Promotion

care should be relevant to all countries (Kaprio 1979). Those, however, with established
primary care medical services paid little attention to the idea (Green 1987).
The rapid development of health promotion thinking and practice began in the
early 1980s. A key early influence was a discussion paper in 1984 often referred to as the
Copenhagen document (WHO 1984). This presented a socio-ecological model of health
and considered the principles of health promotion, areas of action and priorities for
the development of policies. Health was seen as a resource for everyday life, with an
emphasis on social and personal resources, as well as physical capacities, and viewed
positively rather than as the absence of disease. Health promotion was described
as: ‘the process of enabling people to increase control over, and to improve their health’,
a statement which was widely adopted. The document outlined five key principles of
health promotion:
• It should involve the population as a whole rather than focusing on people at risk
for specific diseases.
• It should be directed towards action on the determinants or causes of health and
required, therefore, cooperation of sectors beyond health services.
• It should combine diverse, but complementary, methods including communication,
education, legislation, fiscal measures, organizational change and community
development.
• It should aim at effective and concrete public participation.
• Health promotion was not a medical service but health professionals had an
important role in nurturing and enabling it and had a special contribution in
education and health advocacy.
Thinking about health promotion was refined further through a series of conferences
and associated documents (WHO 1986, 1988, 1991, 1997, 2000, 2003). Possibly
because it came early in the development process the Ottawa Charter (WHO 1986) has
been the document most widely quoted. It endorsed the above definition for health
promotion and set out the prerequisites for health as: peace; shelter; education; food;
income; a stable ecosystem; sustainable resources; and social justice. In order to secure
health improvements three prerequisites were needed:
• advocacy for health representing the interests of disadvantaged groups and
lobbying to influence policy;
• enablement: achieving equity in health through reducing differences in health
and ensuring equal opportunities and resources to enable all to achieve health
potential;
• mediation: social groups, professionals and health personnel had a major
responsibility to mediate between differing interests in society for the pursuit of
health.
The key action elements of health promotion listed in the Ottawa Charter and
consistently used thereafter to categorize practice were:
• Building healthy public policy
MENTAL HEALTH PROMOTION 35