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to get the file - Fonds Gesundes Österreich

1.2 Health Promotion in an Historical, Social, Health Policy and

Economic Context

In its introduction, the expert report describes the development of health promotion

and prevention in an historical, social, health policy and also economic context. In the

estimation of FB+E, this is the only way to present the prevailing philosophies in health

promotion and prevention in a clear, distinct and understandable way. The major findings

of this analysis were as follows:

q Prevention and health promotion both have a long and varying tradition in

(medical) history extending back to Antiquity.

q The period after World War II must be viewed as atypical compared with earlier

periods (e.g. industrialization) in the focus on individualized curative treatment

by many health systems (especially in Austria and Germany) and in the neglect

of medicine for the general population. This was largely due to the after-effects

of the National Socialists having discredited this kind of medicine.

q The 1970’s saw an upturn in prevention in the form of secondary prevention

but the general approach of individualized curative treatment was retained. At

the same time, various European countries (e.g. Germany, Finland, Italy) conducted

model projects in primary prevention aimed mostly at cardiovascular diseases.

The objective of these projects was to demonstrate that morbidity and

mortality could be reduced with behavioral prevention measures based primarily

on risk factors of the type being carried out in the United States. This objective

was largely achieved.

q The advent of the “Health Movement” in the early 1970s (by no means the

first of its kind in history) created a platform for formulating and organizing

criticism of prevailing traditional medicine and of risk-factor oriented primary

prevention.

q The 1986 Ottawa Declaration of the WHO laid the first programmatic foundation

for a health promotion approach conceived as an alternative to risk-factor behavioral

prevention and based on worldly wisdom. This approach was subsequently

further underpinned theoretically by “salutogenesis”, a concept developed

by the Israeli-American medical sociologist Antonovsky.

q Since 1986, health promotion and prevention have attracted the increased attention

of researchers, politicians and the general public, particularly in a programmatic

sense, and have received some – quite limited – funding.

q With the demographic changes in society, increased life expectancy and the

scenarios they evoke of a further explosion of public health care costs, more

and more health economists are now recognizing and citing prevention and

health promotion as ways and means of reducing and/or stabilizing public health

costs.

q As a result of health economists’ increased recognition of the importance of

health promotion and prevention, these fields are now subject to the “efficiency

postulate” of health economics. This means that health promotion and prevention

measures must now be undertaken on the basis of evidence and that

their efficacy and efficiency must be demonstrated.

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