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I. Health Promotion Advocacy

1. Presentation by Richard Keelor - Health Advocacy

II. Activities of the IIHP — by Wolf Kirsten

III. Committee Sessions

1. Global Fitness Testing
2. Training and Curriculum
3. Advocacy and Communication
4. Worksite Health Promotion

IV. Planning Session: The IIHP in the New Millenium

• Participant List
• IIHP Committees
• Presentation List

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5^th ANNUAL IIHP MEETING IN WASHINGTON, DC

The International Institute for Health Promotion (IIHP) recently held its Fifth Annual Meeting from October 18-21 at American University in Washington, DC. 34 health promotion professionals from government agencies, private corporations and non-profit organizations from 18 countries convened in Washington, DC to discuss the issue of advocacy for health promotion, advance the working committees, share their professional initiatives, and develop a plan for the next five years of the IIHP. The participants agreed upon that more effective advocacy is necessary to move forward the field of health promotion.

Two speakers from the United States introduced their advocacy initiatives. Richard Keelor from Be Active America, a non-profit corporation for the purpose of promoting physical activity, emphasized the significance of grassroots change to enhance physical activity and reduce the onset and severity of obesity. Michael O'Donnell of the American Journal of Health Promotion described his targeted efforts of influencing the political establishment in Washington, DC to build health promotion into the national agenda. In spite of the clear relationships between lifestyle and health and between lifestyle and medical care costs, and the fact that health promotion is a critical element of "Healthy People 2010", only minimal dollars are being spent on health promotion research or programs. The overriding goal of this national initiative is make health promotion part of mainstream health care.

The committees covered the following four interest areas:

1. training/curriculum
2. workplace health promotion
3. global fitness testing
4. advocacy/communication

All of the committees drafted work plans for the coming year. Most notable plans are an international workplace initiative within the framework of the Corporate SANGALA project, which comes out of South Africa and is headed by Gert Strydom of Potchefstroom University, and the development of an international fitness test battery for comparison purposes. This initiative is facilitated by Dieter Lagerstrøm of the German Sport University in Germany. It is envisioned that both of these projects will be implemented with the cooperation of large international organizations like the Pan American Health Organization (PAHO) and of multinational corporations. Furthermore, the US and the European academic institutions in the training and curriculum committee are drafting a proposal to receive funding for a transatlantic exchange project.

Due to the interdisciplinary nature of the IIHP network, the brief presentations by the participants covered a wide range of topics in health promotion.

After the first five years of existence, IIHP members are extremely motivated to become more involved in collaborative projects and gain increased international recognition in the next five years. The meeting participants agreed that the IIHP should maintain its strengths, i.e. informal nature, lack of bureaucracy, flexibility, interdisciplinary forum, and American University as the stable base. Nevertheless, the desire was expressed to become more visible and develop strategic initiatives to help countries, thereby evolving into a "health promotion avant-garde".

Richard Keelor is the Founding Director of Be Active America, as well as the President of the Sugar Association. He describes himself as a physical educator, even though he is more active in the political arena. In 1964, he started the first and only legitimate politically active committee for physical activity termed SHARP PAC that advocated for physical education from grades K-14. In this committee, he worked with lobbyists and coalitions to build a base for physical education.

Keelor believes that what we [IIHP] are doing is invaluable. Everyone here has the capacity to inspire those who do not engage in physical activity. So many health problems today are due to inactivity.

In order to create change within individuals, we need to engage our emotions. Emotions drive our behaviors. In order to get the attention of students, we need to go beyond science. We should only use science if it is emotionally engaging.

We must teach our teachers and students of health promotion the art of advocacy, including practical experience. Change occurs through two components: politics and money.

Keelor is the President and CEO of the Sugar Association, which represents anyone concerned with the production of sugar. He got involved in the industry because of the energy in=energy out equation. In other words, because our nation does not have an equal balance of energy in and out, we are rapidly becoming the most obese country in the history of the human race.

Physical education is the key to the obesity crisis. We talk a lot about the crisis, however we continue to get more fat and less fit. Be Active America, of which Richard Keeler is the Founding Director, is an organization that trains people to advocate physical activity. We have more health promotion practitioners than any other country, yet things are not changing. A teacher once taught him- what we learn we practice and become. We have not prepared our students for the reality of change.

