Advancing health promotion in low-resource countries

Abstract

The agenda for health promotion that has been established since 1986 (Ottawa Charter: providing safe or supportive environment; developing healthy public policy; developing personal skills, community action; reorienting the health service) is now firmly embedded in the framework of health promotion activities in more economically developed countries. The progress in developing it within less economically developed countries has shown some significant forward movement. The evidence for the effectiveness of the strategies of the Charter is mixed. In order to prove effective, the individual interventions need to act in conjunction with each other and with certain supporting actions. Strong evidence exists for the effectiveness of one strategy linked to building public policies for health. In contemporary societies, health tends to become fragmented into various sub-institutions dealing with particular aspects of health or health systems, while the capacity to assemble the various aspects of public policy that jointly determine health is under-developed. The epistemological model underpinning health promotion is based on systems theory. The reciprocity of the interactions of the different elements of the system or organisation is acknowledged as a driving force. All actors – all health professionals, patients, their families, the community and all other relevant social actors including policy makers – are part of the system and all have the power to change its functioning. A participative and collaborative attitude is essential to optimise a given system’s status.