Advocating for vulnerable groups’ health promotion: development of institutional data

The right to health is a fundamental human right but better health is a shared responsibility.

The relationship between religion and human rights is an ambiguous and complex one, but there are academic, moral and political arguments for the inclusion of human rights in religious education (RE). The Universal Declaration of Human Rights advocates education in human rights and the English school curriculum aims to encourage a commitment to human rights. This article examines the arguments for the inclusion of human rights in RE. It explores whether English secondary RE curricula encourage the study of human rights and the link with religion. This is perceived through a post secular context, one which is marked by the continuing presence of religion in the modern world. The article suggests that there are compelling arguments for the inclusion of human rights in RE, but identifies a questionable variability among local agreed syllabi and GCSE specifications which makes RE an inconsistent ally for the national and international human rights education movement.

Traditionally, health protection and health promotion activities have operated independently of each other in the workplace. Health protection has usually been viewed as encompassing the activities that protect workers from occupational injury and illness ranging from basic safety training to the us

Health promotion has been a part of the policies, strategies and services of the Nordic welfare states since the beginning of the millennium. This article contributes to analyses of health promotion in political programs, institutions and practices in Denmark in later years, and holds a special interest in how inequality in health is addressed. In the Nordic countries, universalism has been a key tenet of welfare services, with great potential of guiding health promotion towards more equality in health. However, a neoliberal development over the last two decades has influenced the field of health and also the ideas, conceptions and strategies of health promotion. This article looks into how health promotion has taken form in Denmark, through conflicts of interest in health policies, and changes in central health promotion programs, that turn away from earlier universalistic and social political framing of health prevention and promotion. Health promotion in Denmark has been marked by years of conflicts and the interest in influencing the psychosocial environment of health to gain more equality in health has weakened. The analysis shows that central health promotion programs that direct local government practices, do not identify the characteristics of the psychosocial environments of health for various groups of citizens, but identify socially less privileged groups with potential health risks, and wishes to intervene into the social reproduction of unwanted health conduct. Health promotion plays an increasing role in the categorisation and discrimination of less privileged citizens on the background of their health conduct and social positions and situations. In institutional practices in child and family health promotion the article finds that inequality in health is not addressed as a professional problem, but is none the less present in the way citizens are deligitimised, categorised and marginalised. Health promotion institutions on this background distribute obligations and invite engagement of citizens in socially segregated ways. These categorising and discriminatory practices contribute to excluding and devaluating the problems of social inequality from health promotion in schools, kindergartens and health care institutions for children and parents.

Health promotion activities are actively encouraged in most countries, including the UK. Meanwhile many health care providers and health experts are becoming increasingly concerned about the growing evidence of significant health inequalities between social groups in the UK, and in particular the strong association between relative deprivation and poor health. In 1995, a report for the British government entitled 'Variations in health: what can the Department of Health and the NHS do?', identified the need for the Department of Health and the NHS to play a key role in coordinating and implementing public health programmes intended to reduce inequalities in health. Examination of existing evidence on the effectiveness of health promotion and prevention programmes designed to improve the health status of the most vulnerable groups in society reveals very little evidence to support current enthusiasm for adopting public health strategies in order to reduce variations in health status between the affluent and the poor. Alternative and potentially more effective health care responses to inequalities in health status need to be considered.

Da invisibilidade à participação social: promoção da saúde em pessoas com deficiência

