Health promotion

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The term health promotion (English health promotion ) is the name given to measures and strategies to strengthen the health resources and potential of people to be reached. It was introduced into the discussion of health policy and science in 1986 with the Ottawa Charter. Health promotion also refers to the process of empowering people to increase their control over conditions of health . In doing so, health behavior and health conditions, i.e. social, economic and environmental conditions, are included. From a holistic perspective, health is defined as physical, psychological and social well-being.

According to the WHO Bangkok Charter from 2005, health promotion is the path to a higher quality of life .

Differentiation between health promotion and prevention

While prevention aims at preventing disease and is z. B. advocates vaccinations , a healthy diet and adequate exercise , the health promotion approach is aimed at strengthening health. The central question is: what keeps people healthy? This shift in the perspective of disease and its origin on the determinants of health is known as salutogenesis . Analytically, health promotion and prevention can be differentiated as follows: Both disease prevention and health promotion aim to gain health, but each in a different way. In the case of disease prevention, the health gain should be achieved by reducing the burden of disease, in the case of health promotion by strengthening health resources. Accordingly, prevention focuses primarily on risk factors for disease, and health promotion primarily on protective factors that keep them healthy. The two forms of intervention can therefore be understood as complementary to each other, whereby depending on the initial situation, one and the other form of intervention can be the most appropriate and promising one. An overly sharp demarcation between prevention and health promotion is scientifically not without controversy.

Strategies for action and fields of action - Ottawa Charter for Health Promotion

The concept of health promotion was developed at the WHO in the run-up to the International Conference in Ottawa and made public with the Ottawa Charter . In the WHO follow-up conferences in Adelaide (1988), Sundsvall (1991), Jakarta (1997), Mexico City (2000), Bangkok (2005), Nairobi (2009) and Helsinki (2013), individual areas of action and policy areas were specified. The basic ideas formulated in the Ottawa Charter are now regarded as an accepted framework for the policy and practice of health promotion. The concept contains the most important action strategies and fields of action in health promotion. A distinction is made between three basic strategies for action and five central fields of action.

Action strategies

The WHO names the following health promotion strategies:

  • Advocacy for health: those working in health promotion actively advocate health; in the sense of influencing political, economic, social, cultural, biological as well as environmental and behavioral factors.
  • Enabling and enabling: This action strategy aims to act in partnership with individuals or groups in order to enable them to exercise control over their health issues and to promote and use their resources ( health literacy , empowerment ). People should be given access to all relevant information and contact persons. This is intended to reduce differences in the state of health, for example due to social inequality .
  • Mediation and networking: Mediation and networking are understood to mean active and permanent cooperation with all stakeholders inside and outside the healthcare system. All areas that have an influence on health (in addition to actors in the health system, for example, the political level, employers, associations and clubs, etc.) should work together in a network and thus ensure continuity in the health-promoting behavior of individuals and in the development of health-promoting living environments .

Fields of action

According to the WHO, the five priority areas and levels of action (so-called multi-level model of health promotion) are:

  • Develop overall health-promoting policy: The primary goal of overall health-promoting policy is that health is on the political agenda in all policy areas and at all levels. Politicians need to be aware of the health consequences of their decisions and their responsibility for health. The political level in the federal, state and local governments has a considerable influence on the conditions of the population in the area of ​​work, training, living, leisure and supply. All policy areas thus have an impact on the health of citizens and can contribute to promoting well-being and quality of life through overall health-promoting policies. An overall health-promoting policy uses mutually complementary approaches, such as legislative initiatives, tax measures, organizational and structural changes.
  • Creating health-promoting living environments: The aim of health promotion is to create living environments that offer people protection from health hazards and enable them to expand their skills and develop self-confidence in relation to health issues. Health-promoting living environments include places where people live, work, play and spend their free time (e.g. city, community, apartment, workplace , school, kindergarten). Living environments include people's access to resources and services for health as well as the interrelationships with their environment.
  • Support health-related community actions: A major endeavor of health promotion is the support of neighborhoods, community activities by citizens, self-help activities and communities in the sense of increased self-determination, autonomy and control over one's own health concerns.
  • Develop personal skills: Health promotion develops personal skills and abilities that enable the individual to shape his or her life, master challenges and integrate changes in the environment. This includes, for example, communication and decision-making skills, problem-solving skills or dealing with stress . Building on this, health-promoting behaviors (such as healthy eating, exercise, social skills, healthy thought patterns) can be learned. Participation and self-determination of the addressees are crucial in order to achieve adequate behavioral changes and to integrate them into everyday life. People should be enabled for lifelong learning. It is called to be able to deal with possible chronic illnesses and disabilities in the different phases of life. This includes health education, health education, health advice and patient education .
  • Reorientation of health services: The health services are to build a care system that focuses on promoting health more strongly and not on medical-curative care as has been the case in the past. Above all, it should be based on people's needs. The reorientation is also intended to improve the possibility of coordination between the health sector and other health-relevant social, political and economic forces.

