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Source: World Health Organization, Geneva
Health
Health
is defined in the WHO constitution of 1948 as:
A
state of complete physical, social and mental well-being,
and not merely the absence of disease or infirmity.
Within
the context of health promotion, health has been considered
less as an abstract state and more as a means to an
end which can be expressed in functional terms as a
resource which permits people to lead an individually,
socially and economically productive
life.
Health
is a resource for everyday life, not the object of living.
It is a positive concept emphasizing social and personal
resources as well as physical capabilities.
Reference:
Ottawa Charter for Health Promotion. WHO, Geneva, 1986
In
keeping with the concept of health as a fundamental human
right, the Ottawa Charter emphasises certain pre-requisites
for health which include peace, adequate economic resources,
food and shelter, and a stable eco-system and sustainable
resource use. Recognition of these pre-requisites highlights
the inextricable links between social and economic conditions,
the physical environment, individual lifestyles and health.
These links provide the key to an holistic understanding
of health which is central to the definition of health
promotion.
Today
the spiritual dimension of health is increasingly recognised.
Health is regarded by WHO as a fundamental human right,
and correspondingly, all people should have access to
basic resources for health.
A
comprehensive understanding of health implies that all
systems and structures which govern social and economic
conditions and the physical environment should take account
of the implications of their activities in relation to
their impact on individual and collective health and well-being.
See
also social responsibility for health
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Health
promotion
Health
promotion is the process of enabling people to increase
control over, and to improve their health.
Reference:
Ottawa Charter for Health Promotion. WHO, Geneva,1986
Health
promotion represents a comprehensive social and political
process, it not only embraces actions directed at strengthening
the skills and capabilities of individuals, but also action
directed towards changing social, environmental and economic
conditions so as to alleviate their impact on public and
individual health. Health promotion is the process of
enabling people to
increase control over the determinants of health and thereby
improve their health. Participation
is essential to sustain health promotion action.
The
Ottawa Charter identifies three basic strategies
for health promotion. These are advocacy for health to
create the essential conditions for health indicated above;
enabling all people to achieve their full health potential;
and mediating between the different interests in society
in the pursuit of health.
These
strategies are supported by five priority action areas
as outlined in the Ottawa Charter for health promotion:
Each
of these strategies and action areas is further defined
in the glossary.
The
Jakarta Declaration on Leading Health Promotion into the
21st Century from July 1997 confirmed that these strategies
and action areas are relevant for all countries. Furthermore,
there is clear evidence that:
 Comprehensive
approaches to health development are the most effective.
Those that use combinations of the five strategies are
more effective than single-track approaches;
Settings for
health offer practical opportunities for the implementation
of comprehensive strategies;
Participation
is essential to sustain efforts. People have to be at
the centre of health promotion action and decision-making
processes for them to be effective;
Health literacy/
health learning fosters participation. Access to education
and information is essential to achieving effective participation
and the empowerment of people and communities.
For
health promotion in the 21st century the Jakarta Declaration
identifies five priorities:
Promote
social responsibility for health
Increase investments
for health development
Expand partnerships
for health promotion
Increase community
capacity and empower the individual
Secure an
infrastructure for health promotion
Each
of these priorities is further defined in the glossary.
Increasing community capacity is addressed in the definition
of community action for health. mpowerment for health
is included as a definition.
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Health
for All
The
attainment by all the people of the world of a level of
health that will permit them to lead a socially and economically
productive life.
Reference:
Glossary of Terms used in Health for All series. WHO,
Geneva,1984
Health
for All has served as an important focal point for health
strategy for WHO and its Member States for almost twenty
years. Although it has been interpreted differently by
each country in the light of its social and economic characteristics,
the health status and morbidity patterns of its population,
and the state of development of its health system, it
has provided an aspirational goal, based on the concept
of equity in health. The Health for All strategy is currently
being redeveloped to ensure its continued relevance into
the next century. A new policy is being developed, to
be adopted by the World Health Assembly in 1998.
The
science and art of promoting health, preventing disease,
and prolonging life through the organized efforts of society.
Reference:
adapted from the “Acheson Report”, London, 1988
Public
health is a social and political concept aimed at the
improving health, prolonging life and improving the quality
of life among whole populations through health
promotion, disease prevention and other forms of health
intervention. A distinction has been made in the health
promotion literature between public health
and a new public health for the purposes of emphasizing
significantly different approaches to the description
and analysis of the determinants of health, and
the methods of solving public health problems. This new
public health is distinguished by its basis in a comprehensive
understanding of the ways in which lifestyles and
living conditions determine health status, and
a recognition of the need to mobilize resources and make
sound investments in policies, programmes and services
which create, maintain and protect health by supporting
healthy lifestyles and creating supportive environments
for health. Such a distinction between the “old”
and the “new” may not be necessary in the future
as the mainstream concept of public health develops and
expands.
The
concept of ecological public health has also emerged
in the literature. It has evolved in response to the changing
nature of health issues and their interface with emerging
global environmental problems. These new problems include
global ecological risks such as the destruction of the
ozone layer, uncontrolled and unmanageable air and water
pollution, and global warming. These developments have
a substantial impact on health which often elude simple
models of causality and intervention.
Ecological
public health emphasises the common ground between achieving
health and sustainable development. It focuses
on the economic and environmental determinants of health,
and on the means by which economic investment should be
guided towards producing the best population health
outcomes, greater equity in health, and sustainable
use of resources.