Recent Australian scholarship has provided a clear rationale for investing in health promotion policy in Australia.1 This is consistent with the aim of the Australian Health Promotion Association (AHPA) ‘to advance the health of all people in Australia through leadership, advocacy and support for health promotion action in practice, research, evaluation and policy’.2 A key element of AHPA advocacy platform has involved the adoption of a multi-partisan approach. This means engagement with political parties of different persuasions as a means to support health advancement in Australia. One recent opportunity involved participation in the Labor Party's National Health Policy Summit (the Summit). It was hosted jointly by the Leader of the Opposition and the Minister for Indigenous Affairs and Aboriginal and Torres Strait Islanders, the Shadow Minister for Health, and the Shadow Minister for Ageing and Mental Health. Held in Canberra on 3 March 2017, it was an invitation-only event attended by 150+ representatives of professional health bodies from around Australia. The authors of this editorial represented AHPA at the Summit, and the commentary reflects our views based on participation in the Summit (it does not necessarily reflect a policy position of AHPA). Protection, prevention and promotion Primary, secondary and community care Hospitals Mental health and suicide prevention Ensuring universal access for all Australians Designing our health workforce for the future Tackling health inequality and other whole-of-government challenges Innovation across our health system. Our aim is to summarise and share the most pertinent themes of the Summit discussions associated with health promotion and tackling health inequities. There was recognition that current investment in prevention has fallen to less than 1.5% of the national health budget. There was a Labor commitment to increase this investment consistent with AHPA's recent advocacy efforts.3 Invited participants called for an investment of 5–6% in prevention, in parity with that of Canada and New Zealand. In addition to the economic investment into health promotion and prevention, we also discussed investments in the social determinants of health (SDH), leadership and governance, data, workforce and Indigenous health. The relationship between the SDH, health equity and health outcomes was a common theme in many sessions. Action across portfolios to address these determinants was widely supported as fundamental to improving health outcomes. Intersectoral action and whole-of-government approaches aiming to achieve health equity were referred to as the adoption of a SDH framework. Debate centred on the utility of the terminology ‘SDH’, especially when engaging the lay public and politicians, and the need to describe responsive actions in a simpler and more accessible way. There were explicit mentions of the value of a Health in All Policies (HiAP) approach as a mechanism for achieving policy change in other sectors including housing, employment, education and climate change. This message was consistently reinforced by colleagues in allied health, nursing and medical professions. HiAP was broadly discussed in relation to drug use, rural and remote health, mental health, disability and Indigenous health, to name a few. There was a plea to take a strengths-based approach when using a SDH framework to address health inequities. As well as all three levels of government needing to collaborate more cohesively, there was a call for government to work with communities and non-government organisations to plan and implement policies, programs and services. Related was a strong push for community governance and empowerment. There were calls for government to be brave in setting policy directions tackling difficult issues, to avoid spending too much time preparing new strategies when they have already been developed, and to implement the advice of health experts. While leadership was a prominent theme that cut across many conversations, there was little discussion about what leadership might look like in terms of governance arrangements for good health promotion and prevention. Perhaps this demonstrates the need for a broader conversation about the leadership and/or stewardship roles that the health (promotion) workforce might take in addressing health outcomes, including through other national public policy priorities such as environment, climate change, employment, education and productivity .4–5 There was discussion about data and evidence at multiple levels, such as surveillance data to guide timely decision making in relation to key health directions. There were frank discussions about service provision and respective outcomes achieved through current health investments, including who benefits and who loses. For example, the generation of good data, independent evaluations and robust evidence to drive decision making were considered critical to support mental health investments and sound mental health promotion. Discussion about recalibrating the national investment into health research towards health promotion and public health, particularly that relating to strategies involving intersectoral action, was also a hot topic. There was broad recognition that research of this nature has the potential to have high translational impact and to contribute significantly to population health gains. Not surprisingly, there was subsequent discussion about the effective translation of evidence into practice and policy spheres in health and other social services sectors. Workforce was identified as a critical enabler of an effective health system. However, scant attention was paid to the health workforce required to tackle health inequities and increase action in health promotion and prevention. While we raised concerns about the health promotion workforce, this received little recognition during the Summit. Comments were made that there is currently poor data on self-regulated and unregulated health professions in Australia. This was also noted previously in a national audit of the preventive health workforce.6 It will be important for AHPA to ensure good data collection on the health promotion workforce as it embarks on the National Accreditation Organisation health promotion practitioner regulation. The profession needs to be more articulate about what the health promotion workforce offers (the recent Virtual Issue of the Health Promotion Journal of Australia, ‘Health Promotion Workforce’, makes a timely contribution in this regard). This involves explaining that health promotion practitioners have core competencies well suited to tackling health inequities and whole-of-government challenges. There was widespread recognition that Indigenous health is a critical area of investment. However, it was also recognised that there is a high level of duplication in resources, without much coordination and collaboration. The importance of promoting self-determination among Indigenous communities in the design, delivery, monitoring and evaluation of services and programs was highlighted. Increasing Indigenous participation in governance was seen as an important issue within mainstream health services (particularly those that commission Indigenous health programs, such as Primary Health Networks). The need to bolster governance support for Aboriginal community-controlled health organisations was also recognised. Another fundamental concern was racism experienced within the health sector, and the need to ensure the cultural competence of the health and social services workforce. There was support from most Summit participants for redressing the minimal investment in prevention and addressing the SDH, particularly through close partnerships with other sectors whose policies and practices affect health outcomes. There was demand for infrastructure requirements to be acknowledged and supported in health policies, including the collection and use of better data to inform decision making. Investment in translational research with a health promotion orientation was also a high priority. The overarching discussion supported the need for a comprehensive approach to health promotion.7 It was recognised that multi-strategy approaches are needed for such an approach to be most effective. Similarly, there was a high uniformity in views about the types of investment required and a common denominator of goodwill. There are some important lessons to take away. In the professional view of the authors, based on their participation in the Summit, the term ‘health promotion’ appears to have lost its utility within current Australian policy contexts. Other terms, such as ‘prevention’, ‘healthy lifestyles’ and ‘promotion’, were used more frequently. For some professionals, these terms are fundamentally different from ‘health promotion’.8,9 It is pivotal to articulate the important role and function that health promotion plays within Australia's health system and that of other sectors, including the human services.5,10 We need to reinforce that the work we undertake, in its various forms, is about improving population health by keeping people healthy and preventing illness. We also need to emphasise that we do this in an equitable, sustainable and economically efficient way. The Summit was the beginning of a process by the Australian Labor Party, which has committed to progressing an ongoing dialogue about health policy directions in Australia. At the conclusion of the Summit, the Opposition Leader, Bill Shorten, commented that ‘we need to keep talking, keep listening and get the smartest views from communities, experts and consumers … We need to be sufficiently ambitious for health care policy …. We have to get from good ideas to good outcomes’.11 The Australian Health Promotion Association looks forward to working with all political parties and contributing to this important national health policy dialogue in an ongoing way.

