INFORME TÉCNICO

What is the meaning of ‘health’? Before proceeding, it is important to understand what health really means. Different groups such as governments, social workers, health professionals, and farmers have defined health from many perspectives. Therefore there is no agreed upon on definition of health promotion.

One of the most often cited definitions of health comes from the World Health Organization (WHO). The WHO (1947) defined health, as “…a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.” From this perspective, health is more than the absence of disease, illness, sickness, and injury. It is a positive state of physical, mental, and social well-being. Mackintosh (1996) proposed that health was a human value and holistic concept that each individual perceives differently. In this point of view, the meaning of health focuses on individuals’ perception and varies in meaning. Parker, Patterson, and Hearne (2003) expanded the meaning of health by including spiritual dimensions. Spiritual health infers a religious involvement or a sense of being part of a world.

Thus, health is a state of well-being, which is a result of complex interactions between physical, social, emotional, and spiritual states. Health is dynamic as its perceived dimensions are continually changing both quantitatively and qualitatively. Health can also be defined in terms of an interaction between multiple dimensions of human life. Health, therefore, as a dynamic process and a positive construct, is necessary for the attainment of human values, human rights, and positive well-being. Health

promotion therefore is one of the most important strategies for individuals, families, and communities.

Sigerist (cited in Terris, 1984) first used the term health promotion in 1945. Sigerist defined the role of medicine in four dimensions: (i) the promotion of health (ii) the prevention of illness (iii) the restoration of the sick, and (iv) rehabilitation. In 1974 Lalonde issued The Lalonde Report that divided the health field concepts into four elements: human biology, environment, lifestyle, and health care organization. The basis of health promotion is still found in the WHO definition of health, which focused on holistic well-being. The Declaration of Alma Ata (WHO, 1978) conference reaffirmed that health was fundamental for human rights and attaining the highest level of health. The Alma Ata event also derived a new force field for health, which integrated social action, health advocacy, and public policy (WHO, 1978). In 1979, the WHO adopted the concept of ‘Health for All by the Year 2000’ as the global strategy for health as part of the Alma Alta Declaration. The declaration focused on a number of important principles for action. Principles such as equity and social justice, intersectoral collaboration, community participation, particular empowerment, and health promotion were

pre-requisites for health include access to adequate food, education, water, sanitation, housing, secure work, and a useful role in society (Commonwealth Department of Health, Housing and Community Services, 1993).

Further clarification of health promotion concepts came from The Ottawa Charter for Health Promotion from the first International Conference on Health Promotion in 1986. The Ottawa Charter defined health promotion as:

…the process of enabling people to increase control over, and to improve their health. To reach a state of complete physical, mental and social well-

being, an individual or group must be able to identify and to realize

aspiration, to satisfy needs, and to change or cope with the environment.

Health is, therefore, seen as a resource for everyday life, not the objective of

living. Health is a positive concept emphasizing social and personal

resources, as well as physical capacities. Therefore, health promotion is not

just the responsibility of the health sector, but goes beyond healthy life-

styles to well-being.

Health promotion plays a significant role not only in asserting people’s skill but also creating a supportive environment. The principle concepts embedded in the Ottawa Charter were as follows: (i) Healthy public policy (ii) Creating supportive environments (iii) Strengthened community action and participation in health promotion (iv)

Developing individual skills in health promotion by providing information, education, and enhancing life skills (v) Reorienting health services to enable individuals, community groups, and health care professionals to work together in pursuit of health. These

The second international conference on health promotion was held in Adelaide, South Australia, 5-9 April 1988, and focused on public health policy and establishing a supportive environment to enable people to lead healthy lives (WHO, 1988).

A third international conference on health promotion was held at Sundsvall Sweden, June 1991, which called for supportive environments for health (WHO, 1991). Environments refer to both the physical and the social aspects of our surroundings. This conference highlighted four aspects: the social dimension, the political dimension, the economic dimension, and women’s skill and knowledge.

A fourth international conference on health promotion was held in Jakarta, Indonesia, 21-25 July 1997, which came at a critical moment in the development of international strategies for health (WHO, 1997). This conference was the first to be held in a developing country and the first to involve the private sector as a health promotion partner. It identified directions and strategies needed to address health promotion in the 21st century. In short, the Jakarta Declaration stated four important principles of health promotion: Equity, empowerment, community participation, and the reorientation of the health services. Health inequalities between and within nations were viewed as

intrinsically unacceptable. Equity is the achievement of preventive medical outcomes and equitable distribution of resources. Empowerment is an essential means of ensuring that individuals and communities are able to make healthy choices. To achieve this goal, a supportive environment, which was composed of sound public policy and strengthened individual capacity, must be supported at every level. Active community participation was another essential principle to sustain efforts. Health must not be left to the medical

profession alone. Medical services should be reformed in term of intersectoral collaboration.

A fifth international conference on health promotion was held at Mexico 5-9 June 2000. This conference focused on improving the lives of economically and socially disadvantaged populations by addressing the social determinants of health (WHO, 2000).

To summarize, the six principles of health promotion that were derived from the international conferences were promoting social responsibility for health, increasing community capacity and empowering the individual, increasing investments for health development, securing an infrastructure for health promotion, strengthening the evidence base for health promotion, and reorienting health systems and health services.