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Primary
health care
Primary
health care is essential health care made accessible at
a cost a country and community can afford, with methods
that are practical, scientifically sound and socially
acceptable.
Reference:
Alma Ata Declaration, WHO, Geneva, 1978
The
Alma-Ata Declaration, also emphasises that everyone should
have access to primary health care, and everyone should
be involved in it. The primary health care approach encompasses
the following key components: equity, community involvement/participation,
intersectorality, appropriateness of technology and affordable
costs.
As
a set of activities, primary health care should include
at the very least health education for individuals and
the whole community on the size and nature of health problems,
and on methods of preventing and controlling these problems.
Other essential activities include the promotion of adequate
supplies of food and proper nutrition; sufficient safe
water and basic sanitation; maternal and child health
care, including family planning; immunization; appropriate
treatment of common diseases and injuries; and the provision
of essential drugs.
Primary
health care as defined above will do much to address many
of the pre-requisites for health indicated earlier.
In addition, at a very practical level, there is great
scope for both planned and opportunistic health promotion
through the day to day contact between primary health
care personnel and individuals in their community. Through
health education with clients, and advocacy
on behalf of their community, PHC personnel are well placed
both to support individual needs and to influence the
policies and programmes that affect the health of the
community.
The
primary health care concept and themes are currently being
reviewed by WHO.
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Disease
prevention
Disease
prevention covers measures not only to prevent the occurrence
of disease, such as risk factor reduction, but
also to arrest its progress and reduce its consequences
once established.
Reference:
adapted from Glossary of Terms used in Health for All
series. WHO, Geneva, 1984
Primary
prevention is directed towards preventing the initial
occurrence of a disorder. Secondary and tertiary prevention
seeks to arrest or retard existing disease and its effects
through early detection and appropriate treatment; or
to reduce the occurrence of relapses and the establishment
of chronic conditions through, for example, effective
rehabilitation.
Disease
prevention is sometimes used as a complementary term alongside
health promotion. Although there is frequent overlap
between the content and strategies, disease prevention
is defined separately. Disease prevention in this context
is considered to be action which usually emanates from
the health sector, dealing with individuals and
populations identified as exhibiting identifiable risk
factors, often associated with different risk behaviours.
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Health
education
Health
education comprises consciously constructed opportunities
for learning involving some form of communication designed
to improve health literacy, including improving
knowledge, and developing life skills which are
conducive to individual and community health.
Reference:
modified definition
Health
education is not only concerned with the communication
of information, but also with fostering the motivation,
skills and confidence (self-efficacy) necessary to take
action to improve health. Health education includes the
communication of information concerning the underlying
social, economic and environmental conditions impacting
on health, as well as individual risk factors
and risk behaviours, and use of the health care
system. Thus, health education may involve
the communication of information, and development of skills
which demonstrates the political feasibility and organizational
possibilities of various forms of action to address social,
economic and environmental determinants of health.
In
the past, health education was used as a term to encompass
a wider range of actions including social mobilization
and advocacy. These methods are now encompassed
in the term health promotion, and a more narrow
definition of health education is proposed here to emphasize
the distinction.
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Advocacy
for health
A
combination of individual and social actions designed
to gain political commitment, policy support, social acceptance
and systems support for a particular health goal or programme.
Reference:
Report of the Inter-Agency Meeting on Advocacy Strategies
for Health and Development: Development Communication
in Action. WHO, Geneva, 1995
Such
action may be taken by and/or on behalf of individuals
and groups to create living conditions which are
conducive to health and the achievement of healthy
lifestyles. Advocacy is one of the three major
strategies for health promotion and can take many
forms including the use of the mass media and multi-media,
direct political lobbying, and community mobilization
through, for example, coalitions of interest around defined
issues. Health professionals have a major responsibility
to act as advocates for health at all levels in
society.
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Alliance
An
alliance for health promotion is a partnership
between two or more parties that pursue a set of agreed
upon goals in health promotion.
Reference:
new definition
Alliance
building will often involve some form of mediation
between the different partners in the definition of goals
and ethical ground rules, joint action areas, and agreement
on the form of cooperation which is reflected in the alliance.
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Community
A
specific group of people, often living in a defined geographical
area, who share a common culture, values and norms, are
arranged in a social structure according to relationships
which the community has developed over a period of time.
Members of a community gain their personal and social
identity by sharing common beliefs, values and norms which
have been developed by the community in the past and may
be modified in the future. They
exhibit some awareness of their identity as a group, and
share common needs and a commitment to meeting them.
Reference:
modified definition
In
many societies, particularly those in developed countries,
individuals do not belong to a single, distinct community,
but rather maintain membership of a range of communities
based on variables such as geography, occupation, social
and leisure interests.
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Community
action for health
Community
action for health refers to collective efforts by
communities which are directed towards increasing community
control over the determinants of health, and thereby
improving health.
Reference:
new definition
The
Ottawa Charter emphasises the importance of concrete
and effective community action in setting priorities for
health, making decisions, planning strategies and
implementing them to achieve better health. The concept
of community empowerment is closely related to
the Ottawa Charter definition of community action for
health. In this concept an empowered community
is one in which individuals and organizations apply their
skills and resources in collective efforts to address
health priorities and meet their respective health needs.
Through such participation, individuals and organizations
within an empowered community provide social support
for health, address conflicts within the community,
and gain increased influence and control over the determinants
of health in their community.
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Determinants
of health
The
range of personal, social, economic and environmental
factors which determine the health status of individuals
or populations.
Reference:
new definition
The
factors which influence health are multiple and interactive.
