way health issues are addressed through health promotion. Health promotion is a comprehensive social and political process, not only including actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to lessen their impact on public and individual health. Effective health promotion requires multiple approaches involving many individuals and organisations. Political, economic, social, environmental and behavioural factors all interact in establishing a climate that is fully supportive of individual and community well-being.


PDHPE Application and Inquiry

Levels of responsibility for health promotion

Health is everybody's business and therefore everyone is responsible for promoting health. Health promotion is not just the responsibility of the health sector but requires a coordinated action by all governments as well as by health and other social and economic sectors, non-government and voluntary organisations, local authorities, industry and the media. Every person can take on the responsibility to promote health, whether as an individual or as a member of a family or community. Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health. The Ottawa Charter was developed in 1986 to build a global `all for health' movement as a means to realise the right to health of all humans. The five action areas of the Ottawa Charter are: · · · · · developing personal skills creating supportive environments strengthening community action reorientating health services building healthy public policy.

goals and effective frameworks or structures that reflect the population health approach. Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. The responsibility of the private sector in promoting health is to ensure that it provides a safe and healthy working environment that has opportunities for continuous learning. In promoting health, the private sector must also take into account its responsibility for protecting the environment and contributing to the overall well-being of the community. At the community level, communities with a common interest or concern can focus their energies on developing partnerships that address the determinants of health. For example, the government may provide funding to healthrelated organisations, such as the Heart Foundation or Cancer Council, to support research; plan and provide highquality services that promote health; share information and resources designed to have optimum health impacts; and involve the individuals who have a vested interest in setting priorities and implementing programs. As individuals, we can all contribute by taking responsibility for our own health and well-being; actively seeking out the information we need to make informed health decisions; building supportive communities; and participating in community activities that have an impact on health. For example, schools have a `no hat no play' policy to protect students from the sun. Within the above levels, there may be partners at different levels. Depending on the context and the nature of the intersectoral action, levels may be defined in different ways; for example, in terms of: · geography (such as local/community, regional, state, national and international levels) · levels of government (that is, local, state/territorial and federal) · levels within organisations (such as senior decisionmaking level and service-delivery level).

The charter aims to develop partnerships and support networks with public, private, government, non-government and international organisations to create and maintain actions to promote health. At the national level, the job of government and organisations is to create an environment for improving health. This is done by providing coordination and leadership; encouraging federal, state and territorial collaboration; providing the public and other stakeholders with the information and resources they need; working together with international bodies to share information; and developing the infrastructure to establish and support a social health approach. At the state and territorial level, the responsibility of government and organisations is to work together to develop healthy public policies, balance investments and regularly provide health information to members of the public. They are also responsible for developing health



As the broad list of examples in Table 4.1 shows, effective health promotion must involve the cooperation of a variety of government and non-government organisations. The public health approach acknowledges that effective health promotion requires intersectoral involvement. It also emphasises the importance of creating an environment that is fully supportive of positive health behaviours and actively involves the community.

accountability for health outcomes. Successful initiatives developed by different sectors are, by their nature, challenging to achieve. Intersectoral action about a health concern makes possible the joining of all the knowledge available about the health concern. It also allows for access to the resources and skills needed to understand and solve complex issues where possible solutions lie outside the capacity and responsibility of a single sector. Intersectoral action can be used to promote and achieve shared goals in a number of areas; for example policy, research, planning, practice and funding. It may be implemented through numerous activities, including advocacy, legislation, community projects, policy and programs. Intersectoral action may take many forms, such as passing of legislation. It is most successful when characterised by a dynamic and flexible process that is perceived as a `win-win' situation by all participants. Intersectoral action requires the development of a strategic plan. This is a clear outline of the steps taken to achieve the goals and intended outcomes of the initiative. For example, the strategic plan outlines a timeline as well as the key people or organisations involved, the budget requirements and an evaluation of the results. A relationship between one or more parts of the health sector and one or more parts of another sector is important.

Critical inquiry

Choose five of the health promotion initiatives listed in Table 4.1. Identify the levels of responsibility involved for each initiative.

The benefits of partnerships in health promotion

The key aspect of health promotion is understanding that improving health is a shared responsibility. Intersectoral collaboration is the teamwork among health and other groups to improve health outcomes. Health groups and those groups not normally associated with health, but whose activities may have an impact on health or the factors known to influence it, share the responsibility and Table 4.1 Initiative Awareness-raising media campaigns Reducing risky behaviour and maintaining a healthy environment Programs to address specific health problems Initiatives for socioeconomically disadvantaged people Non-government organisation initiatives Business-sector developments Economic incentives Economic disincentives Environmental developments Community/individual initiatives Sample health promotion initiatives Examples

