Health Promotion Policy

By Dr. Bob Karch

 

Much of the energy that has been spent on advancing the concepts of health promotion has been focused on the development of programs that attempt to help people change their current lifestyles. By embracing health behaviors that are shown to be positive for their overall well being, hopefully individual healthy lifestyle habits will be adopted. Therefore, we strive to involve people in these programs as early as possible to pre-empt the ravages of disease. However, it is conceivable that far more could be accomplished in advancing health promotion if we, as health promotion professionals, focused our efforts at an even earlier stage and advanced the formulation and implementation of public health promotion policies.

For too long, the pervading philosophy for policy implementation has been one leading to ineffective policy that focuses on an "after the fact" approach, or treat disease and chronic illness, rather than one that contains costs and enhances the quality of life through the prevention of disease. A priority shift in policy formation and a reallocation of resources by decision makers is needed to best change this system globally. Health promotion policy formation, like many other policies, must consider all segments of society, particularly the needy.

 

Defining Policy

At the most basic level, a policy is a principle or course of action chosen to guide decision making. Thus, by extension, we might conclude that public health promotion policies are clearly stated courses of actions that are grounded in well-established principles known to be beneficial to health. They can serve as the foundation for decision making with respect to developing, implementing, operating and evaluating health promotion programs.

Given this definition, it is logical to then ask how we as health promotion professionals can gain a better understanding of this process or get involved with the development of such policies. A partial answer that addresses the complexity of this issue is provided by Thomas R. Dye in his book, Understanding Public Policy. Dye writes: "...most public policies are a combination of

  • rational planning
  • incrementalism [policy that is a continuation of past government activity with gradual changes];
  • competition among groups [group struggle on issues that leads to compromise and equilibrium];
  • elite preferences [those few who shape policy as a result of the masses who may be apathetic and ill-informed];
  • systemic forces [those institutions and activities that respond to a certain political system]; and
  • public choice, political process and institutional influences."

Further, it is important that one becomes keenly aware of the social and economic conditions that exist within any given political system. Health promotion policy formation also includes an economic and social construct.

 

Beyond Health Policy

An effective approach is to study, through policy analysis, the causes and consequences of various existing health promotion policies and then apply current knowledge by advocating new policies. This edition of Health Promotion: Global Perspectives focuses on this and the wider implications of using strategic alliances, as mentioned in the article based on the World Health Organization's "Health for All Policy," for effective policy formation.

Ineta Pirktina, director of the Health Promotion Centre in Latvia, discusses the policy changes occurring in this country that have increased the participation at the local level and strengthened cooperation between all levels of government and the private sector. The Health Education Authority (HEA) in London is involved in making contributions to improving physical and mental well-being and has been an important supporter of England's National Health Strategy. Additionally, the HEA has advised other countries that seek to form health promotion policy effectively. Francis Namisi of Kenya says the country is actively expanding its resources by redistributing resources toward preventive programs and Flavio Prospero in Brazil has seen a government movement that supports the quality of life philosophy of that country. Yosuke Chikamoto has also reported on a move away from health promotion policy in Japan that focuses on only physical activity to one that expands the scope of primary prevention to a Total Health Promotion plan (THP).

Alliances and partnerships with the private and governmental sectors in most countries are viewed as the best way to effect change. All players must be considered as essential in the formation of health promotion policy that involves social and economic policies as part of this process. Also, recent globalization can be a positive force when formulating health promotion policy to the extent that consultation across the spectrum of nations can aid in each individual country's decision making.

Health Promotion Economics

By Dr. Bob Karch

 

Over the past twenty years, the concepts of health promotion have increasingly become better understood and generally accepted throughout the world. And while it is true that more progress with respect to the developing, implementing, and evaluating of health promotion programs is evident in the industrialized countries, there are promising indicators that emerging and developing countries are also embracing the fundamental element of sound health promotion program planning. Today it is a very rare exception if you don't find some reference to health promotion in the health policy documents of countries throughout the world. However, embracing the theoretical concepts of health promotion and articulating those concepts in national policy documents is not enough to ensure success. Absent the authority and necessary funds to proliferate well-designed and culturally specific health promotion programs, little can be expected.

 

Effecting Progress with Fiscal Progress

To date, no government has enacted strong and consistent fiscal policies that directly tie to the implementation of progressive health promotion programs. Without the willingness of governments to establish such policies, the concepts of health promotion cannot be turned into programmatic actions which in turn would yield positive health outcomes.

The good news, however, is that to varying degrees, most societies tend to accept regulations when those regulations are for the common good. Thus it seems logical that most citizens of the countries of the world would be willing to accept legislation and regulations and fiscal processes that are designed to have an immense direct as well as indirect impact on their health status.

 

All Countries are Challenged

As health promotion professionals we must strive to gain a much deeper understanding of the relationship between fiscal policies (both national and local) and their inextricable link to successful health promotion programming. To this end, this edition of Health Promotion: Global Perspectives presents insight as to how five countries have approached the financing of their respective health promotion programs.

Specifically, Professor Igbo Egwu from the University of Calabar, Nigeria, presents a very articulate discussion as to the theory and actual practice of financing health promotion programs in Nigeria as well as presenting some creative options which clearly have utility beyond Nigeria.

The challenge in developing and financing health promotion programs facing the post-revolutionary Czech Republic are very similar to other Eastern European countries. Zdenek Kucera presents an insider's view of that country's current status.

Always progressive leaders when it comes to health promotion, Finland and Canada have well-established practices in place to fund their program initiatives. I think you will find Antero Heloma of Finland's discussion of how the health lobby of Finland put in place a "budgetary allocation for health promotion" enlightening, as well as Professor Irving Rootman's discussion of the six main sources of funding of health promotion initiatives in Canada.

The fifth country presented in this edition is Germany. Gregor Breucker presents an insightful overview of Germany's "middle of the road" approach to developing and funding health promotion programs and in particular those in the workplace.

And lastly, the country profile of Lebanon by Sahar Tabarra, shows us that a focus in health promotion based on educational trends, as well as facility expansion, is increasing to challenge the potential impact associated with major health risk factors.
 
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