Health promotion is
fundamentally concerned with action and advocacy to address
the full range of potentially modifiable determinants
of health – not only those which are related to the
actions of individuals, such as health behaviours
and lifestyles, but also factors such as income
and social status, education, employment and working conditions,
access to appropriate health services, and the physical
environments. These, in combination, create different
living conditions which impact on health. Achieving change
in these lifestyles and living conditions,
which determine health status, are considered to
be intermediate health outcomes.
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Empowerment
for health
In
health promotion, empowerment is a process through which
people gain greater control over decisions and actions
affecting their health.
Reference:
new definition
Empowerment
may be a social, cultural, psychological or political
process through which individuals and social groups are
able to express their needs, present their concerns, devise
strategies for involvement in decision-making, and achieve
political, social and cultural action to meet those needs.
Through such a process people see a closer correspondence
between their goals in life and a sense of how to achieve
them, and a relationship between their efforts and life
outcomes. Health promotion not only encompasses
actions directed at strengthening the basic life skills
and capacities of individuals, but also at influencing
underlying social and
economic conditions and physical environments which impact
upon health. In this sense health promotion
is directed at creating the conditions which offer a better
chance of there being a relationship between the efforts
of individuals and groups, and subsequent health outcomes
in the way described above.
A
distinction is made between individual and community
empowerment. Individual empowerment refers primarily
to the individuals’ ability to make decisions and
have control over their personal life. Community empowerment
involves individuals acting collectively to gain greater
influence and control over the determinants of health
and the quality of life in their community,
and is an important goal in community action for health.
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In
health promotion, enabling means taking action in partnership
with individuals or groups to empower them, through the
mobilization of human and material resources, to promote
and protect their health.
Reference:
new definition
The
emphasis in this definition on empowerment through
partnership, and on the
mobilization of resources draws attention to the important
role of health workers and other health activists acting
as a catalyst for health promotion action, for example by
providing access to information on health, by facilitating
skills development, and supporting access to the political
processes which shape public policies affecting health.
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Epidemiology
Epidemiology
is the study of the distribution and determinants of health-states
or events in specified populations, and the application
of this study to the control of health problems.
Reference:
Last, JM. Dictionary of Epidemiology. UK, 1988
Epidemiological
information, particularly that defining individual, population
and/or
physical environmental risks has been at the core of public
health, and provided the basis for disease prevention
activities. Epidemiological studies use social classifications
(such as socioeconomic status) in the study of disease in
populations, but generally make less than optimal use of
social sciences, including economic and public policy information,
in investigating and understanding disease and health
in populations.
Social
epidemiology has evolved as a discipline during the
past two decades. Social epidemiology is the study of health
and illness in populations which is informed by a social,
psychological, economic and public policy information, and
uses that information in the definition of public health
problems and proposal of solutions. As the discipline of
epidemiology further develops and expands such distinctions
will be less important in the future.
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Equity
in health
Equity
means fairness. Equity in health means that people’s
needs guide the distribution of opportunities for well-being.
Reference:
Equity in health and health care. WHO, Geneva, 1996
The
WHO global strategy of achieving Health for All is
fundamentally directed towards achieving greater equity
in health between and within populations, and between countries.
This implies that all people have an equal opportunity to
develop and maintain their health, through fair and
just access to resources for health. Equity in health is
not the same as equality in health status. Inequalities
in health status between individuals and populations
are inevitable consequences of genetic differences, of different
social and economic conditions, or a result of personal
lifestyle choices. Inequities occur as a consequence
of differences in opportunity which result, for example
in unequal access to health services, to nutritious food,
adequate housing and so on. In such cases, inequalities
in health status arise as a consequence of inequities
in opportunities in life.
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Health
behaviour
Any
activity undertaken by an individual, regardless of actual
or perceived health status, for the purpose of promoting,
protecting or maintaining health, whether or not
such behaviour is objectively effective towards that end.
Reference:
Health Promotion Glossary, 1986
It is
possible to argue that almost every behaviour or activity
by an individual has an impact on health status.
In this context it is useful to distinguish between behaviours
which are purposefully adopted to promote or protect health
(as in the definition above), and those which may be adopted
regardless of consequences to health. Health behaviours
are distinguished from risk behaviours which are defined
separately as behaviours associated with increased susceptibility
to a specific cause of ill-health.
Health
behaviours and risk behaviours are often related
in clusters in a more complex pattern of behaviours referred
to as lifestyles.
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Health
communication
Health
communication is a key strategy to inform the public about
health concerns and to maintain important health issues
on the public agenda. The use of the mass and multi media
and other technological innovations to disseminate useful
health information to the public, increases awareness of
specific aspects of individual and collective health as
well as importance of health in development.
Reference:
adapted from Communication, Education and Participation:
A Framework and Guide to Action. WHO (AMRO/PAHO), Washington,
1996
Health
communication is directed towards improving the health
status of individuals and populations. Much of modern
culture is transmitted by the mass and multi media which
has both positive and negative implications for health.
Research shows that theory-driven mediated health promotion
programming can put health on the public agenda, reinforce
health messages, stimulate people to seek further information,
and in some instances, bring about sustained healthy lifestyles.
Health
communication encompasses several areas including edutainment
or enter-education, health journalism, interpersonal communication,
media advocacy, organizational communication, risk communication,
social communication and social marketing. It can take many
forms from mass and multi media communications to traditional
and culture-specific communication such as story telling,
puppet shows and songs. It may take the form of discreet
health messages or be incorporated into existing media for
communication such as soap operas.