`Slip, Slop, Slap', `Stop, Revive, Survive' and `Drink, Drunk, the Difference is U' Bicycle helmet laws, pool fencing, health warnings on cigarette packets, reduced speed limits, unleaded petrol, reduction of chlorofluorocarbons (CFCs) National Drug Strategy, National Mental Health Strategy Aged pensions, single-parent pensions, unemployment benefits, Medicare Safety Net, housing support National Heart Foundation's `tick' for healthy food, Cancer Council mobile clinic, Red Cross first-aid courses, Sun-Herald City-to-Surf, Sydney City Mission emergency accommodation, `Quit' programs, Alcoholics Anonymous Lean beef, 100 per cent ultraviolet (UV) clothing, car air bags, ergonomic furniture, sports safety equipment, `Weight Watchers', nicotine patches Lower tax on low-alcohol beer, reduced life insurance premiums for non-smokers Higher taxes on alcohol and cigarettes Smoke-free areas, lead-free petrol, dual-lane carriageways, shaded areas at beaches, exercise equipment in public parks Car pooling, Neighbourhood Watch, Safety Houses, environmental protection groups, Lions Clubs' `Driver Reviver' stations, Health Promoting Schools, Healthy Food Canteens

PDHPE Application and Inquiry


This will help to ensure the action taken to address an issue and achieve health outcomes is a more effective, efficient and sustainable approach than is possible when the health sector works alone. There is no doubt that intersectoral action for health has worked. There are many success stories at international, national and local levels. For example, publicly funded immunisation programs that involve the health, education and, in some cases, social services systems have been successful in reducing the incidence and prevalence of communicable diseases and their complications. Healthy communities projects all across Australia have brought about changes that have resolved health problems and greatly improved the quality of life of people. The National Mental Health Strategy brought together federal government departments with state and territorial governments, community groups, professional associations and private sector organisations to develop an intersectoral response to addressing mental health issues. Intersectoral action results in increased public awareness; implementation of a range of health, social service, criminal justice and housing services; and networks of partners who continue to work together. There are significant potential benefits to be realised from adopting, supporting and sustaining an intersectoral action approach, including: · a greater capacity to tackle and resolve complex health and social problems that have eluded individual sectors for decades, resulting in improved population health and well-being, and reduced demand for health care and social services in future

· a pooling of resources, knowledge and expertise, and development of networks, that will allow partners to address current problems more effectively and position them to respond better to future issues · reductions in duplication of effort among different partners and sectors · new collaborative and inclusive ways of working together that will enable partners to contribute to improvements in social cohesion, provide increased opportunities for sustainable human development, and create a more dynamic and vibrant society.

Research and Review


The public health approach requires the cooperation of government and community. Explain, with the use of examples, how this cooperation can take place. Smoking is a major health concern in Australia. Conduct a review of health promotion strategies designed to reduce smoking. Argue the benefits that partnerships have had on health promotion in relation to smoking. Complete the task for other major risk factors related to the national health priorities; for example, nutrition and physical activity.



Figure 4.1 There are significant benefits of partnerships in health promotion



How health promotion based on the Ottawa Charter promotes social justice

The Ottawa Charter promotes social justice as it is designed to provide access to health opportunities for all members of society. This requires policy approaches, planning decisions and strategies to enhance access to those factors and situations that support health. Resources need to be allocated appropriately, taking into account that some need more than others. It is important that all individuals or groups be accounted for in the decision-making processes, as this allows the decisions to be made within a social justice framework. Social justice involves treating all people equally and providing people with equal rights. Basically, it is about giving everyone a `fair go'. Since inequality still exists in society, treating everyone the same does not necessarily mean fairness of treatment. Social justice targets the marginalised groups of people in society--it focuses on the disadvantaged. Social justice recognises that there are situations where applying the same rules to unequal groups can generate unequal results. Social justice provides equitable outcomes to marginalised groups by recognising the existence of past disadvantage and that structural barriers embedded in the social, economic and political system perpetuate systemic discrimination. In promoting health, equity underpins practice. A socially just society is much more likely to be a healthy society--physically, economically, spiritually, emotionally and environmentally. According to a 1986 report by WHO, the Ottawa Charter refers to health promotion as the `process of enabling people to increase control over, and to improve, their health'. The Fourth International Conference on Health Promotion held in Jakarta in 1997 provided an opportunity to reflect on what had been learned about effective health promotion, to re-examine the determinants of health, and to identify the directions and strategies that must be adopted to address the challenges of promoting health in the twentyfirst century. The Jakarta Declaration presents actions for health promotion that need to occur in the twenty-first century. According to a 1997 report by WHO, it reinforces the importance of collaborative partnerships in effective health promotion; that is, where organisations work together to achieve common goals. The Jakarta Declaration also highlights the need to `increase community capacity and empower the individual'. Those groups who do not have power, or feel powerless, experience worse health. However power might be measured, those with more power are healthier. When individuals are given the opportunity to participate in the political, cultural or social process they are able to state their needs accurately. They are in a position to contribute actively to the development of strategies designed to assist them. Rather than merely be the recipient of the health promotion outcome, they become a part of the process. Individuals are empowered when their decision-making abilities are