This topic is profoundly important to health promotion, however it is not discussed often. In order for change to occur, there must be a general sense of distress and an idea that things could be better. The rate of change is a product of fear, pain, sense of loss and outrage. There is a fictional meter-called an outrageometer-that has denial on one side and outrage on the other side. In the past, health promotion advocates felt no outrage. In several structured interviews with major leaders in health promotion, results indicated that the professional is in denial, not at all outraged. We need to be outraged in order to change. We need to do as well as the environmental advocates, and be risk takers. We need to experiment with different solutions because according to the Systems Theory, the system will always want to stay in balance [two books were recommended at this point: Deep Change and Be a Risk Taker].

There is a preservation of status quo by vested interests (power, control, money, ego, etc.) The degree to which the status quo has been woven into the fabric of the culture (institutionalized) depends upon the frequency, duration, intensity, and priority of the control, manipulation and sanctions by groups and individuals in power. For example, obesity and inactivity have become the status quo in our nation. We have to be willing to shake things up.

Methodology for Change (Advocacy)

Change must begin with personal empowerment. We are always trying to change kids, but not ourselves. Kids do what we do, not what we say. Change occurs through observation, evaluation and transformation. We need to identify what works and what does not (differentiation). We need to commit to outcomes rather than be enslaved to the process.

The skills we need to develop in order for change to occur include:

• Building a strategic plan for change
• Develop communication skills-how to tell your story in a disciplined nature to say what you mean short and succinctly
• Dare to make the cover overt-we are going to talk about the truth
• Exercise flexible intelligence-stop doing the same thing over and over again expecting different results; failure is not an option because we have no fear of it
• Identify and recruit constituents (train, train, train)-politicians don’t do what’s right, they do what’s expedient; their number one goal is to get re-elected
• Identify power groups and individuals and multiply leverage-we are powerless in this country; identify people who have power and get an alignment
• Edify and engage-be able to tell our story in the free enterprise industry; get them emotionally involved in what you do; put the truth on the table

These are the steps we need to implement a strategic plan:

• Identify and organize a constituency-some may not be in our groups (e.g. ACS)
• Fundraising-don’t ask for handouts; don’t ask the government for anything, because if we do there will always be a condition; we become so accustomed to receiving handouts that not receiving them becomes an inhibitor of change
• Marketing and Branding-we have to approach physical activity with the same ingenuity and discipline of those who are selling cars, etc.
• Focus on grassroots- think globally, work locally
• Legislative action as needed
• Evaluation and measurement-we can measure change
• Fine tune the plan
• Failure is not an option

The epidemic of obesity in the U.S. has changed tremendously over the last 15 years. In 1985, there were seven states with greater than 15% of their population overweight. In 1998, there were 39. More than 300,000 Americans die prematurely each year from obesity and inactivity. More than 60% of U.S women do not engage in regular exercise, nearly half of American youth are not active on a regular basis, and 60% of adult Americans are not getting even moderate daily exercise. Obesity is the "disease of diseases"; it is a causative factor in many diseases and conditions. The problem is low energy expenditure.

What are we doing about this epidemic? We are holding multiple conferences and scientific sessions, declaring concern, chest pounding, citing landmark reports from the Surgeon General, blaming and shaming, denying and procrastinating. Keelor suggests we get back to the basics- let’s get physical education back in all the schools. Let us get worksite kickbacks for those that execute health and fitness programs. In 1984, there was a bill that included a tax incentive for worksites to have fitness programs. This never got out of committee-we need surveillance on the hill.

The sole purpose of this non-profit organization is to create change to enhance physical activity and reduce onset and severity of obesity. They are a newly organized, non-profit corporation licensed to do business in Washington, D.C. They are affiliated with several of the leading health promotion professional organizations. Their only membership criteria is to have an open mind and a willingness to work for changes that assure physical activity opportunities for every American.

Mission

• To encourage individuals, families, organizations, and communities to participate in, promote, and support physical activity to reduce the human and economic burden of diseases related to inactive lifestyles.

Objectives

• Establish quality physical education as an essential subject and confirm its contribution in reducing the onset and severity of obesity in children and adolescents.
• Create a highly visible campaign based on well documented, peer-reviewed science.
• Use proven, effective methodology that has a history of successful outcomes-teach skills for change.

• Create a public-private partnership to lead this campaign.
• Train existing health promotion and physical education professionals to become effective change agents for the purpose of generating media, political, and private sector support for increased levels of physical activity with particular emphasis to be placed on quality school physical education.