Advances
in communication media, especially in the multi media and
new information technology continue to improve access to
health information. In this respect, health communication
becomes an increasingly important element to achieving greater
empowerment of individuals and communities.
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Health
development
Health
development is the process of continuous, progressive improvement
of the health status of individuals and groups in
a population.
Reference:
Terminology Information System. WHO, Geneva, 1997
The
Jakarta Declaration describes health promotion
as an essential element of health development.
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Health
expectancy
Health
expectancy is a population based measure of the proportion
of expected life span estimated to be healthful and fulfilling,
or free of illness, disease and disability according to
social norms and perceptions and professional standards.
Reference:
new definition
Health
expectancy belongs to a new generation or type of health
indicator which are currently being developed. These indicators
are intended to create measures which are more sensitive
to the dynamics of health and determinants. Health
expectancy indicators combine information from life expectancy
tables and health surveys of populations. They need to be
based on life expectancy at country level or a similar geographic
area.
Examples
of health expectancy indicators currently in use are disability
free life years (DFLY) and quality adjusted life years (QALY).
They focus primarily on the extent to which individuals
experience a life span free of disability, disorders and/or
chronic disease. Health promotion seeks to expand
the understanding of health expectancy beyond the absence
of disease, disorder and disability towards positive measures
of health creation, maintenance and protection, emphasizing
a healthy life span.
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Health
gain
Health
gain is a way to express improved health outcomes.
It can be used to reflect the relative advantage of one
form of health intervention over another in producing the
greatest health gain.
Health
goals summarize the health outcomes which, in the
light of existing knowledge and resources, a country or
community might hope to achieve in a defined time
period.
Reference:
new definition
Health
goals are general statements of intent and aspiration, intended
to reflect the values of the community in general,
and the health sector in particular, regarding a
healthy society. Many countries have adopted an approach
to setting health goals and health targets as statement
of direction and intent with regard to their investments
for health. WHO has supported the development, and promoted
the use of health goals and targets at global and regional,
national and local levels.
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Health
indicator
A
health indicator is a characteristic of an individual, population,
or environment which is subject to measurement (directly
or indirectly) and can be used to describe one or more aspects
of the health of an individual or population (quality, quantity
and time).
Reference:
modified definition
Health
indicators can be used to define public health problems
at a particular point in time, to indicate change over time
in the level of the health of a population or individual,
to define differences in the health of populations, and
to assess the extent to which the objectives of a programme
are being reached.
Health
indicators may include measurements of illness or disease
which are more commonly used to measure health outcomes,
or positive aspects of health (such as quality of life,
life skills, or health expectancy), and of behaviours
and actions by individuals which are related to health.
They
may also include indicators which measure the social and
economic conditions and the physical environment as it relates
to health, measures of health literacy and healthy
public policy. This latter group of indicators may be
used to measure intermediate health outcomes, and
health promotion outcomes.
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Health
literacy
Health
literacy represents the cognitive and social skills which
determine the motivation and ability of individuals to gain
access to, understand and use information in ways which
promote and maintain good health.
Reference:
new definition
Health
literacy implies the achievement of a level of knowledge,
personal skills and confidence to take action to improve
personal and community health by changing personal lifestyles
and living conditions. Thus, health literacy means
more than being able to read pamphlets and make appointments.
By improving people’s access to health information,
and their capacity to use it effectively, health literacy
is critical to empowerment. Health literacy is itself
dependent upon more general levels of literacy. Poor literacy
can affect people’s health directly by limiting their
personal, social and cultural development, as well as hindering
the development of health literacy.
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Health
outcomes
A
change in the health status of an individual, group
or population which is attributable to a planned intervention
or series of interventions, regardless of whether such an
intervention was intended to change health status.
Reference:
new definition
Such
a definition emphasizes the outcome of planned interventions
(as opposed, for example, to incidental exposure to risk),
and that outcomes may be for individuals, groups or whole
populations. Interventions may include government policies
and consequent programmes, laws and regulations, or health
services and programmes, including health promotion programmes.
It may also include the intended or unintended health outcomes
of government policies in sectors other than health. Health
outcomes will normally be assessed using health
indicators. See also intermediate health outcomes,
and health promotion outcomes.
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Health
policy
A
formal statement or procedure within institutions (notably
government) which defines priorities and the parameters
for action in response to health needs, available resources
and other political pressures.
Reference:
modified definition
Health
policy is often enacted through legislation or other forms
of rule-making which define regulations and incentives which
enable the provision of health services and programmes,
and access to those services and programmes. Health policy
is currently distinguished from healthy public policy
by its primary concern with health services and programmes.
Future progress in health policies may be observed through
the extent to which they may also be defined as healthy
public policies.
As with
most policies, health policies arise from a systematic process
of building support for public health action that
draws upon available evidence, integrated with community
preferences, political realities and resource availability.
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Health
promoting hospitals
A
health promoting hospital does not only provide high quality
comprehensive medical and nursing services, but also develops
a corporate identity that embraces the aims of health
promotion, develops a health promoting organizational
structure and culture, including active, participatory roles
for patients and all members of staff, develops itself into
a health promoting physical environment and actively cooperates
with its community.
Reference:
based on Budapest Declaration on Health Promoting Hospitals.
WHO, (EURO), Copenhagen, 1991
Health
promoting hospitals take action to promote the health of
their patients, their
staff, and the population in the community they are located
in. Health promoting hospitals are actively attempting to
become “healthy organizations”. Health Promoting
Hospitals are being implemented since 1988. An international
network has developed to promote the wider adoption of this
concept in hospitals and other health care settings.