improved and this gives them more control over their lives. The empowerment of individuals is fundamental to the public health approach. When individuals are empowered, social justice is achieved. People are enabled to make changes in the context of their lives that enhance their health. Health workers can be advocates to influence policy at all levels through formal lines of authority. Health promotion work involves advocating on behalf of vulnerable community groups for the desired changes to be enshrined in policy. Policy within government can also be used to bring about change in the social environment, management systems and structures, and to provide the rationale for action in support of the community. In a similar fashion to individual empowerment, communities are given the opportunity to express their needs and to be an active part of the health promotion process. The public health approach develops structures and policies to support communities in achieving their goals. According to a 1986 WHO report, as the Ottawa Charter for Health Promotion stated: `At the heart of this process is the empowerment of communities, their ownership and control of their own endeavours and destinies'. The Ottawa Charter identified the `strengthening of community action' as a fundamental principle of health promotion. The emphasis Communities are not of the public health approach is necessarily defined by on working with communities. This geographic barriers. approach supports strategies that are developed by communities, not those strategies that are imposed on them. In this way, communities feel a sense of ownership and confidence. As a result, the chances of successful interventions significantly increase. It is important to note that communities are not necessarily defined by geographic barriers. Communities may be characterised by other factors, such as race, socio-economic status or profession.


The scenarios opposite are common examples of situations that occur in our society. By applying the actions of the Ottawa Charter we can promote social justice and promote health.

practical application

Social justice principles


PDHPE Application and Inquiry

Read each of the scenarios opposite. For each scenario:

a b

Discuss the principles of social justice that are not applied. Discuss the responsibility of individuals, communities and governments under the action areas of the Ottawa Charter.


Principles of social justice: health promotion scenarios

`I wish my mum didn't live so far way. I never knew it would be this hard juggling work and the kids. And Cal and I hardly see each other, what with him working the overnight shift.You're so lucky to be home with your kids ... I know, I know, but really, you're lucky! I worry all the time. The sitter lets them watch way too much TV. But it's so hard to find someone. And my eldest, JJ, is only in kindergarten, but already the teacher wants to get him tested for behaviour problems. I try to do everything but ...' `Things haven't been so great, so I was glad to find out about this place. I left school pretty early--always had trouble with reading--so I'm taking classes here to upgrade. And after lunch, I get to play a little basketball and let off a bit of steam. They're hoping to start up a retraining program again, and the staff here say for sure I'll qualify for it. My life sure has changed. I got work right after I dropped out of school--on the assembly line. Not a union job, but still pretty good, and I put in 16 years there. But six months ago, the place closed down. A year ago, I remarried, and we had planned to start a family. But now I wonder how we'll manage.'

`Do I like cleaning windshields for a living? Except for the dirty looks, it's okay. And sometimes drivers are really nice. But do I like it? Look, I'm 16, I don't live at home and I need the money. I'm not into trading sex for money--my best friend just found out she has HIV-- and I won't deal drugs. Getting a straight job is hard, really hard--especially when you don't have a permanent address. I've been staying with a bunch of kids and everybody comes in at all hours. I'm not sleeping much and I've got a really bad cough. If I had a place of my own, I'd probably feel a whole lot better about everything, but I doubt I'll ever be able to afford that.'

`I don't know what's gotten into me--I just don't feel like myself. For one thing, I know I'm jumpy. Maybe it's worrying about the bills, with everything getting more expensive. I suppose I could move into something smaller, but this is my home. I surely don't want to go to some institution, and where else would I go? Anyway, I made an appointment with Dr Jones, and maybe I'll ask about those nerve pills.'



The Ottawa Charter in action

The five action areas of the Ottawa Charter reflect the `public health approach', with a special emphasis on social justice issues. (The action areas are listed on page 73.) Australia's six health priorities were discussed in detail in Chapter 3. The six priority issues for investigation are: · · · · cardiovascular disease cancer diabetes respiratory disease · injury · mental health problems and illnesses.

Table 4.2

Ottawa Charter framework for the analysis of the six health priority issues Reorientating health services Range of services available · Listtherangeofservicesavailableforpeoplewith this illness/condition. · Aretheseservicesaimedatprevention,promotion or cure? Gaining access to services · Isaccesstotheseservicesequitableforall? · Whatfactorsrestrictequitableaccessforall? · Whatcanbedonetoimproveaccess? Building healthy public policy Public policy developments · Identifyarangeofpublicpolicydevelopmentsaimed to address the priority issue. · Whatadditionalpublicpolicieswillassistin addressing the priority issue? Impact of policy on health · Whatimpact,ifany,havethesepolicieshadon health in relation to the priority issue? · Howcanpublicpolicyinrelationtothepriorityissue be influenced by individuals and communities? · Whodecideswheremoneyisspentinrelationto the priority issue? Further questions · WhichofthefiveactionareasoftheOttawaCharter are most significant for the priority issue? · HowdothefiveactionareasoftheOttawaCharter interact in relation to the priority issue?

