Education And Debate

The search for evidence of effective health promotion

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7104.361 (Published 09 August 1997) Cite this as: BMJ 1997;315:361
  1. Viv Speller, senior lecturera,
  2. Alyson Learmonth, director of health promotionb,
  3. D Harrison, health promotion general managerc
  1. a Wessex Institute for Health Research and Development, Winchester SO22 5DH
  2. b North Durham Community Health Care Trust, Health Centre, Chester-le-Street, Durham DH3 3UR
  3. c North West Lancashire Health Promotion Unit, Sharoe Green Hospital, Preston PR2 8DU
  1. Correspondence to: Dr Speller
  • Accepted 3 February 1997

Introduction

A conceptually sound evidence base for interventions that aim to promote health is urgently required. However, the current search for evidence of effective health promotion is unlikely to succeed and may result in drawing false conclusions about health promotion practice to the long term detriment of public health. The reasons for this are threefold: lack of consensus about the nature of health promotion activity; lack of agreement over what evidence to use to assess effectiveness; and divergent views on appropriate methods for reviewing effectiveness. As a consequence health promotion may be designated “not effective” because it is being assessed with inappropriate tools.

What are we looking for?

Health promotion is a multifactorial process operating on individuals and communities, through education, prevention, and protection measures.1 The statement of principles known as the Ottawa charter for health promotion, developed by the World Health Organisation, is internationally accepted as the guiding framework for health promotion activity. This describes five approaches; building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services.2 Health promotion methods may include activities as diverse as awareness raising campaigns, provision of health information and advice, influencing social policy, lobbying for change, professional training, and community development—often in combination in complex interventions. However, health promotion is rarely judged on its effectiveness in all these areas.

Not just about individual behaviour

In Britain the Health of the Nation strategy's concentration on reducing disease and behavioural risk factors3 has overemphasised the role of health promotion in developing personal knowledge and skills and focused attention on assessing individual health outcomes. In Europe, however, health promotion emphasises the development of health promoting settings, such as schools, workplaces and hospitals, which aim to enable and support healthy behaviour. Practice therefore includes management and organisational development approaches.4 In the Pacific countries the emphasis is on sustaining …

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