Health promotion

Health promotion was introduced in 1945 as one of the four major tasks of medicine along with prevention of illness, restoration of the sick and rehabilitation; 'Health is promoted by providing a decent standard of living, good labour conditions, education, physical culture, means of rest and recreation' and requires the co-ordinated efforts of statesmen, labour, industry, educators and physicians (Breslow 1999).

The term health promotion was revisited in 1986, in the Ottawa Charter for Health Promotion where it is defined as 'the process of enabling people to increase control over, and to improve, their health'.

The Ottawa Charter indicates three basic strategies for health promotion:

• Advocate – Health advocacy helps in making political, economic, social, cultural, environmental, behavioural, and biological factors favourable to health.
• Enable – Health promotion focuses on achieving equity in health. It aims to reduce differences in current health status and ensure equal opportunities and resources, to thus enable all people to achieve their fullest health potential.
• Mediate – The prerequisites and prospects for health cannot be ensured by the health sector alone; coordinated action is required also by other sectors such as governments, nongovernmental and voluntary organizations, local authorities, industry and the media.

Improvement in health requires a secure foundation in its basic prerequisites, namely peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity (Ottawa Charter). 

Five integrated health promotion action areas have been identified in the Ottawa Charter (WHO 2016):

• Build healthy public policy
• Create supportive environments
• Strengthen community actions
• Develop personal skills
• Re-orient health services

Disease prevention

Disease prevention commonly refers to interventions (either population or individual-based) which aim to minimise the burden of diseases and associated risk factors (WHO 2017 (pdf)).

Prevention is frequently categorised as primary, secondary, and tertiary prevention; quaternary prevention has been introduced recently.  

• Primary prevention refers to actions that avoid the manifestation of a disease. It may comprise actions to improve health through changing the impact of social and economic determinants, the provision of information on behavioural and medical health risks, and measures to decrease them. Examples are nutritional and food supplementation, oral and dental hygiene education, clinical preventive services such as immunization and vaccination.
• Secondary prevention is associated with early detection of a disease which may result in improved chances for positive health outcomes. It encompasses evidence- and population-based screening programmes, including production and purchasing of screening tests for early disease detection. Moreover, maternal and child health programmes including screening and prevention of congenital malformations, and production and purchasing of chemoprophylactic agents to control risk factors are considered secondary prevention (WHO 2017 (pdf)), WHO EMRO).
• Tertiary prevention is associated with services that promote better quality of life for those living with disease. It includes rehabilitation, disease management programmes, and support for patients with an established disease to minimise residual disabilities and complications.
• Quarternary prevention is related to avoiding over-medicalisation of patients, protecting them from unnecessary interventions and suggesting ethical alternatives (WHO 2015).

The topics covered in this sections are related to nutrition, alcohol related harm, physical activity and other policy areas.

References

• Breslow L. (1999), From Disease Prevention to Health Promotion, JAMA. 1999;281(11):1030-1033
• WHO (2015) World Health Organization, Self-assessment tool for the evaluation of essential public health operations in the WHO European Region (pdf)
• WHO (2016), World Health Organization, The Ottawa Charter for Health Promotion, First International Conference on Health Promotion, Ottawa 21 November 1986
• WHO (2017) World Health Organization, Assessment of essential public health functions in countries of the Eastern Mediterranean Region (pdf)
• WHO EMRO, Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity
• WHO, World Health Organization, The Ottawa Charter for Health Promotion