Developing personal skills Modify personal behaviour · Whatbehaviourmodificationswillreducetheriskof developing this illness/condition? · Whatpersonalskillsareneededtoadoptpositive behaviour? Accessing information and support · Wherecanreliableinformationonthis illness/condition be obtained? · Whatsupportservicescanassistindeveloping this positive health behaviour? Creating supportive environments Support networks and community services · Whatcommunityservicesexisttosupportpeople with this illness/condition? · Howhastheenvironmentbeenmodifiedtoreduce the incidence of this illness/condition? Environmental influences on health · Somepopulationgroupsexperiencethisillness/ condition more than others. With this point in mind, how do the following impact on: ­ socio-cultural factors ­ physical factors ­ political factors ­ economic factors? Strengthening community action Empowering communities to take action · Whatcommunity-inspiredinitiativeshavebeen designed to address this priority issue? · Whatmotivatesindividualsandcommunitiesto take action? · Howhavetheseinitiativesbeensupportedby the government and private sectors? · Howhavethegovernmentandprivatesectors worked in opposition to these initiatives?

PDHPE Application and Inquiry

practical application

The Ottawa Charter in action

Choose two health promotion initiatives related to Australia's health priorities. You may like to choose the initiatives from those listed in Table 4.1 (page 74). Critically analyse the importance of the five action areas of the Ottawa Charter to improve health. Use the questions in Table 4.2 to assist your investigation.




Chapter summary · Health promotion is a comprehensive social Revision activities

1 2 3

Define the term `health promotion'. Identify and describe the actions of the Ottawa Charter. Describe a health promotion initiative that is:


and political process, not only including actions directed at strengthening skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions. Effective health promotion requires multiple approaches involving many individuals and organisations. Health promotion is not just the responsibility of the health sector but requires a coordinated action by all. The Ottawa Charter was developed to build a global `all for health' movement as a means to realise the human right to `health for all'. Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. The public health approach acknowledges that effective health promotion requires intersectoral involvement. The key aspect of health promotion is understanding that improving health is a shared responsibility. The Ottawa Charter promotes social justice as it is designed to provide access to health opportunities for all members of the society. Social justice is treating all people equally and providing people with equal rights. The five action areas of the Ottawa Charter are developing personal skills, creating supportive environments, strengthening community action, reorientating health services and building healthy public policy.

· · · · · · · · ·

a an awareness-raising media campaign b an economic incentive c an environmental development d a community or individual incentive.

Define the term `social justice'.


Extension activities


Discuss the benefits of partnerships in health promotion. Compare and contrast the levels of responsibility for health promotion. Discuss how health promotion based on the Ottawa Charter promotes social justice. Argue the benefits of health promotion.

2 3 4

Exam-style questions


Analyse how building healthy public policy can address two national health priority issues you have studied. (10 marks) Analyse two action areas of the Ottawa Charter that are used to address either skin cancer or lung cancer. (10 marks) Describe the influence of the Ottawa Charter on the implementation of a major health promotion initiative in Australia. (6 marks) Discuss how the Ottawa Charter influences the development of health promotion initiatives in Australia. (8 marks) Identify two principles from the Ottawa Charter for health promotion and show how they apply to the management of one health issue. (8 marks)

2 3 4 5




A student: H7 explains the relationship between physiology and movement potential H8 explains how a variety of training approaches and other interventions enhance performance and safety in physical activity H9 explains how movement skill is acquired and appraised H10 designs and implements training plans to improve performance H11 designs psychological strategies and nutritional plans in response to individual performance needs H16 devises methods of gathering, interpreting and communicating information about health and physical activity concepts H17 selects appropriate options and formulates strategies based on a critical analysis of the factors that affect performance and safe participation.



Factors affecting performance

lowing chapters exa c o m in g up ... The folformance, including mine the dynamic the theoretical and and varied factors that affect per ces ological and psychological influen practical applications of the physi ouraged to participate in, and on performance. Students are enc ng to the following as they relate to critically analyse, experiences relati n, training principles, skill acquisitio performance: exercise physiology, and recovery from exercise. sports psychology, sports nutrition

focus questions

* * * *

How does training affect performance? ................[page 82] How can psychology affect performance? ............[page 114] How can nutrition and recovery strategies affect performance? ............................................ [page 130] How does the acquisition of skill affect performance? ........................................... [page 148]




10 pages

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