"Health Promotion - An International Phenomenon" by Wolf Kirsten - National Center for Health Fitness American University

Introduction

Very few causes engender more universal interest and appeal than the issue of health. The concern for the health of individuals transcends the boundaries of race, religion, culture, and national origin. Over the past decade, there has been an increased focus in the international community on the importance of maintaining or improving one's health status through the practice of health-enhancing activities. The rising popularity of the promotion of wellness and healthy lifestyles has been spurred by the participation of institutions from many different fields. Academic institutions, government authorities, private corporations, insurance companies, hospitals, medical groups, community groups as well as other significant individuals in health promotion have joined the universal effort to improve the quality of life. While health promotion has emerged as a respected field of study in the United States and a few other select countries, many other countries are also displaying considerable momentum for advancement and recognition of the field. These developments have generated a global desire for intense networking and international collaboration in the area of health promotion.

I The concept of health promotion

It is not an easy task to define the concept since the promotion of health means different things to different people, especially in different countries. Disease prevention, health education, wellness, quality of life, and health promotion are some of the terms commonly used in the international community, often times depending on the translation. In spite of the confusion around terminology, this paper will highlight some of the most frequently used and inclusive models of health promotion at this time.

Definition of health

First, it is essential to examine what the terms "health" and "promotion" literally mean. Health has been defined in many different ways over history. The ancient Greek physicians believed health to be a condition of perfect body equilibrium. For the New World Indians being healthy was considered as being in harmony with nature. The ancient Chinese believed that health was a reflection of a vital body force called "Qi" (Edelman, 1986). In contrast, Western medicine attempted to understand the construct of health by analyzing its single components rather than the interconnection of the various parts. The Western approach has been advocated throughout the world for years which led the medical field to primarily focus on disease and disability. Only recently has this medical outlook begun to gradually change towards a more holistic view. As far back as 1946, the World Health Organization (WHO) introduced a positive dimension of health to its definition: "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Dubos (1968) took a similar perspective: "Health is a quality of life involving social, emotional, mental, spiritual and biological fitness on the part of the individual, which results from adaptations to the environment." These definitions refer to health as a state of well-being. From this understanding the now common term "wellness" originated.

To underline the difference between the traditional and the more holistic approach to health it is helpful to consider Travis' (1975) health continuum model (Fig. 1). The left side of the health continuum represents a state of extreme illness or premature death, whereas the right side of the health continuum represents a state of optimal health. In between the left and right side of the health continuum lie many different degrees of illness or wellness.

Traditional Western medicine has almost exclusively focused on the left or illness side. Health promotion has traditionally focused on the right or optimal health side of the continuum, targeting overtly healthy people, but at risk of becoming ill (O'Donnell, 1986). However today, health promotion programs are designed to transcend the full spectrum of the health continuum. For example, health promotion targets the left side of the health continuum by facilitating the recovery of ill patients (e.g., cardiac rehabilitation).

Promotion is defined as "the act of furthering the growth or development of something" (Webster's 9th Dictionary, 1984).

Health promotion - an interdisciplinary field

In comparison to other established fields such as medicine, psychology, or sociology, the field of health promotion has only recently evolved. Health promotion has its roots in many different disciplines. As the field has developed, more and more components have become incorporated in it. Many of these components have existed beforehand in their own isolated and limited sphere of influence: health education in schools or primary health care settings, public health programs such as immunizations or screenings, or occupational health measures aimed at preventing disease or accidents at the workplace. These activities involve education, prevention, protection and legislation and all relate to the concepts of positive health, well-being and lifestyle. The health promotion model developed by Downie, Fyfe, and Tannahill (1990) demonstrates the wide range of possibilities for health promotion by incorporating prevention, health education, and health protection in overlapping spheres. Prevention (1) focuses on services such as immunizations, cervical screenings, hypertension case-finding, the use of nicotine-containing chewing gum to aid smoking cessation, etc. Health education (5) is aimed at influencing behavior on positive health grounds and seeks to help individuals, groups, or whole communities to develop positive health attributes which are central to the enhancement of true well-being. Health protection (6) deals with regulations and policies such as the implementation of a workplace smoking policy in the interests of providing clean air or the commitment of public funds to the provision of accessible leisure facilities in order to promote positive health.

Health promotion not only incorporates all of the domains described above, but also the overlapping areas. Preventive health education (2) includes educational efforts to influence lifestyle in the interests of preventing ill-health, as well as efforts to encourage the uptake of preventive services. Preventive health protection (3) addresses policies and regulations of preventive nature, such as fluoridation of water supplies to prevent dental caries. Health education aimed at health protection (7) involves raising awareness of, and securing support for, positive health protection measures, among the public and policy-makers. All three dimensions come together as health education, prevention, and health protection overlap (4) in efforts to stimulate a social environment conducive to the success of preventive health protection measures, e.g., intensive lobbying for seat-belt legislation.

