VCE Health & Human Development (Year 12) · Health Promotion · 22m read

Health Promotion — Frameworks and Strategies

Ever wondered why some health campaigns actually work while others fall flat? The Ottawa Charter is a powerful framework that flips the script—instead of just telling people to be healthier, it focuses on building the systems and environments that make healthy choices possible. You'll use this in almost every VCE exam, so mastering how to apply it to real initiatives (like school wellness programs or public health campaigns) is your key to strong marks.

Learning objective: Apply the Ottawa Charter framework to evaluate health promotion initiatives and explain health promotion principles.

By the end of this lesson you can:

• I can state and explain all five Ottawa Charter action areas.
• I can apply the Ottawa Charter to evaluate a health promotion initiative.
• I can distinguish health promotion, disease prevention and early intervention.

Health promotion frameworks are toolkits. The Ottawa Charter and other models tell you which tools to pick for each health problem.

Ottawa Charter for Health Promotion (1986)

The Ottawa Charter was adopted at the First International Conference on Health Promotion in 1986. It defines health promotion as:

> "The process of enabling people to increase control over, and to improve, their health."

This represents a shift in thinking: from health as individual responsibility to health as a product of social, environmental and political conditions.

### The three strategies (overarching)

• Enable — creating conditions that enable all people to achieve health
• Mediate — bridging different interests (government, industry, community, individuals)
• Advocate — arguing for policy and system changes that support health

### The five action areas

#### 1. Building a Healthy Public Policy

Putting health on the agenda of ALL policy makers — not just health departments. Requires that legislation, taxation, organisational change and fiscal measures all consider health impacts.

Examples: Plain packaging laws for tobacco; sugar taxes; minimum wage legislation; road safety laws (seatbelts, blood alcohol limits).

#### 2. Creating Supportive Environments

Changing the physical and social environments to support healthy choices — making the healthy choice the easy choice.

Examples: Cycling lanes; smoke-free public spaces; healthy food in school canteens; green spaces in urban areas.

#### 3. Strengthening Community Action

Empowering communities to own and drive health improvements for themselves. Communities often understand their own needs better than external experts.

Examples: Indigenous community-controlled health organisations; community gardens; local health networks; parent groups addressing childhood obesity.

#### 4. Developing Personal Skills

Providing health education and opportunities that increase individuals' knowledge, skills and confidence to manage their health.

Examples: School sexual health education; smoking cessation programs; chronic disease self-management courses; mental health first aid training.

#### 5. Reorienting Health Services

Shifting the health system from a focus on treatment and cure toward prevention and health promotion. Health services should serve the community, not just manage disease.

Examples: Primary care emphasis on preventive check-ups; allied health integration; chronic disease management programs; reducing hospital readmissions through community follow-up.

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### Principles of health promotion

Social justice: Health equity requires addressing the conditions that create disadvantage.

Empowerment: People are not passive recipients — they are active agents in their own health.

Partnerships: Effective health promotion requires collaboration across sectors (government, NGOs, community, private sector).

Sustainability: Programs must be able to continue over time; short-term campaigns rarely create lasting change.

Holism: Health is multidimensional — effective programs address multiple determinants simultaneously.

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### Levels of prevention

| Level | Aim | Example |
|-------|-----|---------|
| Primary | Prevent disease before it occurs | Immunisation, health education, tobacco control |
| Secondary | Early detection of disease | Cancer screening, diabetes checks |
| Tertiary | Managing existing disease, preventing progression | Cardiac rehabilitation, disease management |

Ottawa Charter application checklist

• Name the action area: Identify WHICH of the five action areas applies.
• Explain HOW it applies: Describe specifically what the initiative does that fits that action area.
• Link to health outcome: Explain how this action area contributes to improved health/reduced disease.
• Multiple areas: Good initiatives usually address multiple action areas — identify them all.
• Social justice lens: Evaluate equity — does the initiative reach those most in need?

Worked example (Hard)

Apply the Ottawa Charter to evaluate Australia's "Get Healthy" telephone coaching service (a free government health promotion program providing lifestyle coaching for adults).

1. Building a Healthy Public Policy. The government has committed public funding to provide this service free of charge — a policy decision that prioritises health promotion access for all income levels. Policy decision: universal access regardless of ability to pay.
2. Creating Supportive Environments. Telephone delivery creates a "supportive environment" by removing geographic barriers — available to rural, remote and time-poor individuals who couldn't attend in-person services. The phone environment is private and convenient.
3. Developing Personal Skills. This is the PRIMARY action area. The coaching explicitly builds knowledge and skills in nutrition, physical activity, weight management and stress management. Participants develop evidence-based strategies and confidence to maintain healthy behaviours.
4. Reorienting Health Services. By focusing on lifestyle modification and prevention, the program shifts attention away from treating disease (hospitals) toward managing risk factors before disease develops — a textbook reorientation of health services.
5. Evaluation. Strong on personal skills development and service reorientation. Limited on community action (no community component) and partial on policy (could be strengthened by commercial food marketing regulations as a complementary policy).

Answer: Get Healthy addresses four of five action areas, with Developing Personal Skills as its primary mechanism. Strengthening Community Action and commercial policy (to address food environment) would make it more comprehensive.