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Health
promoting schools
A
health promoting school can be characterized as a school
constantly
strengthening its capacity as a healthy setting for living,
learning and working.
Reference:
Promoting health through schools. Report of a WHO Expert
Committee on Comprehensive School Health Education and Promotion.
WHO Technical Report Series N°870. WHO, Geneva, 1997
Towards
this goal, a health promoting school engages health
and education officials, teachers, students, parents and
community leaders in efforts to promote health. It fosters
health and learning with all the measures at its
disposal, and strives to provide supportive environments
for health and a range of key school health education
and promotion programs and services. A health promoting
school implements policies, practices and other measures
that respect an individual’s self esteem, provide multiple
opportunities for success, and acknowledge good efforts
and intentions as well as personal achievements. It strives
to improve the health of school personnel, families and
community members as well as students, and works with community
leaders to help them understand how the community
contributes to health and education.
WHO’s
Global School Health Initiative aims at helping all schools
to become “health promoting” by, for example,
encouraging and supporting international, national and subnational
networks of health promoting schools, and helping to build
national capacities to promote health through schools.
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Health
promotion evaluation
Health
promotion evaluation is an assessment of the extent to which
health promotion actions achieve a “valued” outcome.
Reference:
new definition
The
extent to which health promotion actions enable
individuals or communities to exert control over their health
represents a central element of health promotion evaluation.
In many
cases it is difficult to trace the pathway which links particular
health promotion activities to health outcomes. This
may be for a number of reasons, for example, because of
the technical difficulties of isolating cause and effect
in complex, “real-life” situations. Therefore,
most recent outcome models in health promotion distinguish
between different types of outcomes and suggest a hierarchy
among them. Health promotion outcomes represent the first
point of assessment and reflect modifications to those personal,
social and environmental factors which are a means to improve
people’s control over their health. Changes in the
determinants of health are defined as intermediate
health outcomes. Changes in health status represent health
outcomes.
In most
cases, there is also “value” placed on the process
by which different outcomes are achieved. In terms of valued
processes, evaluations of health promotion activities may
be participatory, involving all those with a vested
interest in the initiative; interdisciplinary, by
involving a variety of disciplinary perspectives; integrated
into all stages of the development and implementation of
a health promotion initiative; and help build the capacity
of individuals, communities, organizations and governments
to address important health problems.
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Health
promotion outcomes
Health
promotion outcomes are changes to personal characteristics
and skills, and/ or social norms and actions, and/or organizational
practices and public policies which are attributable to
a health promotion activity.
Reference:
new definition
Health
promotion outcomes represent the most immediate results
of health promotion activities and are generally directed
towards changing modifiable determinants of health. Health
promotion outcomes include health literacy, healthy public
policy, and community action for health. See also health
outcomes and intermediate health outcomes.
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Health
sector
The
health sector consists of organized public and private health
services (including health promotion, disease prevention,
diagnostic, treatment and care services), the policies and
activities of health departments and ministries, health
related nongovernment organizations and community groups,
and professional associations.
Reference:
adapted from Glossary of Terms used in Health for All series
N° 9. WHO, Geneva, 1984
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Health
status
A
description and/or measurement of the health of an individual
or population at a particular point in time against identifiable
standards, usually by reference to health indicators.
Reference:
adapted from Glossary of Terms used in Health for All series
N° 9. WHO, Geneva, 1984
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Health
target
Health
targets state, for a given population, the amount of change
(using a health indicator) which could be reasonably expected
within a defined time period. Targets are generally based
on specific and measurable changes in health outcomes, or
intermediate health outcomes.
Reference:
new definition
Health
targets define the concrete steps which may be taken towards
the achievement of health goals. Setting targets also provides
one approach to the assessment of progress in relation to
a defined health policy or programme by defining a benchmark
against which progress can be measured. Setting targets
requires the existence of a relevant health indicator and
information on the distribution of that indicator within
a population of interest. It also requires an estimate of
current and likely future trends in relation to change in
the distribution of the indicator, and an understanding
of the potential to change the distribution of the indicator
in the population of interest.
<Back
to Glossary>
Healthy
cities
A
healthy city is one that is continually creating and improving
those physical and social environments and expanding those
community resources which enable people to mutually support
each other in performing all the functions of life and in
developing to their maximum potential.
Reference:
Terminology for the European Conference on Health, Society
and Alcohol: A glossary with equivalents in French, German
and Russian. WHO (EURO), Copenhagen, 1995
The
WHO Healthy Cities project is a long-term development project
that seeks to place health on the agenda of cities
around the world, and to build a constituency of support
for public health at the local level. The healthy
cities concept is evolving to encompass other forms of settlement
including healthy villages and municipalities.
<Back
to Glossary>
Healthy
islands
A
healthy island is one that is committed to and involved
in a process of achieving better health and quality of
life for its people, and healthier physical and social
environments in the context of sustainable development.
Reference:
adapted from Yanuca Island Declaration. WHO (WPRO), Manila,
1995
The
Yanuca Island Declaration states that Healthy Islands
are places where children are nurtured in body and mind;
environments invite learning and leisure; people work and
age in dignity; and ecological balance is a source of pride.
This Declaration was ratified by the Health Ministers of
fourteen Pacific Island nations in 1995 and has since become
an inter-regional source of reference for Healthy Islands
programmes throughout the world.
