A pragmatic concept

Renowned health expert Ilona Kickbusch in an interview with “Healthy Europe” on the significance of health promotion in times of crisis, and on strategies for the future to achieve greater well-being among all citizens.

Interview: Dietmar Schobel


Over the last 2.5 years, the challenges presented by climate change have been joined by the COVID-19 pandemic, war in Ukraine and rising inflation. Does the political agenda have any room for an idealistic concept such as comprehensive health promotion as defined by the World Health Organization (WHO)?

Ilona Kickbusch: Comprehensive health promotion as described by the World Health Organization (WHO) may seem “idealistic” to some people. But the concept is actually highly pragmatic. It assumes that our health is only shaped to a comparatively small degree by the quality of health systems, and that the quality of our everyday life has a considerably greater influence. In other words, we need to be focussing on settings in which we “learn, work, play and love” as specified in the Ottawa Charter, which was approved at the first WHO Conference on Health Promotion in 1986.


What are the critical areas of life in those settings?

Ilona Kickbusch: Our health is influenced by all areas of social life – from the economy and infrastructure through to the education and social systems. And so the topic of health needs to be integrated into all areas of policy as well. However, in recent years there has been a lack of sustainable investment in the health of populations. And specifically, insufficient attention has been paid to strengthening vulnerable population groups. This is one of the reasons why the COVID-19 pandemic had such a severe impact on many countries. Especially in view of the challenges posed by the current crises, health promotion should and must retain its standing on political agendas in the countries across Europe and around the world. This can be justified from an economic standpoint as well, because even a relatively small amount of investment in health promotion measures can have a huge impact.


The Ottawa Charter was drawn up 36 years ago. How has health promotion developed since then, particularly in Europe as well?

Ilona Kickbusch: The principles of health promotion have now been adopted into the mindset of many young people and also many decision makers, as has the concept “Health in All Policies”. Nevertheless, it must be stated quite clearly that political action has failed to keep pace with this new way of thinking. That said, the Scandinavian countries deserve special mention as far as progress in health promotion across Europe is concerned. And the Prevention Act passed in Germany in 2015 was an important step because it commits the health insurance funds to making investments in the health of the population. There are also a number of cities where health promotion is being implemented systematically. Vienna is one example.


Where does the European Union stand right now as regards health promotion?

Ilona Kickbusch: When it comes to health promotion, there is still considerable room for improvement in most of the Member States of the European Union. Developing the EU towards a health union with more extensive decision-making powers could exploit this potential. Incidentally, the fact that health is supposed to play a larger role in future, including the forthcoming development of a common health policy, was also a key result of the “Conference on the Future of Europe”, which was organised in a participative process. At this conference, 800 EU citizens selected at random were invited to express their opinion between spring 2021 and spring 2022. Overall, it is a matter of turning the European Union into a socially equitable economic area where inequalities are reduced and a good, healthy life made possible for all. And also where environmental policy targets are taken seriously, such as limiting the rise in the average temperature around the world to 1.5 °C by 2050.


What are the most important strategies for the future concerning health promotion?

Ilona Kickbusch: Increasing importance is being awarded to coming together to deliberate issues affecting health, society, the economy and the environment, to process them with a target-oriented approach, and to use the synergies that are created in the process. In connection with this, the work of economic pioneers who advocate realignment of the economy has immense significance as well: instead of maximising profit at the expense of people and the environment, the economy should aim to achieve the highest possible well-being among citizens.

Instead of maximising profit, the economy should aim to achieve the highest possible well-being among citizens.



Can you give some examples?

Ilona Kickbusch: In her model of a “doughnut economy”, British economist Kate Raworth describes how basic human needs can be fulfilled without overstretching the natural resources of our planet. Cities like Melbourne, Brussels, Amsterdam, Berlin and Sydney are already trying to implement this concept. Economist Mariana Mazzucato suggests in her latest book “Mission Economy: A Moonshot Guide to Changing Capitalism” that we take a brave and targeted approach to addressing the major problems of our times, in a similar way to the US moon landing mission in the sixties. The World Health Organization (WHO) has already placed stronger emphasis on the necessity of our economies to realign and to rethink how we value health. For example, a “Council on the Economics of Health for All” chaired by Mariana Mazzucato was established at the World Health Assembly in November 2020.


What role does health promotion as a whole currently play in the work of WHO?

Ilona Kickbusch: At the 75th World Health Assembly in May this year, health promotion was made the highest priority of WHO. WHO Director-General Tedros Adhanom Ghebreyesus has declared that the urgently necessary change in paradigm towards promoting health and well-being and preventing disease by addressing its root causes must be accomplished. After all, in many cases, diseases are a consequence of poor diets, polluted environments, unsafe roads and workplaces, inadequate health literacy, and the aggressive marketing of products that harm health. The only way forward is to take action and achieve improvement through health promotion. The continual increase in the number of people who are overweight, obese or have chronic diseases incurs unaffordable costs for health systems over the long term. To counter this, it will also be necessary to raise the share of spending on health promotion and prevention from its current level of only three percent of overall state health expenditure.

The only way forward is to take action and achieve improvement through health promotion.

Portrait of global health expert Ilona Kickbusch

Ilona Kickbusch was born in Munich and studied sociology and political sciences at the University of Konstanz. Between 1981 and 1998 she worked for the World Health Organization (WHO) and was the key instigator of the Ottawa Charter for Health Promotion in 1986 which serves as the basis of health promotion at national, international and global levels. She is Founding Director and Chair of the Global Health Centre of the Graduate Institute for International and Development Studies Geneva, Switzerland, and Vice-President of the European Health Forum Gastein. Ilona Kickbusch is also a member of the Global Preparedness Monitoring Board (GPMB) – an independent monitoring and accountability body to ensure preparedness for global health crises, co-convened by the World Health Organization and the World Bank Group.


The “co-benefits through health promotion” in other areas of society will also be discussed in a session on this topic organised by the Austrian National Public Health Institute “Gesundheit Österreich GmbH” in the framework of the Austrian federal Health Promotion Agenda at the European Health Forum Gastein (EHFG) 2022 on Wednesday, 28 September 2022 from 11 am to 12.30 pm. This event will include an introduction of health promotion flagship initiatives in Europe and a discussion of the importance of innovative intersectoral approaches, and it will also address the health co-benefits of climate action at community level. Further details can be found in the EHFG programme.