Approaches and models of health promotion

In addition to the strategies and fields of action, several approaches and models of health promotion can be distinguished.

Approaches to health promotion

  • The medical or preventive approach aims to reduce the burden of disease. There are three levels (primary, secondary and tertiary) of prevention. Health promotion is primarily at the primary level and serves to improve medical interventions.
  • The behavior change approach targets individuals and their health-related behavior. Changes in behavior should be achieved, for example, through campaigns or nudging .
  • The health education approach seeks to provide people with the knowledge, skills and abilities they need to make self-determined decisions about their health behavior. This can be done through information brochures, exhibitions, counseling sessions, group discussions or training programs.
  • By empowering people should receive a higher level of self-determination of their health. Empowerment helps to recognize and understand health-relevant aspects of lifestyle. This is where quality of life research provides valuable information on breaking through the barriers to action that stand in the way of a healthy lifestyle.
  • The approach of social and political change aims at general living conditions and specifically at socio-economic conditions as determinants of health and how they can be shaped in all policy fields, especially through social and health policy. This approach is also known as Health in All Policies or Public Health in All Policies .

Models of health promotion

The model according to Caplan & Holland (1990) consists of four paradigms or perspectives of health promotion, which result from the type of knowledge (objective or subjective) and from the type of society (fundamental change or social regulation). The traditional view reflects the approaches of medicine and behavior change with imparting knowledge. The humanistic point of view draws on the approach of health information and education. The fundamental humanistic view is to be understood with the term “empowerment”. The fourth fundamental, societal perspective deals with the connection between social inequality and health.

Beattie developed a model in 1991 that consists of four strategies for health promotion (information and education, legislative activities, personal advice, community work), which result on the one hand from the type of intervention (authoritative or based on negotiation) and on the other hand on the Relate the starting point of thought (objective or subjective).

The Tones (1994) model contains the fundamental goal of rediscovering empowerment. Health promotion is the process of overall health-promoting policy multiplied by health education and health education.

The practical model from Tannahill (1996, divided into three interlinked intervention areas health education and prevention, prevention, health protection) is widely recognized among people working in the health sector. It keeps the whole spectrum of health promotion in mind.

Setting approach

It aims to change everyday life through low-threshold systemic interventions in specific living environments such as schools, businesses or districts that involve all those involved. The basic philosophy of the setting intervention is that the target groups acquire active skills (life skills) to perceive their own health-related interests (empowerment) and are not recipients of health-promoting messages and offers. Elements of the settings approach are the development of life skills. Participation is the participation or the degree to which individuals or groups can participate in decision-making processes and courses of action in higher-level organizations (e.g. trade unions, parties) and structures (society, state).

“Settings are organizations that represent a social unit recognized by their structure and task” (Baric, Conrad 2000, p. 18). It is therefore a question of relatively permanent social relationships from which important impulses for health (health burdens, health resources) emanate. According to the definition of the World Health Organization (WHO), health is the state of complete physical, mental, emotional and social well-being.

Health promotion at work and in companies

The employees in a company are a self-contained target group for health promotion. It increases the chance of participation in health programs, as there are already established communication channels in the companies. One reason for promoting health in the workplace is occupational health and safety , i.e. protecting employees from damage to their health that can be caused or increased by certain occupational activities. The aim of occupational health and safety is to avoid or reduce the unhealthy stress caused by the work environment. Health promotion in the workplace deals, among other things, with the areas of first aid and medical treatment, pre-employment examinations, accident prevention, monitoring of health and infection risks, education and advice on healthier lifestyles, procedures and regulations for creating healthier working conditions and the provision of services. In addition to nutrition and stress management, the promotion of physical activity is one of the three central pillars for improving the health of employees. Activity-related interventions are among the most common measures offered in companies.

Health promotion in schools and day care centers

Schools and day-care centers are seen as the most important health promotion settings, as they allow a large part of the population to be reached over many years. The special importance of schools and day-care centers is also based on the recognition that knowledge, attitudes and behaviors in dealing with health and illness are acquired in early childhood. It is important that the children and young people improve their understanding of health and make more conscious decisions about their health behavior.

