Defining health promotion

Defining health promotion

The most well known definition of health promotion is that of the World Health Organization’s Ottawa Charter (1986):

Health promotion is the process of enabling people to increase control over, and to improve their health (the full definition is provided in the WHO website).

This definition was slightly modified in 2005, in WHO’s Bangkok Charter for Health Promotion in a Globalised World to:

Health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health.

WHO has produced seven consensus documents on health promotion, the latest in 2009 in Nairobi. For more information on these, go to Milestones in health promotion and the7th Global Conference on Health Promotion.

Models of health promotion

While the definition of health promotion has been universally adopted, there have been a number of different approaches to promoting health. Over the past 30 years, three key models of health have influenced health promotion. 

The biomedical model of health (pre-1970s):

  • focuses on risk behaviours and healthy lifestyles
  • emphasises health education – changing knowledge, attitudes and skills
  • focuses on individual responsibility
  • treats people in isolation of their environments

 The social model of health (from 1970s onwards):

  • addresses the broader determinants of health
  • involves inter-sectoral collaboration
  • acts to reduce social inequities
  • empowers individuals and communities
  • acts to enable access to health care

 The ecological model of health (from late 1970s onwards):

  • acknowledges the reciprocal relationship between health-related behaviours and the environments in which people live, work and play (behaviour does not occur in a vacuum)
  • considers the environment is made up of different subsystems – micro, meso, exo and macro
  • emphasises the relationships and dependencies between these subsystems
  • is comprehensive and multi-faceted, using a shared framework for change at individual and environmental levels

VicHealth uses the social model of health and aspects of ecological thinking (sometimes called systems thinking) that highlights the different levels of influence. See the diagram on page 4 of the VicHealth Strategic Plan (adapted from Dahlgren G & Whitehead M 1991, Policies and Strategies to Promote Social Equity in Health, Institute for Futures Studies, Stockholm).

If you would like to read more about ecological approaches have a look at the Summer 2006 VicHealth Letter Healthy planet, healthy people: shaping a sustainable future.