Training Philosophy

• Organize leadership to train at local level, focusing on teaching people to do things themselves.
• Leadership skills will include:
• advocacy skills
• communication theory
• media relations
• legislative action
• business planning
• fund raising
• coalition building
• personal empowerment
• government/state relations
• principle of partnering with private industry
• program development
• publicity, promotion and public affairs
• volunteer recruitment and training
• youth leadership development
• assessment and evaluation

Several pilot activities of Be Active America are taking place today. Among these is Be Active North Carolina. This program was started three years ago, when North Carolina ranked 49^th in physical activity. Today, they are ranked 38^th. It was determined that physical inactivity in North Carolina costs $2.4 billion a year. Inactivity costs will rise 23% annually with no intervention, whereas if 5% of adults increase their activity, it will save N.C. $355 million a year. An increase of 10% will save $680 million and an increase of 15% will save $1.02 billion. Increases in physical activity will save the state large amounts of money, and money is what drives people to change.

The goal of Be Active North Carolina is to raise $15 billion dollars. Success of the program will look like children playing on safe playgrounds, physical education for all children, more sidewalks, bikeways, and greenways, volunteers working in communities, senior centers becoming senior wellness centers, worksites having walking trails and fitness facilities, etc. Channels that Be Active N.C. will use include communities, faith organizations, health care settings, schools and worksites. The money they raise will be spent on administration (10%), marketing and branding (5%) and community funding and skill development (85%).

The campaign schedule for this year and next includes a national Be Active America summit, four regional advocacy training conferences, two regional physical activity and sports clinics, and the national fund raising campaign launch.

Q: Is the federal government the enemy?

A: The federal government is not the enemy, we are losing because we are not in the game. The enemy is us. We have to learn the rules and re-educate our teachers and health promotion professionals. Are we teaching how to deal with the high risk population? We are treating the same people-the fit are fitter and the fat are fatter. We need to empower high risk people. Once they leave our influence, they go back to the condition that kept them overweight and inactive in the first place. Professional associations and universities are part of the problem. We are not stopping the epidemic and arming kids with the knowledge they need.

Q: How can you do this so quickly?

A: We want to get people excited and move them now. We can’t rely too much on charismatic leadership. Programs stay strong until the people leave, and it is hard to train charismatic leaders. We need a strong system.

Q: What is your opinion on the growth in the obesity rate? Since we have more technology, do you think this has anything to do with obesity rates?

A: Obesity is a function of inactivity. We prioritize spending on reading, writing, math, etc. without adequate advocacy program for physical education. This is a function of many things: more money being spent on the academic subjects, not an adequate advocacy program for physical activity. This happened because we were not on guard, not prepared. We live in a democracy and we were not involved in the democratic process. We have to speak loud and get people pumped up in order to move this back in the right direction.

Q: How would you answer to people who say that increasing physical education in schools is the worst thing to do because physical educators are poorly trained and poor role models?

A: We need to retrain the old, tired guys. We need to teach sports and fitness skills. Train, train, train.

O’Donnell became interested in getting health promotion into the National Agenda when he was working in Korea with top level instructors in the Department of Preventative Medicine. During this time, the tobacco settlement in the United States was taking place. The Federal government had brought suit against the tobacco industry and failed. However, when the States joined in, the country won $246 billion dollars. There was hope that the money would at least in part be applied to health promotion, along with tobacco prevention. However, only eight states are using their money for tobacco control.

That was when he realized something had to be done. We had to create a political presence in Washington, D.C. and in each state capital. He decided to focus on the Federal Government.

There is a clear relationship between lifestyle and health and lifestyle and medical care costs (with stress alone accounting for 8% of total costs). Health promotion is a central element of 2010 Healthy People objectives. However, how much is spent on health promotion? The National Institutes of Health have a budget of $17 billion. How much of that is spent on health promotion? No one knows. Medicare and Medicaid have a budget of $400 billion. None of that goes to health promotion. The government is saying health promotion and lifestyle change is key to improving the state of health in this country, but no money is getting spent. Why? Because we as a profession lack political clout! We have to take political action.

The long-term goal is to make health promotion part of main stream health care, schools, business, families, and communities. The short-term goals include funding for health promotion research and increase funding for dissemination of information. There are large groups of people we are not hitting. There is very little success in large numbers of populations; we don’t know how to gain success in these groups. We don’t have the science that tells us how to be successful. We need research. Our field is not taken seriously as a science. We need a critical mass of research on how to help people change. There are also huge gaps between great programs and mediocre ones. We need to close that gap. We have to get information out there to the people in the field.

