The Health Promotion Movement and Evaluation
Since the Alma-Ata Conference, the WHO and a large number of member countries, as an extension of the “Health for All” Principle, have supported a variety of inter- and intra-country HP-DP initiatives over the last 30 years: Healthy Cities, Health-Promoting Schools, Health-Promoting Hospitals, and Healthy Workplaces. The Ottawa Charter for Health Promotion (WHO, 1986), the Adelaide Recommendations (WHO, 1988), The Sundsvall Statement on Supportive Environments (WHO, 1991), the Jakarta Declaration on Leading Health Promotion into the 21st Century (WHO, 1997), and the Mexico Charter in 2000 continued to promote expansion, at the national and global level, of a “Health Promotion Philosophy.” A new Health Promotion Charter was adopted by the 700 international health participants and officials from 100 countries at the Sixth Global Conference on Health Promotion in Thailand (2005). The Bangkok Charter for Health Promotion highlighted the challenges facing global health, including the growing double burden of communicable and chronic diseases. The Charter called for a commitment to making health promotion a core responsibility for all governments, a key focus of communities and civil society, and a requirement for good corporate practice. The Charter calls on local, regional, and national governments to make investments in health as a priority and to provide sustainable financing for health promotion activities.
While there has been general agreement and support among a significant proportion of the domestic and global public health policy, science, and practice communities for a “Health Promotion Philosophy,” the cumulative body of valid empirical evidence from behavioral impact evaluations and economic analyses of a “Health Promotion Program Model” is very limited. A criticism of the health promotion field has been the tendency of its proponents to focus on the advocacy of the philosophy and breadth/scope of activity, for example, 500 Healthy Schools, 200 Healthy hospitals, and 100 Healthy Cities, but to place insufficient emphasis and commitment of resources to conduct rigorous scientific evaluations of individual “Health Promotion Programs.”
Unfortunately, when a program is based primarily on political advocacy and purports to be focused on sociopolitical determinants of health, is planned with little empirical evidence, and does not collect valid data to measure progress, it misses the opportunity to document health impact and health improvement. Evaluation results and evidence, for example, significant changes in behavior and health status, supporting the “Health Promotion Program Model,” have typically documented no significant impact. Systematic reviews, using meta-evaluation criteria, typically confirm that very few Health Promotion Program evaluations had adequate internal or external validity. The advocacy approach has produced much skepticism among the population health science community. These issues are discussed in greater detail in the next section.