<Back
to Glossary>
Healthy
public policy
Healthy
public policy is characterized by an explicit concern for
health and equity in all areas of policy, and by
an accountability for health impact. The main aim of healthy
public policy is to create a supportive environment
to enable people to lead healthy lives. Such a policy makes
healthy choices possible or easier for citizens. It makes
social and physical environments health enhancing.
Reference:
Adelaide Recommendations on Healthy Public Policy. WHO,
Geneva, 1988
The
Ottawa Charter highlighted the fact that health
promotion action goes beyond the health care sector,
emphasizing that health should be on the policy agenda
in all sectors, and at all levels of government. One important
element in building healthy public policy is the notion
of accountability for health. Governments are ultimately
accountable to their people for the health consequences
of their policies, or lack of policies. A commitment to
healthy public policies means that governments must measure
and report on their investments for health, and the subsequent
health outcomes, and intermediate health outcomes
of their investments and policies in a language that all
groups in society readily understand. Closely related to
the health promotion concept of healthy public policy is
the strategy of investment for health. Investment for
health is a
strategy for optimizing the health promoting impact of public
policies.
<Back
to Glossary>
Infrastructure
for health promotion
Those
human and material resources, organizational and administrative
structures, policies, regulations and incentives which facilitate
an organized health promotion response to public health
issues and challenges.
Reference:
new definition
Such
infrastructures may be found through a diverse range of
organizational structures, including primary health care,
government, private sector and nongovernmental organizations,
self-help organizations, as well as dedicated health
promotion agencies and foundations. Although many countries
have a dedicated health promotion workforce, the greater
human resource is to be found among the wider health
workforce, workforces in other sectors than health (for
example in education, social welfare and so on), and from
the actions of lay persons within individual communities.
Infrastructure for health promotion can be found not only
in tangible resources and structures, but also through the
extent of public and political awareness of health issues,
and participation in action to address those issues.
<Back
to Glossary>
Intermediate
health outcomes
Intermediate
health outcomes are changes in the determinants of health,
notably changes in lifestyles, and living conditions
which are attributable to a planned intervention or interventions,
including health promotion, disease prevention and
primary health care.
Reference:
new definition
See
also determinants of health, health outcomes and intermediate
health outcomes
<Back
to Glossary>
Intersectoral
collaboration
A
recognized relationship between part or parts of different
sectors of society which has been formed to take action
on an issue to achieve health outcomes or intermediate
health outcomes in a way which is more effective, efficient
or sustainable than might be achieved by the health sector
acting alone.
Reference:
modified from Intersectoral Action for Health: A Cornerstone
for Health for All in the 21st Century. WHO, Geneva, 1997
Intersectoral
action for health is seen as central to the achievement
of greater equity in health, especially where progress depends
upon decisions and actions in other sectors, such as agriculture,
education, and finance. A major goal in intersectoral action
is to achieve greater awareness of the health consequences
of policy decisions and organizational practice in different
sectors, and through this, movement in the direction of
healthy public policy and practice. Not all intersectoral
action for health need involve the health sector. For example,
in some countries the police and transport sectors might
combine to take action to reduce road transport injury.
Such action, although explicitly intended to reduce injury,
will not always involve the health sector. Increasingly
intersectoral collaboration is understood as cooperation
between different sectors of society such as the public
sector, civil society and the private sector.
<Back
to Glossary>
Investment
for health
Investment
for health refers to resources which are explicitly dedicated
to the production of health and health gain.
They may be invested by public and private agencies as well
as by people as individuals and groups. Investment for health
strategies are based on knowledge about the determinants
of health and seek to gain political commitment to healthy
public policies.
Reference:
new definition
Investment
for health is not restricted to resources which are devoted
to the provision and use of health services and may include,
for example, investments made by people (individually or
collectively) in education, housing, empowerment of women
or child development. Greater investment for health also
implies reorientation of existing resource distribution
within the health sector towards health promotion
and disease prevention. A significant proportion
of investments for health are undertaken by people in the
context of their everyday life as part of personal and family
health maintenance strategies.
See
also healthy public policy
and supportive environments for
health
<Back
to Glossary>
Jakarta
Declaration on Leading Health Promotion into the 21st Century
See
health promotion (section
I)
<Back
to Glossary>
Life
skills
Life
skills are abilities for adaptive and positive behaviour,
that enable individuals to deal effectively with the demands
and challenges of everyday life.
Reference:
Life skills education in schools. WHO, Geneva, 1993
Life
skills consist of personal, inter-personal, cognitive and
physical skills which enable people to control and direct
their lives, and to develop the capacity to live with and
produce change in their environment. Examples of individual
life skills include decision making and problem solving,
creative thinking and critical thinking, self awareness
and empathy, communication skills and interpersonal relationship
skills, coping with emotions and managing stress. Life skills
as described above are fundamental building blocks for the
development of personal skills for health promotion
described as one of the key action areas in the Ottawa
Charter.
<Back
to Glossary>
Lifestyle
(lifestyles conducive to health)
Lifestyle
is a way of living based on identifiable patterns of behaviour
which are determined by the interplay between an individual’s
personal characteristics, social interactions, and socioeconomic
and environmental living conditions.
Reference:
modified definition
These
patterns of behaviour are continually interpreted and tested
out in different social situations and are therefore not
fixed, but subject to change. Individual lifestyles, characterized
by identifiable patterns of behaviour, can have a profound
effect on an individual’s health and on the health
of others. If health is to be improved by enabling
individuals to change their lifestyles, action must be directed
not only at the individual but also at the social and living
conditions which interact to produce and maintain these
patterns of behaviour.