1. Be achievable or winnable
2. Be simple and specific so anyone can explain them in a sentence or two
3. Involve and unite the advocates
4. Make contribution to the field
5. Be part of a larger strategy

Achieving our goals increases the energy and motivation to achieve more goals.

Using the small and winnable theory of goal setting, O’Donnell has set one of the goals to piggy back the current doubling of the NIH budget over five years. The budget is going to increase every year for the next five years. He feels health promotion should get a piece of that increase. This way, money is not being taken from anyone. There are no enemies to this goal. No one thinks health promotion is a bad idea and the money requested is reasonable.

Issue Refinement Committee

This committee will decide which programs we need the government to focus on, how much money we will need, and which agencies will receive the money.

We would like to see a Center for Health Promotion or a division in the National Institutes of Health for Health Promotion created with a fair budget. We would also like to see declaration in Congress to include Health Promotion into congressional sessions.

We need to determine what is required to achieve our goals, what is feasible and what the agencies want. We must be careful of the Hatch Act Limitations which requires us to get the National Institutes of Health to ask Health and Human Services what they want to see done. We have to walk a fine line and let the agencies determine how they see things so that we will have the support we need to get legislation passed. We want to involve the Centers for Disease Control for information dissemination.

Advocacy Process

Professional advocates do this full time. Grassroots are regular people who elect officials. We need to persuade senators to introduce a bill in Congress, and persuade sub and full committees to pass the bills so the president can sign it.

How can we do this?

Involve professional associations and advocacy groups who have professional lobbyists. Harness people who are members of associations to encourage their senators and congresspeople to pass the bill. Pooling resources and developing a critical mass is essential. We have to be able to inform all the individuals and groups that want to get involved on the processes necessary to help get this goal accomplished. Some of these advocacy groups may make it their single issue, other groups may make it a secondary issue for their group.

Scientists and marketing professionals that can create and craft information so it can be disseminated to public, advocacy groups and eventually the government.

This committee will decide what to pursue once we have achieved the first goal of getting money for health promotion.

It is important to find "champions" in the political arena to be on your side politically to get bills passed. Specific senators or congresspeople who have been personally affected healthwise will hopefully be motivated to get these bills passed. Voters are also important in influencing their political people to pass the bill. The key to getting it passed is that we are not trying to take money away from any other groups competing for funding. For example, in Australia there is a tax on tobacco that funds health promotion programs. In Korea, they adopted the same law. So we can see how ideas in one country can facilitate action in other countries.

The American Journal of Health Promotion will by hosting a conference in Washington, D.C. in February that will be dedicated to getting health promotion into the national agenda.

Q: Is research money the ultimate goal?

A: Yes, at first. Then the money will go to the dissemination of information.

Q: Who conducts the research, the government or will money be given to academics to do research?

A: In addition to NIH and the government, there are hopes to give grants to universities which will fund development of centers around the US.

Q: Are there other possibilities to develop the model before going directly to US government (i.e. go to state having success then using that)?

A: We looked at these options, but it would not be efficient if we had to get approved in each state. Instead, we are looking to coincide with increased NIH funding and increased interest in health promotion. I hope this federal effort will stimulate the states to get involved on a state level, and in turn creating a budget for health promotion

Q: Have you thought about involving private sector to increase lobbying power?

A: Not yet.

Q: How should this process be modified to other countries?

A: Should be a little easier than US, due to the size of the U.S.

Patricia Owen

The 5^th Global conference on Health Promotion was organized by WHO, the Pan American Health Organization, and the Ministry of Health of Mexico. The overall goal of the conference was to examine the contribution of health promotion to improve the health and the quality of life of people. More than 600 participants from 100 countries were present in Mexico City. The program consisted of two joint sessions — a five day technical program and a two day ministerial program.

The Ministerial program included a statement from Mexico for promotion health signed by 86 ministers. This affirms the contribution of health promotion to local and national actions in health and pledges to draw up country wide plans of actions to monitor progress made in health promotion strategies. Other themes present in this program included: healthy public policies, equity for health promotion and social responsibility.

The themes present in the technical program included: strengthening the evidence base, increasing investments for health development, promoting social responsibility for health, and increasing communication capacity. The program format included a technical report presentation, case studies, and breakout sessions broken up by language.

This conference produced six technical reports, 15 case studies, a statement from Mexico with 86 signatures, and framework plans for health promotion. The key issues raised at this conference were the restatement of the relevance of health promotion, a focus on determinants of health, bridging the equity gap, making health promotion scientifically sound, socially relevant and politically sensitive, and defining the role of women in health promotion.

