Common questions about health promotion: CrossCurrents Summer 2003
CrossCurrents
How does the concept of health promotion differ from concepts such as harm reduction, prevention, relapse prevention and health
recovery?
Health promotion, the process of enabling people to increase control over and improve their health, can be considered the
umbrella term that incorporates many strategies directed at social and environmental conditions and community, individual
and social change. It focuses on improving health in individuals and populations, and emphasizes the importance of engaging
people in decisions affecting their health. It includes strategies to change policies and socio-environmental conditions.
Harm reduction is a policy or program directed toward decreasing the adverse health, social and economic consequences of drug
use without requiring abstinence. Prevention can be divided into three levels: primary prevention aims to prevent the initial
occurrence of a disorder; secondary seeks to stop or retard existing disease and its effects; and tertiary seeks to reduce
the occurrence of relapses. Relapse prevention includes specific clinical strategies designed to help clients achieve their
substance use and mental health goals. Health recovery includes early intervention, treatment, rehabilitation and harm reduction.
How has the definition of health promotion evolved?
Many events and documents have shaped the development of health promotion. Key milestones include the release in 1974 of health
minister Marc Lalonde's A New Perspective on the Health of Canadians, which expanded the concept of how health is created to include genetics, lifestyle, environment and the organization of
health services. Evidence shows that lifestyle influences health more than do medical services, yet less than one per cent
of health care spending was invested in preventive services in Canada. As a result of the Lalonde report, more attention was
paid to changing behaviours and lifestyles.
In 1986, the Ottawa Charter for Health Promotion was developed. It continues to guide health promotion worldwide. The key strategies were building healthy public policy,
creating supportive environments, strengthening community action, developing personal skills and reorienting health services.
This resulted in more attention to changing policies, creating healthy schools, workplaces and municipalities, and community
development and citizen participation.
The concept of health promotion has shifted from thinking that medical services create health and marketing healthy lifestyles
to include a focus on advocacy and healthy economic, social and service policies, as well as creating living conditions conducive
to good health. The understanding of health promotion has been expanded to include determinants of health, such as housing,
income and social support, which affect both healthy people and people with health issues. Indeed, the Kirby Report on the Federal Role on Health Care found that 75 per cent of our health is determined by the physical, social and economic environment.
How can mental health and addiction services implement health promotion approaches in their work with clients?
A health promotion approach to mental health and addiction means that programs and services provided by health care workers
take a holistic approach to client care and are responsive to the social, environmental, economic and personal factors that
determine health.
The Enhancing Prevention and Health Promotion Implementation Team at the Centre for Addiction and Mental Health in Toronto has developed four key principles to guide clinical programs. First,
clinical programs should embrace a holistic view of the client, which considers the client's mental, emotional, physical and
spiritual health. Second, programs should address both protective and risk factors in their clients' lives. Third, care plans
should build on client strengths. Finally, programs should include clients as partners in the development and delivery of
services.
Mental health and addictions services can also contribute to improved quality of life for clients and their families by advocating
for healthy public policies or becoming involved in other health promotion work that will improve quality of life for clients
in the community, for example, anti-stigma campaigns, employment initiatives and access to affordable housing.
What are some resources for health care practitioners wishing to implement health promotion strategies/approaches?
Health Canada's Health Promotion Online for Health Professionals Web site offers health promotion resources and guides for health care professionals and community leaders. Also, visit the Web site
of Health Canada's Mental Health Promotion Unit.
The Ontario Health Promotion E-mail Bulletin (www.ohpe.ca) is a weekly newsletter produced by the Ontario Prevention Clearinghouse and the Health Communication Unit. It provides information
on workshops, conferences, job postings, projects, issues and resources.
The Canadian Mental Health Association's Mental Health Promotion Tool Kit provides resources for community initiatives in developing, implementing and evaluating mental health promotion projects.
The Web site of the Department of Noncommunicable Disease and Health Promotion of the World Health Organization provides a list of organizations around the world involved in health promotion.
Compiled by Hema Zbogar with assistance from Jennifer Boyko, Andrea Stevens-Lavigne and Marianne Kobus-Matthews, Centre for
Addiction and Mental Health.
Sources: Enhancing Prevention and Health Promotion Implementation Team Final Report, CAMH, 2000; Health Canada Web site; Ottawa Charter for Health Promotion, WHO, 1986; Suzanne Jackson, Director, Centre for Health Promotion, University of Toronto, Toronto, Ontario; World Health
Organization Web site.
Centre for Addiction