Health promotion in the social living environment

The decisive factor in health promotion in this setting is that people define their social living environment themselves and have the feeling that they are doing something for their common future, the service offers and the appearance of their residential area. By dealing directly with the social structure and quality of life, residents can gain more control over their living conditions, get to know their neighbors, step out of isolation and have a say in decisions. The methods of health promotion in the residential environment originate largely from community work. The theory is used, for example, in neighborhood management, an instrument of the federal government's “Socially Integrative City” program. A second approach, the “healthy city” as defined by the WHO, is committed to a holistic approach (body, mind and soul) and should make an active effort at all levels (kindergartens, schools, companies, hospitals and general health promotion) be. The particular strength of health promotion in the residential area is the accessibility of socially disadvantaged people and thus the possibility of making an efficient contribution to promoting equal health opportunities.

Health promotion in primary health care and in the hospital

Primary health care is the first tier of local health care. The WHO “Health for All” program called for a reorientation of health services. The focus of the health system should be on primary care as the health promoting principles of participation, collaboration and equal opportunity can be integrated. Primary care provides a setting in which health promotion takes place at the primary, secondary and tertiary levels.

The hospital offers a wide range of opportunities for health promotion, as a large number of the employees are in close contact with the patients. This happens at a time when they have an increased awareness of health and disease. They are therefore more motivated to make decisive changes in their way of life. Health promotion in hospitals includes both measures for more holistic patient care and strategies to improve the working conditions of all hospital staff.

Health reporting

The health coverage is the health status and influencing him a population sizes and interprets the relationships. Individual health reports are created locally, e.g. B. 2010 by the Center for Health of the German Sport University Cologne. In 2012 the German Health Insurance Association (DKV) commissioned a second study. The result shows that young Germans live less healthily than ever before. 46 percent of people are overweight and 22 percent are active smokers. The population should be educated. Overweight and lack of exercise should be given just as much attention as AIDS prevention, demands Clemens Muth from the DKV.

Legal basis

Various legal bases apply to health promotion in Germany, some of which are fundamentally:

Digital health promotion

The term Digital Health Promotion (Engl. Digital Health promotion ) brings together all the measures and concepts that by supporting digital media and applications on the strengthening of health on the principle of salutogenesis aimed. The growing market for e-healthcare products such as wearables and health apps is also playing an increasingly important role. These support the process of sustained maintenance of health. However, there are also risks associated with the emerging products within digital health promotion. The subject of data protection is heavily debated and requires uniform legislation so that user data that provide information about the state of health of a user cannot reach third parties.

Health promotion expenses

According to the OECD , spending on prevention and public health increased by 6% between 2000 and 2005 and in 2005 averaged 2.5% of total national health expenditure in the 20 countries covered. The variance ranged from 0.6% (Iceland) to 6.1% (Canada), New Zealand (6.0%), the USA (3.5%) and Germany (3.3%) are above the average, France , Switzerland (2.1% each), Austria (2%) and Italy (0.7%) below.

Training, studies and professional field

Health promotion can be studied as a scientific education in Germany at several universities at Bachelor's and Master's level explicitly and with a focus on public health or prevention, but can also be found implicitly in various vocational training programs and courses such as B. Elderly care or nursing science. With the bachelor's degree in "Health Promotion and Prevention " at the Zurich University of Applied Sciences ZHAW , there has also been an opportunity in Switzerland since 2016 to train as a health promoter. The professional field is heterogeneous and ranges from activities in scientific institutions to corporate health management to self-employment, e.g. B. in consulting. There are two professional associations in Germany for health promotion professionals.

  • The professional association health promotion e. V. is a professional interest group for health economists. It was founded on May 15, 2004 in Magdeburg . The main concern of the association is the creation of transparency with regard to the qualifications of actors in the occupational field of health and prevention and the establishment of a uniform model for the occupational field of a health economist. Today around 380 members are represented in all professional and educational matters. The professional association organizes training courses, members' meetings and participates in congresses and specialist conferences.
  • The professional association for integrative health promotion e. V. was founded by graduates of the course of the same name at the Coburg University in 2007. The association represents its members in all professional policy matters and represents a platform for the continuous development of the professional profile. In addition to promoting further education and quality assurance, it works on the constant expansion of networking with relevant actors in health promotion. The professional association also supports students in their everyday studies. The professional association is independent in its work and does not pursue any economic interests.