The conclusions and recommendations from the conference were to:

• strengthen the science and art of health promotion
• continue to invest in appropriate research and development
• develop a list of indicators which are most sensitive and related to health
• improve interaction, cooperation, and participation among researchers, policy-

• identify practical strategies to bring together findings from research
• identify the best ways to communicate, targeting those that can make the most of

• facilitate the use of practical skills of health promotion leaders-globalization of

• develop communication capacity built on good access to information on the

• create of networks
• strengthen political skill and action for health promotion

• improve interactions between politicians and policy makers

Participants requested WHO take the next step to establish an alliance for global health, however it was not fully backed by participants.

All the information presented on this conference can be accessed at www.who.int/hpr/conference

Q: How do we get video?

A: It can be ordered online, but there is no price set to date, however you can contact me through email.

Q: What kind of support can PAHO give to the private sector?

A: PAHO can provide technical assistance focused on intersectorial initiatives. There is no strategy in place as of now to involve private sector, however there is a possibility through the healthy communities initiative.

Q: Why didn’t the participants want the statement from Mexico in the document?

A: Because they felt a huge group was given too much power

Q: How much advanced preparation was needed to get the ministers of health to agree?

A: Over 10 months. All countries had to agree and show their political support.

Q: How many active ministers are there?

A: There are 86 high delegations, with at least 60 ministers of health.

PAHO’s mission is to provide leadership to promote health across the life-course; to prevent and control non-communicable diseases as well as injuries and violence.

PAHO’s workplace health promotion’s regional plan on worker’s health is to strengthen cooperation with and among the countries to control dangerous development of occupational hazards.

Looking ahead:

There is a Costa Rica action plan for workers created 2000-01, and a conference is planned for December, hoping for representatives to represent each region of

Wolf Kirsten

The IIHP has been present for 5 years, and has grown from 30-40 members to 200 members in that time. The IIHP is a unique global communication network with interdisciplinary partnerships representing 200 institutions in more than 60 countries.

The first meeting took place in Washington, D.C. in October of 1996. At this meeting, members discussed why the IIHP should exist. Among the listed reasons were lack of effective international communication, global health problems, need for international information exchange, create new models, and increase cohesion internationally.

A mission statement and strategic objectives were drafted. Some of these included personnel exchange, cooperation and networking, advocacy of health promotion and quality of life concept, research and development, and new education programs. A vision was formulated that the IIHP would be an advisory group in policy/curriculum development, sponsor seminars on topical themes, develop training goals and guidelines, set standards for programming and testing, organize interactive teleconferences, and publish position papers and articles. Other topics of this meeting included terminology, health issues, curriculum, training seminars, health risk appraisals/evaluation, and trends.

With an expanded network, the second meeting of the IIHP took place in Mauritius in 1997. Core topics included curriculum, health/fitness global database, the concept of health promotion, communication, and technology. By the end of the meeting, a health/fitness testing committee was formed, an international newsletter launched, and training seminars planned.

The third meeting took place in Washington, D.C. in 1998. At this meeting, members discussed health policy, health communication, training, research and database development, how to increase participation, and different organizational models. The formation of regional satellite centers was planned.

The fourth meeting took place in Curitiba, Brazil in 1999. Core topics of this meeting included policy, economics, advocacy, fitness testing, and training. It was concluded that more effective advocacy is a priority of the IIHP. The "Curitiba Declaration" was developed, calling for policies supporting health promotion, enhanced source allocation for health promotion, a supportive environment, and government agencies to make health promotion a priority. The recommendations for the future of the IIHP included staying an open forum, strengthening ties with influential organizations, having focus groups and committees within the network working on specific collaborative projects. The committee structure was set up to be as follows:

1. Training and Curriculum
2. Workplace Health Promotion
3. Global Fitness Testing
4. Advocacy and Communication
5. IIHP Meeting Planning

Presently, the IIHP is embarking on several projects.