Ten years have passed since the release of the final report of the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH),1 a landmark document that provided a global blue‐print for the health promotion community and the stakeholders we work with. Three overarching recommendations were outlined, improving daily living conditions; tackling the inequitable distribution of power, money and resources; and measuring and understanding the problem and assessing the impact of action.1 The extent to which progress has been, and continues to be, made is contested. This editorial briefly reflects on what has been achieved over the past decade—in broad terms—about action on the social determinants of health (SDH) in Australia. We deliberately take a balanced view by highlighting the weaknesses and strengths in what has been achieved by governments, non‐government organisations, research institutions, peak bodies and civil society. We also reflect on the ongoing role that the Australian Health Promotion Association (AHPA) has played in advancing our understanding about, and action on, the SDH.

The evolution of human rights and fundamental freedoms has been hampered by many obstacles over time, and the horrific events of human dignity, rights and freedoms, which have led to widespread attention to human rights at the international and domestic levels. The question of the inclusion of human rights in the national constitutions of States gives them a great deal of attention and protection, since in no case can the State evade its international obligations in this area, since the universal and regional human rights conventions to which states have regulations require that their legislation be made is consistent with the obligations deriving from these conventions. The notion of international protection is still a relatively recent idea in the field of human rights, as protection concerns emerged for the first time in relation to the protection of minorities in the Treaty of Westphalia in 1648, and hence international agreements in this area, and now international protection is a concrete reality, the result of international circumstances and regional conflicts of national and international interests, the protection of human rights has become the law of the international community.