Networks and organizations

Actors in health promotion are networked nationally and internationally at different levels :

literature

  • Stefan Bär: Sociology and Health Promotion. Introduction for study and practice. Beltz Juventa, Weinheim 2016, ISBN 978-3-7799-3407-3 .
  • Federal Center for Health Education (Hrsg.): Key concepts of health promotion and prevention. New edition. Publishing house for health promotion, Werbach-Gamburg 2011.
  • Gesundheit Berlin (Ed.): Getting active for health. Work aids for prevention and health promotion in the neighborhood. Berlin 2008.
  • Lotte Habermann-Horstmeier: Health Promotion and Prevention. Hogrefe Verlag, Bern 2017, ISBN 978-3-456-85707-7 .
  • Klaus Hurrelmann, Theodor Klotz, Jochen Haisch (Eds.): Textbook Prevention and Health Promotion. Bern 2010.
  • Jennie Naidoo, Jane Wills: Textbook of Health Promotion. 2nd, revised edition. Publisher for Health Promotion :, Werbach-Gamburg 2010.
  • Fred Paccaud: Disease Prevention and Public Health. In: Healthcare Switzerland 2007–2009. Publisher Hans Huber, Bern 2007.
  • Christian Schmahl: Corporate health management. epubli, 2012, ISBN 978-3-8442-4141-9 .
  • World Health Organization: Glossary of Health Promotion. Gamburg 1998.
  • Sintje Mayländer, Maria Walden, Tobias Stefan Kaeding (eds.): The vital company: How to get your employees moving. Richard Pflaum Verlag, Munich 2019.
  • Kirsten Haas: Improvement of cognitive performance through a measure of workplace health promotion: Investigation of participation and participant behavior . Dissertation TU Dortmund. Dortmund 2014 ( pdf )

Web links

Individual evidence

  1. ^ WHO: Ottawa Charter for Health Promotion. 1986. Translated: Ottawa Charter
  2. ^ Richard Hennessey, Roland Mangold: Making health promotion more effective. In: Social Security. Issue 11/2009, pp. 12–15. (PDF 2.32 MB).
  3. ↑ Aaron Antonovsky: Salutogenesis. To demystify health. German edition by Alexa Franke. dgvt-Verlag, Tübingen 1997, ISBN 3-87159-136-X .
  4. ↑ Klaus Hurrelmann, Theodor Klotz, Jochen Haisch: Prevention and Health Promotion . Huber, Bern 2010, p. 17.
  5. ↑ Martin Hafen: What is the difference between prevention and health promotion? In: Prevention - Journal for Health Promotion, H. 1 2004, pp. 8-11.
  6. ↑ Martin Hafen: What is the difference between prevention and health promotion? In: Bauch, Jost (Ed.): Health as a system. System theoretical considerations of the health system. 2006, Konstanz, pp. 129-138.
  7. ↑ Brigitte Ruckstuhl: Health Promotion. Development history of a new public health perspective . 2011, Weinheim, Juventa
  8. ↑ who.int
  9. ↑ a b c d e f Naidoo & Wills, 2003.
  10. ^ Richard Hennessey, Roland Mangold: Making health promotion more effective. In: Social Security. 11/2009, p. 14.
  11. ↑ rki.de
  12. ^ Russell Caplan, Ray Holland: Rethinking health education theory . In: Health Education Journal . tape 49 , no. 1 , March 1990, ISSN  0017-8969 , pp. 10-12 , doi : 10.1177 / 001789699004900103 .
  13. ↑ Rosenbrock 2004, pp. 155–159.
  14. ↑ Susanne Hartung / Rolf Rosenbrock: Setting approach / lifeworld approach . In: Federal Center for Health Education (Ed.): Key terms in health promotion - online glossary . doi : 10.17623 / BZGA: 224-i106-1.0 ( bzga.de [accessed on February 25, 2018]).
  15. ↑ Health promotion protection of data. (PDF) Retrieved March 22, 2019 .
  16. ↑ Sintje Mayländer, Maria Walden, Tobias Stefan Kaeding (eds.): The vital company: How to get your employees moving. Richard Pflaum Verlag, Munich 2019.
  17. ↑ bundesgesundheitsministerium.de
  18. ↑ Health apps: many opportunities, little evidence. Deutscher Ärzteverlag GmbH, accessed on April 22, 2019 .
  19. ↑ Health Promotion. Federal Ministry of Health, accessed on March 22, 2019 .
  20. ↑ Federal Commissioner for Data Protection and Information Security: Data Protection E-Healthcare. (PDF) Retrieved March 22, 2019 .
  21. ^ OECD Health Data 2007, Paris 2007.
  22. ↑ studycheck.de
  23. ↑ studycheck.de
  24. ↑ studycheck.de
  25. ↑ Bachelor in Health Promotion and Prevention. Retrieved on April 4, 2019 (Swiss Standard German).
  26. ↑ Professional Association of Health Promotion V.
  27. ↑ Professional association for integrative health promotion e. V.
  28. ^ Gesundheitsfoerderung-hochschulen.de
  29. ↑ hochges.de
  30. ↑ Healthy-staedte-netzwerk.de
  31. ↑ bmgf.gv.at
  32. ↑ dngfk.de
  33. ↑ dnbgf.de