• summer school training course,
• collaborative research projects,
• global testing of physical fitness levels,
• presentations at conferences in Taiwan, Mexico, China, Japan, Canada, and India,
• seminars in Washington, D.C., and Brazil,
• global newsletter — "Global Perspectives",
• SANGALA Project — an international research project
• Expansion of the communication network

Some selected activities of the IIHP members include:

1. South Africa: Corporate SANGALA project
2. Romania: "Sport for All" movement
3. Norway: "Frilufsliv" movement
4. Poland: tobacco legislation
5. Brazil: quality of life movement
6. Taiwan: Fitness Passport program

The IIHP is proud of the various strengths of the organization. The IIHP has an informal nature, a lack of bureaucracy, flexibility, and a multi-disciplinary forum of distinguished professionals. However, this poses the question of where to go from here? On a macro level, it has been suggested that the IIHP market health promotion as a new concept in order to gather more active members, and realize the potential of most international organizations. Specifically, what can a member do for IIHP? A member can increase motivation, reward active members, represent the IIHP regionally, and look to receive more direction from Washington, D.C. On a micro level, the IIHP can develop an international comparative study, produce a short course program, and develop an international survey.

Recommendations for the future include putting energy in one specific project, either in the workplace or other settings, and link with key organizations such as the World Health Organization and other corporations. The IIHP could also increase focus on training seminars, facilitate academic exchange programs, create an international internship position at IIHP, develop a website that is a first class information resource, approach funding sources more aggressively (national/international), raise visibility through publications, and increase cooperation with the corporate sector.

Four committees were assigned and covered the following four interest areas:

1. Global Fitness Testing

2. Training and Curriculum

3. Advocacy and Communication

4. Workplace Health Promotion

The assignment for the committees was:

1. To discuss the communication process this past year, is there a need for a committee and what was learned from the experience.
2. To discuss the main initiatives for the coming year, what is realistic to achieve, what is the preferred mode of communication, how should the rest of the IIHP network be involved and what are other potential partners.
3. A timeline for 2000-2001 should be drafted.

1. Global Fitness Testing Group

This group discussed the name of the fitness test — "IIHP Profile" was suggested. In November the group wants to decide if they call it health and fitness profile or just health profile. They need to be aware of choosing the best words for the profile. If they include the word health, in Europe it would be too similar to a medicine profile. The reason to develop a global fitness test is because of the lack of physical activity and associated costs.

The group decided to develop a framework in which the profile can be put into, so that the same framework can be used all over the world. Due to cultural differences, they can not make the exact same test for each nation. But they will have a common framework for everyone to use to develop a profile. The frame should have two things, metabolic and cardiovascular system and musculoskeletal system. Maybe later it should integrate abuse-alcohol and tobacco. They are thinking about a two or three step system. The profile will also be an age-oriented profile.

The first step should be an easy testing procedure. This step is supposed to be not expensive. In the second step machines should be used, and in the third step health factor testing, like HDL readings, blood testing etc. should be included. It is important to look at risk factors and protective factors in the profile.

The main problem will be the implementation, because of different circumstances in different cultures. The interest in fitness in various countries is different.

The group decided to continue work on this until Christmas and then communicate again to see on what they come up with. After that they want to set a schedule for every two months to discuss the results.

Q: Will different standards for different age groups be developed?

A: Yes, it will be an age-oriented profile. We should try to find protocols that can be

achieved by everyone.

Q: Why do want a global fitness test?

A: The reason for a global fitness test is the lack of physical activity and cost of this. It is

also helpful for insurance cooperation information. Countries want to compare fitness

levels with the same kind of data.

The mission of the IIHP includes training and curriculum. The IIHP also accomplishes goals through education and research. Four potential projects were introduced which will be followed by strategic plans.

The first potential project is to set up cooperative agreements between academic institutions and put together a small framework for faculty and students to communicate. The second is a weeklong program geared to students and young professionals with the topic of global health and cultural awareness. The course will gather students and professionals in place for a week. The third potential project is the European and US consortium to provide internships for faculty and students in other countries whether it be the school or business environment. Fourth, looking at the Brazilian model, where groups of people from different worksites get together to talk about what each does in terms of worksite health promotion. It would have a standard curriculum and so it would be easy to implement in different countries. Ricardo DeMarchi heads this up in Brazil.

The next step would be that the IIHP will endorse one or more of the projects. One of the communication members needs to take a leadership role to get it underway.

3. Advocacy and Communication

One question in this group was to spread the information about advocacy. One idea is to put a link on the internet to promote the IIHP and to let people know that the IIHP exist. Another idea is to contact different health promotion agents and to get them to spread the word about the IIHP. A marketing strategy could be to create links from different websites and to the IIHP, as well as locate strategic people to get involved in the IIHP to develop new associations and to build up the IIHP. This means partnering with associations to spread information about health promotion and find groups who share common objectives to further the message.

The group suggested to have local meetings along with the IIHP meetings to get members from same countries together.