Background Health and ill health are created in the settings where people live. Thus, health inequity is strongly linked to the social, cultural, and environmental contexts of people's everyday lives. In disadvantaged neighbourhoods, residents generally have poorer health than the general population, especially when it comes to type 2 diabetes (T2D) and mental illnesses. Meanwhile, studies show positive health outcomes of multilevel, multicomponent participatory community interventions pointing towards the need for increased health promotion and prevention of T2D in local communities. Conceptualisation This session presents the Supersetting, an intervention strategy for multilevel, multicomponent community interventions. The Supersetting strives to attain synergistic effects from coordinated actions carried out across multiple settings. Stakeholder participation is a core element of a Supersetting. Consequently, a Supersetting initiative must work with a comprehensive organisation structure for dialogue, decision-making, coordination and action between citizens, civil society organisations, public authorities and their institutions, private sector corporations, and researchers. Instead of predefined and meticulously planned actions, the Supersetting approach builds on five overarching principles guiding the development and implementation of interventions. These are 1) integration, 2) participation, 3) empowerment, 4) context-sensitivity and 5) knowledge. Case The Supersetting has mainly been implemented in the long-term strategic health promotion imitative Tingbjerg Changing Diabetes (TCD), which aims to create well-being and promote good, healthy lives while preventing T2D in the disadvantaged neighbourhood of Tingbjerg, Denmark. Data on T2D from national health registers will be presented. Conclusions The Supersetting approach is a relevant, context sensitive conceptual framework for developing initiatives for sustainable impact in community health promotion.

The inclusion of human rights in the constitution gives a new status for these rights to become constitutional rights. The guarantee of human rights in the constitution has not been in line with legal efforts to protect these rights. Mechanisms constitutional review in Indonesia only accommodates the testing effort constitutionality of Law (judicial review), whereas there are still many objects of state action that can harm the constitutional rights of citizens, but they do not have any resolution because they have not been provided for by Indonesian positive law. This study aims to identify how the interrelationship between guaranteeing human rights in the constitution and strengthening constitutionalism due to the inclusion of human rights in the constitution, how the concept of constitutional complaints in various countries is, and how relevant is it to be applied in Indonesia. This research describes the material that exists in historical, comparative and reconstruction (modification) aspects as an effort to make the concept relevant to be applied in Indonesia. This research shows that human rights and the constitution have a reciprocal relationship (reciprocal), various concepts in other countries have a lot of relevance to Indonesia, and there are several technical-procedural concepts and juridical arrangements that are relevant to be applied in Indonesia. So, it is necessary to regulate constitutional complaints as a legal measure to protect the constitutional rights of citizens which have been guaranteed by the constitution and increase the value of the constitutionalism of citizens in Indonesia.

Sermons to Address Obesity in Partnership With African American and Latino Churches

Defining the concepts of ‘vulnerability’ and ‘vulnerable groups’ is challenging, since vulnerability is a multi-dimensional concept used with both universal and particular meanings in a variety of disciplines, and can moreover be examined from different perspectives. In this chapter, we seek to define the concepts of ‘vulnerability’ and ‘vulnerable groups’ from sociological and legal perspectives in order to build a theoretical background for the subject analysed in this book. The approach taken in this chapter is based on the idea that to be human is to be vulnerable; nevertheless, although all humans are vulnerable, some groups are more vulnerable than others.The chapter begins with the sociological approach to vulnerability. It could be argued that contemporary societies consist of fragmented and often antagonistic communities with only a small number having access to adequate social welfare and services. The remaining individuals have little hope of realising their human potential. They are often called vulnerable or marginalised groups or groups at risk of social exclusion. In different spheres of life, vulnerable groups experience deep exclusion that negatively affects their quality of life, well-being and future life opportunities. Moreover, there exists a dominant discursive tradition that imposes a burden of guilt, shame and even greater vulnerability on socially afflicted and vulnerable groups. Rather than accepting this discursive tradition, sociologists have turned their attention to researching social exclusion, social suffering, and daily hardship, thereby turning vulnerable people’s experiences of injustice, harm and damage into crucial sociological issues.After a brief sociological analysis of vulnerable groups, the chapter continues by presenting the international legal framework. The authors identify and discuss the main universal and regional human rights instruments that provide for the protection of vulnerable groups and their individual members and note the relevant practice of the UN treaty monitoring bodies and UN Committees. In this way, the chapter sketches the framework of international legal regulation linking the international, regional and national levels.KeywordsVulnerable groupsVulnerabilityConcept of ‘vulnerable groups’Vulnerable groups in international lawVulnerable groups in EU instruments

