Definition

Health promotion encourages consumer behaviors with the goal of optimizing health potentials (physical, mental and psychosocial) through health information, preventive programs, and access to health care services. Health promotion efforts target individuals in group settings, peer groups, and communities to encourage sustainable, life-long behavior changes that maintain and improve health.

Health promotion strategies may be applied to a variety of population groups, age cohorts, risk factors, diseases, and settings. Strategies such as education, community development, policy, legislation and regulation may be used in some combination to address a wide range of health concerns ranging from disease specific issues to health disparities.

In contrast to the public health-influenced approach of health promotion, the concept of wellness is defined as an individual’s pursuit of emotional, mental, physical, social and spiritual well-being with the goal of reaching and maintaining one’s personal potential in his or her community. Wellness programs tend to emphasize the rewards of good health (outdoor activities, increased energy, feeling better,) as a way to encourage responsibility for lifestyle choices and prevent the negative consequences of poor health.

Health promotion and wellness strategies both work to promote individual responsibility. Both types of programs seek to motivate individuals to be accountable for their health and be active participants in their health and healthcare decisions.

Relevance and Challenges

Almost half of all premature deaths in developed countries are caused by unhealthy lifestyle choices with rates rapidly increasing in threshold and poor counties. Health promotion and wellness strategies aim to prevent many of these deaths and improve quality of life by encouraging people to exercise regularly, eat nutritious foods, avoid tobacco and excess alcohol, manage stress, enhance social networks and economic conditions, clarify lifestyle values, and achieve a sense of fulfillment in their pursuits.

Health promotion and wellness programs often take different approaches to imparting health information to the public. Health promotion, a concept that originated in the public health domain and was adopted by such groups as the World Health Organization, takes a more paternalistic approach to educational programming, often emphasizing negative consequences of poor health. In contrast, wellness programs are commonly rooted in and promoted by the commercial sector and evolved in response to the traditional health promotion strategies. Wellness programs tend to stress the benefits of healthy behaviors and encourage individuals to take responsibility for their lifestyle choices as active participants.

Regardless of the terminology, the key to creating successful wellness programming is moving past the exclusively stern health messages of the past and including positive incentives –adding “carrots” to the familiar “carrot vs. stick” scenario. Some health promotion programs depend on fear as the principal motivation for lifestyle change. However, positive messages have proven to be powerful in engaging individuals in lifelong lifestyle changes and may have greater long-term impact.

Context

Efforts in many developed countries such as France, New Zealand, and the United States demonstrate how health promotion, wellness, and prevention strategies can be implemented alongside traditional healthcare treatment to increase efficacy of care. Even with vastly different health care systems, each country has set goals for health and in some cases outlined specific methods for reaching those goals.

Historically, the French health care system has been oriented towards therapeutic rather than preventive care. In 2004, the French government adopted a new Public Health Act that outlined a five-year plan for public health that included health promotion and wellness outreach. The Act included 100 national public health objectives ranging from reducing smoking to addressing antibiotic resistance. The effort has had difficulty in reaching its goals. Critics argue that the absence of concrete measures have made it impossible to reach the goals.

New Zealand has taken a more targeted approach to wellness promotion by focusing on health disparities as well as overall population health. Beginning in 2001, the Ministry of Health authorized the Primary Health Organizations to provide preventative services to disadvantaged population groups such as low-income New Zealanders and the Maori, the island nation's aboriginal inhabitants. As of late 2007, the health targets have not been achieved with critics citing a lack of identifiable incentives as the problem.

The United States government began setting 10-year national objectives for promoting health and preventing disease in 1979. Known as “Healthy People”, the program sets and monitors national health objectives designed to meet a broad range of health needs, encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activity. The Healthy People program leverages lessons learned from the past decades, along with new knowledge of current data, trends, and innovations to improve messages for health.

Finally, the United Kingdom set health inequalities targets in 2003, to be met by 2010, around infant mortality rates and life expectancy figures. The targets are intended to narrow health disparity levels between the country’s poorest socio-economic classes and the poorest performing regions (28% of the population of England). Local authorities are supposed to compete against each other to improve health. While the health in these communities is improving somewhat, the gap between these under-served areas and the general population continues to widen. Critics argue that the program does not include adequate incentives.

Innovative Options - Country Examples

The idea behind health promotion and wellness is that “good health does not just happen anymore”, as many people today lead sedentary, urban lives. The following examples represent public and private efforts that promote good health and wellness through a variety of strategies.

United Kingdom On-Line Wellness Programming

A core principle of the United Kingdom’s National Health Services is "to provide information services and support to individuals in relation to health promotion, disease prevention, self-care, rehabilitation and after-care." NHS fulfills this mission by providing ample information on its website and disseminating information to a wide audience. The detailed, user friendly NHS website includes a multitude of resources. Consumers can find:

• Over 100 healthy recipes, meal planners and shopping lists
• General “wellness” resources including detailed information on treatments and conditions,
• Interactive health calculators and symptom checkers,
• Topical news stories on health, and
• Seasonal issues (e.g. increase risk of salmonella at summer barbeques, ways to get exercise in the winter)

Programs focus primarily on positive benefits of good health such as a recent campaign called “Living Well: Healthy Living for Everyone,” which provides tips for healthy living. In contrast to traditional programs that focus on the bleak consequences of poor health choices, these campaigns focus on more positive benefits of health improvement. An article on quitting smoking argues “quit smoking and boost health” – informing readers that “after 15 years of not smoking, your risk of heart attack is the same as if you never smoked at all.” This perspective provides a stark contrast to traditional strategies emphasizing risk of lung disease or pictures of diseased lungs.

Healthwise Handbook (Boise, Idaho, USA)

Healthwise is an organization which develops consumer health content to help people make health decisions that are right for them. A major component of their efforts is the Healthwise Handbook which helps people make better health decisions for themselves and their family. The Handbook includes detailed information on health topics ranging from ear infections to asthma. First published in 1975, over 30 million copies have been distributed. Now in its 17th edition, the handbook teaches readers:

• When to call a health professional;
• Home treatment and prevention;
• How to prepare for health care visits and communicate effectively with the provider;
• How to make lifestyle choices to improve health;
• How to find more information; and
• How to live better with chronic disease.

Healthwise company also develops consumer materials on specific health topics (chronic diseases) to provide consumers with information to help them make better health decisions. The informational materials are used by hospitals, health insurance plans, and disease management companies.

Kaiser Permanente’s Prevent Heart Attacks and Strokes Everyday (PHASE)

Kaiser Permanente, a population-oriented integrated delivery system based in the California area, sponsors a program to promote heart health and wellness. Implemented at the community-level, the program, Prevent Heart Attacks and Strokes Everyday (PHASE) provides information on how to prevent heart attack or stroke through appropriate medication and lifestyle changes. The program identifies and manages people at high risk of heart attack or stroke -- those with diabetes, coronary artery disease, chronic kidney disease, or previous stroke or heart attacks. Participants are provided with information on how to talk to their provider about heart medications, as well as healthy eating, physical activity, and weight management. Rather than just providing participants with education materials, the program provides classes on these topics with an eye toward mentoring and a relaxed approach.

Using a more narrowly focused effort, PHASE is implemented at the community level by partnering with community health clinics and tailoring programs to specific communities. The program empowers individuals to reduce their risk of heart attack or stroke. The program’s success demonstrates that targeted educational efforts with useful tools can have a dramatic impact on improving health.