The categories are not rigidly separate compartments but are in reality often combined. For example, most health promotion measures are of preventive nature and aimed at empowering individuals to adopt healthy lifestyles. Further, the model underlines the necessity to include other disciplines such as psychology, sociology, public administration, business and economics, communications, politics, etc. Downie, Fyfe, and Tannahill (1990) describe health promotion as comprising efforts to enhance positive health and prevent ill-health, through the overlapping spheres of health education, prevention, and health protection.

II Universal need for health promotion

The social and humanistic value of health promotion provides a compelling argument in favor of supporting and advancing the field.

An additional incentive to initiate health promotion programs is the positive economic impact. Over the last few years health care costs have been rising in many countries throughout the world. Most industrialized countries face the problem of an aging population contributing significantly to the increase of health care costs. Many of the current lifestyles in most industrialized countries, and in a rising number of developing countries, have been linked to the majority of morbidity and mortality causes. Diseases like cancer, cardiovascular and cerebrovascular disease are considered "lifestyle" diseases. A great number of studies have illustrated a correlation between smoking and cancer, smoking, inactivity, obesity and heart disease, stress and stroke, etc. Some of these correlations are stronger than others with a growing number of scientific studies with various populations supporting the findings. It is known that the leading causes of mortality in most Western industrialized nations are cardiovascular disease and cancer (in the U.S., these two causes make up over 50% of all deaths). However, even in China, accounting for one fourth of the total world population, the leading death causes are cerebro- and cardiovascular disease (37% of total deaths in urban areas), respiratory disease (26% in rural areas), and cancer (22% and 17% respectively in urban and rural areas).

Lifestyle diseases such as heart disease, cancer, alcohol and drug use, etc. make up 43% of all hospital admissions in the U.S. annually (Chapman, 1995). With lifestyle changes a great number of these admissions are preventable. One only needs to take note of the profound effects of such a high-risk habit as smoking. It is estimated that 400,000 (19%) of all deaths in the U.S. can be attributed to tobacco consumption making it the number one cause (McGinnis & Foege, 1993). The task for the field of health promotion is to slow the onslaught of chronic disability and shift the direction towards a healthier and more productive society.

III Conclusion

The recent developments with regard to health have generated a great interest in health promotion and a desire for intense networking throughout the world. This paper provides a rationale for the significance of health promotion. The investment in health promotion is regarded as an investment in human capital. Changes in lifestyle, expressed in learned individual and group behaviors, have an increasing impact on the improvement of health in many countries. China has expressed its commitment to the concept of health promotion through the recent establishment of the China Institute for Health Promotion and the involvement in the International Institute for Health Promotion (IIHP) based at American University in Washington D.C. In order to maximize the multiple efforts across the globe, three major goals are being followed by the IIHP:

  • To increase international communication and collaborative projects.
  • To develop a global database on health and fitness indicators.
  • To develop and support educational programs to train future health promotion professionals.

All involved parties can benefit immensely if experiences are exchanged through regular communication and common projects are undertaken. A global and electronically stored database will provide immediate access to valuable information, even in remote areas, resulting in more effective programs worldwide. By providing quality educational experiences for future professionals all countries greatly increase the prospects for healthier citizens. However, in spite of the big strides taken in the right direction, there is a great need for all health promotion professionals to pool their resources and bring forth healthier and more productive nations.

Note: Mr. Wolf Kirsten's area of expertise is the international health promotion field as he has visited with many health promotion leaders worldwide and given lectures in numerous countries such as China, Brazil, Germany, France, etc. and taught health promotion classes in Portugal and the United States.

The full version of this article is also on-line.

References

Chapman, L.S. Proof Positive: an analysis of the cost-effectiveness of wellness. 2nd edition. Seattle: Corporate Health designs, 1995.

Downie, R.S., Fyfe, C. & Tannahill, A. 1990. Health promotion models and values. Oxford, England: Oxford University Press.

Dubos, R. 1968. Man, medicine, and environment. New York: Praeger.

Edelman, C. & Mandle, C.L. 1986. Health promotion throughout the lifespan. St.Louis: Mosby Company.

McGinnis, J.M. & Foege, W.H. Actual causes of death in the United States. JAMA, 270, (1993): 2207-12.

Mish, F.C. et al. (1983). Webster's Ninth Collegiate Dictionary (9th edition). Springfield, MA: Merriam-Webster.

O'Donnell, M. Definition of health promotion. American Journal of Health Promotion, 1,1 (1986): 4-5.

Travis, J.W. Meet John Travis, Doctor of Wellbeing. Prevention, 4 (1975): 62-69.

World Health Organization (1946). Constitution. WHO, New York.
 
american university