It is
important to recognize, however, that there is no “optimal”
lifestyle to be prescribed for all people. Culture, income,
family structure, age, physical ability, home and work environment
will make certain ways and conditions of living more attractive,
feasible and appropriate.
<Back
to Glossary>
Living
conditions
Living
conditions are the everyday environment of people, where
they live, play and work. These living conditions are a
product of social and economic circumstances and the physical
environment – all of which can impact upon health
– and are largely outside of the immediate control
of the individual.
Reference:
modified definition
The
Ottawa Charter action of creating supportive environments
for health is largely focused on the need to improve and
change living conditions to support health.
<Back
to Glossary>
Mediation
In
health promotion, a process through which the different
interests (personal, social, economic) of individuals and
communities, and different sectors (public and private)
are reconciled in ways that promote and protect health.
Reference:
new definition
Producing
change in people’s lifestyles and living conditions
inevitably produces conflicts between the different sectors
and interests in a population. Such conflicts may arise,
for example, from concerns about access to, use and distribution
of resources, or constraints on individual or organizational
practices. Reconciling such conflicts in ways which promote
health may require considerable input from health promotion
practitioners, including the application of skills in advocacy
for health.
<Back
to Glossary>
Network
A
grouping of individuals, organizations and agencies organized
on a non
hierarchical basis around common issues or concerns, which
are pursued proactively and systematically, based on commitment
and trust.
Reference:
new definition
WHO
actively initiates and maintains several health promotion
networks around key settings and issues. These include,
for example, the intersectoral healthy cities network, networks
of health promoting schools, and WHO country networks for
health promotion such as the WHO mega country initiative.
Networks of networks are also being established. Examples
include the WHO(EURO) initiative “Networking the networks”
and global networking initiatives for health promotion in
order to build a global alliance for health promotion.
<Back
to Glossary>
Ottawa
Charter for Health Promotion
See Health Promotion (section
I)
<Back
to Glossary>
Partnership
for health promotion
A partnership
for health promotion is a voluntary agreement between two
or more
partners to work cooperatively towards a set of shared health
outcomes.
Reference:
new definition
Such
partnerships may form a part of intersectoral collaboration
for health, or be based on alliances for health promotion.
Such partnerships may be limited by the pursuit of a clearly
defined goal – such as the successful development and
introduction of legislation; or may be on-going, covering
a broad range of issues and initiatives. Increasingly health
promotion is exploring partnerships between the public
sector, civil society and the private sector.
See
also social responsibility for
health and primary health
care (section I)
<Back
to Glossary>
Personal
skills
See life skills
<Back
to Glossary>
Quality
of life
Quality
of life is defined as individual’s perceptions of their
position in life in the context of the culture and value
system where they live, and in relation to their goals,
expectations, standards and concerns. It is a broad ranging
concept, incorporating in a complex way a person’s
physical health, psychological state, level of independence,
social relationships, personal beliefs and relationship
to salient features of the environment.
Reference:
Quality of Life Assessment. The WHOQOL Group, 1994. What
Quality of Life? The WHOQOL Group. In: World Health Forum.
WHO, Geneva, 1996.
This
definition highlights the views that quality of life refers
to a subjective evaluation, which induces both positive
and negative dimensions, and which is embedded in a cultural,
social and environmental context. WHO identified six broad
domains which describe core aspects of quality of life cross-culturally:
a physical domain (e.g. energy, fatigue), a psychological
domain (e.g. positive feelings), level of independence (e.g.
mobility), social relationships (e.g. practical social support),
environment (e.g. accessibility of health care) and personal
beliefs/spirituality (e.g. meaning in life). The domains
of health and quality of life are complementary and
overlapping.
Quality
of life reflects the perception of individuals that their
needs are being satisfied and that they are not being denied
opportunities to achieve happiness and fulfilment, regardless
of physical health status, or social and economic
conditions. The goal of improving the quality of life, alongside
preventing avoidable ill-health, has become of increased
importance in health promotion. This is particularly
important in relation to meeting the needs of older people,
the chronically sick, terminally ill, and disabled populations.
<Back
to Glossary>
Re-orienting
health services
Health
services re-orientation is characterized by a more explicit
concern for the achievement of population health outcomes
in the ways in which the health system is organized
and funded. This must lead to a change of attitude and organization
of health services, which focuses on the needs of the individual
as a whole person, balanced against the needs of population
groups.
Reference:
adapted from Ottawa Charter for Health Promotion. WHO, Geneva,
1986
The
Ottawa Charter also emphasizes the importance of
a health sector which contributes to the pursuit
of health. Responsibility for achieving this is shared between
all the health professions, health service institutions
and government, alongside the contribution of individuals
and communities served by the health sector. In most
cases this will require an expansion in health promotion
and disease prevention action to achieve an optimal balance
between investments in health promotion, illness prevention,
diagnosis, treatment, care and rehabilitation services.
Such an expanded role need not always be achieved through
an increase in direct health system activity. Action by
sectors other than the health sector may be more effective
in achieving improved health outcomes. Governments
need to acknowledge the key role of the health sector
in supporting such inter-sectoral action for health.
See
also Health Promoting
Hospitals
<Back
to Glossary>
Risk
behaviour
Specific
forms of behaviour which are proven to be associated with
increased susceptibility to a specific disease or ill-health.