Worked example (Hard)

A government introduces a 20% tax on sugar-sweetened beverages (SSBs). Apply the Ottawa Charter to analyse this policy and evaluate its likely effectiveness.

1. Building Healthy Public Policy (primary). A sugar tax is the quintessential "healthy public policy" — using fiscal policy to influence health behaviour at the population level. The UK Soft Drinks Industry Levy (2018) achieved a 44% reduction in sugar content of taxed drinks within two years, as manufacturers reformulated products BEFORE the tax even took effect. This demonstrates that policy can change industry behaviour, not just consumer behaviour.
2. Creating Supportive Environments. A sugar tax changes the economic environment by making unhealthy drinks relatively more expensive. If revenue is hypothecated to health programs (as Mexico directed SSB tax revenue to water fountains in schools), the policy simultaneously creates healthier physical environments. This makes healthier choices relatively easier and cheaper.
3. Limitations and missing action areas. The tax alone does not develop personal skills (people need to understand WHY sugary drinks are harmful), does not strengthen community action (community ownership is absent from a top-down tax), and does not reorient health services. Additionally, an SSB tax may be regressive — low-income households spend a larger proportion of income on food and beverages, meaning the tax burden falls disproportionately on those who can least afford it.
4. Evaluation. Evidence from Mexico (12% sales reduction), the UK (44% sugar content reduction), and Berkeley, California (21% sales reduction) supports SSB taxes as effective. However, a comprehensive approach would combine the tax with: nutrition education (personal skills), community food programs (community action), and GP dietary counselling (reorienting health services).

Answer: An SSB tax is a powerful healthy public policy tool with strong international evidence. It is most effective when combined with other Ottawa Charter action areas — particularly personal skills development and supportive environmental changes that complement the price signal.

Common mistakes

• Listing the five Ottawa Charter action areas without applying them to the specific program in the question VCAA examiners want APPLICATION, not definition. Generic descriptions of action areas without connecting them to the actual program earn minimal marks. Fix: Always name the program first, then explain HOW the specific program fits each action area: "SunSmart's 'no hat, no play' school policy is an example of Building Healthy Public Policy because it uses institutional rules to make sun-safe behaviour the default."
• Confusing the three levels of prevention (primary, secondary, tertiary) with the Ottawa Charter action areas These are different frameworks. Levels of prevention describe WHEN intervention occurs (before, during, after disease). Ottawa Charter action areas describe HOW health is promoted (policy, environments, community, skills, services). Fix: Keep them separate: "Immunisation is PRIMARY prevention (prevents disease before it occurs), delivered through Building Healthy Public Policy (government-funded national immunisation program) and Reorienting Health Services (GP-administered in routine consultations)."
• Stating that "Developing Personal Skills" is always the most important action area The Ottawa Charter explicitly argues that information alone is insufficient — structural change (policy, environments) is essential for sustainable health improvement. Fix: Demonstrate understanding that multi-level action is needed: "While Developing Personal Skills raises awareness, it is most effective when supported by Healthy Public Policy and Supportive Environments — as demonstrated by tobacco control, where education alone had limited impact but combined with plain packaging, taxation, and smoke-free laws achieved an 11% smoking rate."

Why the Ottawa Charter shifted health promotion paradigms

Before the Ottawa Charter, health promotion was largely focused on individual behaviour change (the "lifestyle approach"): persuading individuals to exercise more, eat better and not smoke.

The Ottawa Charter recognised that this approach was inadequate and potentially unjust — it places full responsibility on individuals while ignoring the social, economic and environmental conditions that make healthy behaviour difficult or impossible.

The social-ecological model: The Charter recognised that health behaviours are shaped by:
- The physical environment (is healthy food available? are there safe places to walk?)
- Social norms (what do peers, family, media say is "normal"?)
- Policy context (do tax, regulation and subsidy favour healthy or unhealthy products?)
- Economic conditions (can people afford healthy food and gym memberships?)

This means that effective health promotion cannot rely on information alone — it must change the conditions that shape behaviour.

Example: "Eat 5 vegetables a day" campaigns (developing personal skills only) are largely ineffective in isolation. They become much more effective when combined with: healthy food subsidies (policy), reduced junk food marketing (policy), better food labelling (supportive environment) and community cooking programs (community action).

This multi-level, multi-determinant approach is the core insight of the Ottawa Charter — and remains the gold standard for health promotion 40 years later.

Practice questions

1. Australia's plain packaging laws for tobacco are an example of which Ottawa Charter action area?

   1. Developing Personal Skills
   2. Building a Healthy Public Policy
   3. Strengthening Community Action
   4. Reorienting Health Services

   (1 marks)

2. A council funds a program that provides free cooking classes to low-income families in an area with limited supermarket access, using local produce from a community garden. Apply the Ottawa Charter to evaluate this program.

   (4 marks)

Summary

• Ottawa Charter (1986): enable, mediate, advocate + five action areas.
• Five areas: Healthy Public Policy, Supportive Environments, Community Action, Personal Skills, Reorienting Health Services.
• Health promotion moves beyond individual behaviour to address conditions that shape health.
• Social justice, empowerment, partnerships, sustainability and holism are guiding principles.
• Levels: primary (prevent), secondary (detect early), tertiary (manage disease).