They also talked about how to communicate the health promotion message in a way it can be heard in different cultures. That means the message has to be adapted in order that it be heard. It is important to keep a constant communication between IIHP members so that people can stay informed and linked.

The group discussed how to sell the image of IIHP to associations in order to get their support. The IIHP has to make sure that it speaks to the needs of each culture that the associations are from.

They also talked about the private sector in terms of raising money to be able to involve more people or groups to participate in the IIHP.

They also want to develop a membership agreement to make people buy into mission statement and objectives of IIHP before they get involved. It is important to think about the concepts and words the group uses and what they try to communicate and to be culturally sensitive.

Q: Will this committee exist through the next year and if so who will chair it?

A: Yes, it will exist through the next year and the committee chair for the next year will be

Itzik Weinstein.

Q: How will it be different to the last year?

A: Compared to the last year the committee wants to have all members active. The

committee has to identify who in the group can identify the message best. The

committee is planning to give each member a specific job and keep in touch over the

next year and have made a commitment to participate over the next year.

Q: Will there be communications between the committees?

A: The chairs should be responsible for this.

After reviewing the committee work over the last year and deciding that nothing happened, it was emphasized that there is a need for the committee. Any improvement would be 100% better. After recapping the IIHP goals, the committee decided to work on a research project and developing a common tool that could be used in various countries. But they tried to be realistic in their approach, so that they can be successful. The committee decided to assign a chair and co-chair that will be changed. They decided to have regular meetings via email and assigned one member per month to contact every person in the committee. The committee also suggested identifying important people in each member’s country to get a membership increase in IIHP, thus promoting IIHP activities to the private sector. They would like to identify international organizations to get involved in IIHP.

The members agrees on working on the Corporate SANGALA project, which Chair Gert Strydom introduced. The first step is to find consensus on the SANGALA questionnaire. This will be completed until the end of January.

The participants saw a need to establish a Social Committee for each IIHP meeting. Another need would be a Finance Committee to get information on how to approach companies and organizations. One suggestion was to develop a board of representatives to represent each region of the world.

Since last year’s conference some people were not meeting up to their expectations. This has been frustrating. The solution may be to narrow down the decided "Good Ideas" to a select few so that members of committees can do them. Maybe three, four or even just one "Good Idea" could be a reachable goal.

The members of this sub-committee are Michael O’Donnell, Neiva Melamed, Gert Strydom, Finn Berggren, Ricardo De Marchi and Jin Jong Quek.

Criteria for selecting meeting sites:

1. It should be a location members would be interested in visiting and financially feasible to visit (travel and hotel).
2. Level of support provided by host institution and country:

• meeting space and audiovisual equipment
• administrative support related to the meeting
• local transportation (airport transfers, hotel)
• meals
• other support
• organize social events & exposure to the country

1. Linking the meeting with a national event such as a conference or campaign to enhance the visibility of IIHP
2. Stability of host organization and host nation is important
3. Organization participation with IIHP is also important.
4. Location should reflect the global membership of IIHP

-seek to hold meetings in all the regions of the world in which IIHP members are located

5. Location should contribute to serving the mission and current priorities of IIHP

Bob Karch seems to be the most central person to ultimately decide the location of the meeting. There were different suggestions from the members. They saw Brazil as a great experience and a great chance to learn by doing, and suggested for the next meeting some sort of adventure. A suggestion was to go to places with a high priority for health promotion. But it is also important that flight routes and hotels are feasible financially. An other suggestion was also to host the meeting in DC every three years since it is the IIHP base, but being in DC every two years seems to be most convenient.

"Five on five" means five years foundations then, build five years on top of that. The IIHP was designed to be a forum for discussion and the sharing of ideas. The IIHP has purposely not taken the form of a traditional organization with a bureaucratic structure. There is a need to be flexible but not flimsy.

The question is how will we build on top of the current IIHP foundation and where do we go from here?

One of the conclusions was that that there must be changes and that it is important to be cooperative. Out of the three strategic postures from which it is possible to change are:

• "Shaping the future" by being entrepreneurial and innovative. This seems to be the current state of the IIHP;
• "Adapt to the future" by being in the comfort zone without being in the lead;
• "Reserving the right to play" by reserving your reactions and watching things play out. This is not the current state of the IIHP members at all.

The members of the IIHP want to "shape the future" by being "avant garde" leaders. That means shaping the future and moving on. The IIHP should be on the leading edge, for example working with governments to develop policies, focus on unique strategic actions to carry out the mission, and go to fellow "soldiers" to carry out tasks worldwide.