Reference:
modified definition
Risk
behaviours are usually defined as “risky” on the
basis of epidemiological or other social data. Changes in
risk behaviour are major goals of disease prevention, and
traditionally health education has been used to achieve
these goals. Within the broader framework of health promotion,
risk behaviour may be seen as a response, or mechanism for
coping with adverse living conditions. Strategies
to respond to this include the development of life skills,
and creation of more supportive environments for health.
<Back
to Glossary>
Risk
factor
Social,
economic or biological status, behaviours or environments
which are
associated with or cause increased susceptibility to a specific
disease, ill health, or injury.
Reference:
modified definition
As is
the case with risk behaviours, once risk factors
have been identified, they can become the entry point or
focus for health promotion strategies and actions.
<Back
to Glossary>
Self
help
In
the context of health promotion, actions taken by
lay persons (i.e. non health professionals) to mobilize
the necessary resources to promote, maintain or restore
the health of individuals or communities.
Reference:
modified definition
Although
self help is usually understood to mean action taken by
individuals or
communities which will directly benefit those taking
the action, it may also encompass mutual aid between individuals
and groups. Self help may also include self care –
such as self medication and first aid in the normal social
context of people’s everyday lives.
<Back
to Glossary>
Settings
for health
The
place or social context in which people engage in daily
activities in which environmental, organizational and personal
factors interact to affect health and wellbeing.
Reference:
new definition
A setting
is also where people actively use and shape the environment
and thus create or solve problems relating to health.
Settings can normally be identified as having physical boundaries,
a range of people with defined roles, and an organizational
structure. Action to promote health through different settings
can take many different forms, often through some form of
organizational development, including change to the physical
environment, to the organizational structure, administration
and management. Settings can also be used to promote health
by reaching people who work in them, or using them to gain
access to services, and through the interaction of different
settings with the wider community. Examples of settings
include schools, work sites, hospitals, villages and cities.
<Back
to Glossary>
Social
capital
Social
capital represents the degree of social cohesion which exists
in communities. It refers to the processes between
people which establish networks, norms, and social
trust, and facilitate co-ordination and co- operation for
mutual benefit.
Reference:
new definition
Social
capital is created from the myriad of everyday interactions
between people, and is embodied in such structures as civic
and religious groups, family membership, informal community
networks, and in norms of voluntarism, altruism and trust.
The stronger these networks and bonds, the more likely it
is that members of a community will co-operate for mutual
benefit. In this way social capital creates health, and
may enhance the benefits of investments for health.
<Back
to Glossary>
Social
networks
Social
relations and links between individuals which may provide
access to or mobilization of social support for health.
Reference:
modified definition
A stable
society is far more likely to have established social networks
which provide access to social support. De-stabilizing
influences such as high unemployment, re- housing schemes,
and rapid urbanization can lead to considerable dislocation
of social networks. In such circumstances action to promote
health might focus on support for reestablishing social
networks.
<Back
to Glossary>
Social
responsibility for health
Social
responsibility for health is reflected by the actions of
decision makers in both public and private sector to pursue
policies and practices which promote and protect health.
Reference:
The Jakarta Declaration on Leading Health Promotion into
the 21st Century. WHO, Geneva, 1997
The
policies and practices pursued by the public and private
sectors should avoid harming the health of individuals;
protect the environment and ensure sustainable use of resources;
restrict the production of and trade in inherently harmful
goods and substances, as well as discourage unhealthy marketing
practices; safeguard the citizen in the marketplace and
the individual in the workplace, and include equity-
focused health impact assessments as an integral part of
policy development.
See
also healthy public policy
<Back
to Glossary>
Social
support
That
assistance available to individuals and groups from within
communities which can provide a buffer against adverse
life events and living conditions, and can provide
a positive resource for enhancing the quality of life.
Reference:
modified definition
Social
support may include emotional support, information sharing
and the provision of material resources and services. Social
support is now widely recognized as an important determinant
of health, and an essential element of social capital.
<Back
to Glossary>
Supportive
environments for health
Supportive
environments for health offer people protection from threats
to health, and enable people to expand their capabilities
and develop self reliance in health. They encompass where
people live, their local community, their home, where they
work and play, including people’s access to resources
for health, and opportunities for empowerment.
Reference:
adapted from Sundsvall Statement on Supportive Environments
for Health. WHO, Geneva, 1991
Action
to create supportive environments for health has many dimensions,
and may
include direct political action to develop and implement
policies and regulations which help create supportive environments;
economic action, particularly in relation to fostering sustainable
economic development; and social action.
<Back
to Glossary>
Sustainable
development
Sustainable
development is defined as development that meets the needs
of the present without compromising the ability of future
generations to meet their ownneeds
(WCED 1987). It incorporates many elements, and all sectors,
including the health sector, which must contribute to achieve
it.
Reference:
Our common future: Report of the World Commission on Environment
and Development (WCED), 1987. Health and Environment in
Sustainable Development. Five years after the Earth Summit.
WHO, Geneva, 1997
Human
beings are at the centre of sustainable development. Sustainable
development refers to the use of resources, direction of
investments, the orientation of technological development,
and institutional development in ways which ensure that
the current development and use of resources do not compromise
the health and well-being of future generations.
There
is no single best way of organizing the complex development-environment-health
relationship that reveals all the important interactions
and possible entry points for public health interventions.
In health promotion, sustainable development is particularly
important in terms of building healthy public policy,
and supportive environments for health in ways which
improve living conditions, support healthy lifestyles,
and achieve greater equity in health both now and in the
future.
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