‘The people are the only power’: such are the words heard on the radio from a demonstrator in Egypt on February 11, day of Hosni Moubarak’s departure. The distribution of power and wealth is central to the recently intensified rebellions in countries of the ‘Arab world’ (1). In his forum, Roy (1) describes the population responsible for these popular upheavals as a generation which ‘lives in social displacement’, a situation deleterious for those who are affected by it. And yet, health promotion aims to reduce social inequalities in health (2) which, as Marmot reminds us (3), are an ‘eminently political problem’. The link between health promotion and power seems evident. Consequently, we believe it important for us to use the opportunity offered by these events to reflect on this link and the interest the health promotion field has in studying the relationship between health promotion and the power held by concerned stakeholders, such as states and their institutions, civil society and social groups. What can we say about this relationship, how do health promotion actors position themselves when faced with the relations of power, and more generally, how is power, largely studied in political sciences, defined in this field? Health promotion and political science are two disciplines that remain too distant. A review of health promotion articles published between 1986 and 2006 around the study of public policies shows that only 17% refer to a political science theoretical framework (4). Another review of published articles on the implementation of public policies between 1933 and 2003 shows that only 15% concern health policies, with regional coverage including only 7% for Asia and the Middle East and 4% for Africa (5). As many media have highlighted, the ‘corrupted dictatorships’ (a term used by Roy [1]) and notably those of Tunisia and Egypt, maintain close economic, financial, military and even private links with certain governments of countries said to be occidental and democratic. This questions the universality of values preached by these same countries, such as democracy, human rights and social justice. What is the position of health promotion actors with regard to this modern state paradox, as De Boeck (6) has already implied: promoting the universality of rights while generating differences? The political dimension of health promotion and the reconstruction of health systems have already been suggested in the case of Iraq (7). This political dimension can be seen as an act aiming to strengthen empowerment, a concept central to the Ottawa Charter’s objectives. If the empowerment issue is not new to health promotion (8,9), the link between health promotion and political science – an important discipline in the understanding of the notion of power and explaining changes (10) – remains fine. And yet, if the implementation of public policies is a pillar of health promotion, one must understand that ‘it is through exercising power that public policies come to fruition or not’ (11) and that the study of this same power is the cornerstone of ‘any serious analysis of collective action’ (12). The theoretical frameworks and concepts of political science (13) could bear fruit not only in better understanding contemporary changes but also, and above all, in the way in which health promotion strengthens (or not) its actions, allowing the development of more equitable public policies, as the redistribution of resources is integral to the

Background: Exposure to tobacco smoke and tobacco smoking leads to numerous adverse health and developmental outcome including widespread cancers. The tobacco epidemic primarily roots in childhood as many adult smokers have started before the age of 18. Health prevention and promotion laws and policies are key to positive health change. Indeed, tobacco control legislation has positively impacted on child health and human rights may play a valuable basis and mechanism to foster health prevention and promotion strategies. Aim: To gain new knowledge on the added value of human rights law in fostering health prevention and promotion strategies by reference to specific findings in the case of tobacco control and children's rights. Methods: Literature research and document analysis. Interpretation on the basis of the treaty interpretation rules of the Vienna Convention on the Law of Treaties (art. 31-32). Results: Human rights are increasingly standard setting in the field of health prevention and health promotion in general. Even though human rights law largely includes open-ended norms, it provides for key legal obligations to protect child (and ultimately adult) health against the negative consequences of tobacco. The 1989 Convention on the Rights of the Child demonstrates that governments should take into account the best interests of the child, protect and promote the life, survival, and development of children, the right to health and its underlying determinants, and regulate the tobacco industry to the extent that it does not harm children's rights including health. Conclusion: The human rights framework may a valuable mechanism to support health prevention and promotion as it includes legally binding and enforceable obligations.