In the Curitiba declaration, it is recommended that the IIHP network should stay an open forum and strengthen ties with influential organizations. The focus groups / committees within the network should work on specific collaborative projects.

The strengths of the IIHP are informal nature, minimal bureaucracy, flexibility, multi-disciplinary forum of distinguished professionals.

The objectives for the IIHP:

- Remain cooperative

- Remain flexible

- Remain avant garde

- Expand globally - expand coverage, broaden subject matter

- Increase communication (multidisciplinary, increase publications, increase program support)

- Take advantage of strategic opportunities

- Obtain Funding — Foundations, MNCs, Government Agencies (IMF, World Bank, USAID), self-generating (running workshops and recycling funds into IIHP Meeting)

- Develop Projects — Reference Committees Report, Education, Data/Fact (becoming data repository of data from studies, etc. around the world, building country profiles)

• List of participants
• IIHP committees
• Presentation List

IIHP COMMITTEES

Chair: Dieter Lagerstrøm: lagerstroem@hrz.dshs-koeln.de

Members:

Clark Jwo: t08002@cc.ntnu.edu.tw

Jin Jong Quek: jjquek@nie.edu.sg

Frank Fristensky: fitconsult@frontier.net

Pavel Stejskal: stejskal@ftknw.upol.cz

GL Khanna: champakmed@vsnl.com

Clotilde Tonial: clotildetonial@conex.com.br

Assistant: Roger Moffat:

Chair: Kevin Sykes: K.Sykes@chester.ac.uk

Members:

Kerstin Baumgarten: Kerstin.Baumgarten@Sozialwesen.FH-Magdeburg.de

Finn Berggren: berggren@sportmed.sdu.dk

Emmanuel Owolabi: OWOLABIE@noka.ub.bw

Radim Slachta: slachta@ftknw.upol.cz

Assistant: Stacy Snelling: Ssnelli@american.edu

Chair: Itzik Weinstein: itzw@macam.ac.il

Members:

Neiva Melamed: humana@svn.com.br

Ineta Pirktina: ineta.vvc@parks.lv

Mai Maser: maser@kodu.ee

Flavia Prospero: prosperovalle@bol.com.br

Pavel Mladonicky: mladonicky@ncpz.sk

Assistant: John Studach: jstudach@american.edu

3. Workplace Health Promotion

Chair: Gert Strydom: mbwgls@puknet.puk.ac.za

Members:

Toshio Yamazaki: yamazaki@nifs-k.ac.jp

Michael O’Donnell: modonnell@healthpromotionjournal.com

Ricardo De Marchi: ricmarchi@cph.com.br

Jorge Cerani: jorge_d.cerani@roche.com

Rita Passos: rita@cph.com.br

Bev Gilmore: gilmore_beverlee_l@cat.com

Franny Elson: frannyelson@hotmail.com

Luis Alberto Chaves de Oliveira: lacoliveira@vol-com.br

Mary Aparecida: vida@cptm.com.br

Yosuke Chikamoto: ychikamoto@fullerton.edu

Assistant: Wolf Kirsten: wolfkirsten@aol.com

1. Emmanuel Owolabi Botswana Health Promotion and HIV/AIDS in Botswana: Need for change or strategy?
2. Neiva Melamed Brazil Brazilian Association for Quality of Life in the state of Parana — advocacy and communication in health promotion and how we include the IIHP
3. Finn Berggren Denmark National Danish Bicycle Project in Odense with the object to promote living, better environment, and healthier citizens
4. Itzik Weinstein Israel Energetically Aspects of kids to normal weight parents and of obese parents and of obese parents
5. Toshio Yamazaki Japan Worksite Health Promotion in Japan: Policy and Model Cases
6. Pavel Mladonicky Slovakia The National Program for Health Promotion - Health for all in the 21^st century
7. Gert Strydom South Africa Corporate SANGALA — A South African Worksite Health Promotion Perspective
8. Clark Jwo Taiwan National Health Fitness Promotion Project for students in Taiwan
9. Frank Fristensky USA Medical Fitness Concept works with at risk population
10. Yosuke Chikamoto USA Findings from a worksite-based resistance training Study in the United States where telephone was used as a medium to deliver program
11. Tiffin Bumpass USA Physical Activity Patterns and Breast

2. Shen Xun-Zhang China 2000 Interventing Strategy for Experimental Communities in Shanghai