Great expectations, modest success?

The possibility of using health promotion to achieve significant improvements in the health of populations at limited expense has been repeatedly discussed and advocated over decades. Healthy Europe asked European experts if this huge potential is now being exploited. Rüdiger Krech, Director of Health Promotion at the WHO; Caroline Costongs, Director of EuroHealthNet; Jan De Maeseneer, Chair of the Expert Panel on Effective Ways of Investing in Health of the European Commission; and Martin Dietrich, Acting Director of the Federal Centre for Health Education (BzGA) in Germany, took part in the survey.

Portrait of Rüdiger Krech, Director of Health Promotion at the World Health Organization based in Geneva
Photo: WHO

Rüdiger Krech is Director of Health Promotion at the World Health Organization based in Geneva.

Whether or not health promotion has gained in importance is a matter of perspective. You only need to consider the instruments of participation, empowerment, intersectoral cooperation and many more that have been initiated by health promotion, and of course enabled for other areas of public health. Or consider the settings approach and the understanding of social, commercial or political determinants of health. All this is part of mainstream public health today. Let’s be proud of it. Nonetheless, health spending is still focussed too heavily on tertiary care. To operationalise the understanding that health promotion is an investment and not a cost, we need to underpin this narrative with concrete and bold national health promotion action plans that identify time frames, budgets and clear accountabilities of stakeholders and the measurement of implementation. This is supported by the fact that WHO Director-General Tedros Adhanom Ghebreyesus – drawing lessons from the latest global public health emergencies – made health promotion the highest priority for the WHO’s work at the 75th World Health Assembly in May this year. I am sure that this will influence Member States when it comes to setting their priorities as well, and thus in the health promotion community we should be prepared to deliver tangible results. Let’s seize this opportunity: the current political environment can clearly mark a new era for health promotion. Taking an active role in the design of digital innovation should be another important factor.

Portrait of Caroline Costongs, Director of EuroHealthNet
Photo: EuroHealthNet

Caroline Costongs is the Director of EuroHealthNet, the European partnership for health, equity and wellbeing representing public organisations, agencies and statutory bodies working on public health, preventing disease, promoting health, and reducing inequalities.

Enhancing the long-term wellbeing of a population’s health is not an easy task due to the many underlying factors that contribute to the initial decline. Such improvement ultimately requires the reorientation of current economic and social structures – something which is challenging and often political.

As siloed approaches continue to prevail across Europe’s health sector, much work is needed to break down barriers and in turn enhance cooperation, specifically between the social, health and educational domains. Such cooperation is required to create a sustainable European workforce and grow financial capacities – key resources needed for an efficient and effective scaling of health promotion.

Furthermore, the recent crises – the COVID-19 pandemic, the war in Ukraine, inflation – have in turn led to an increase in socioeconomic inequalities and exacerbated society’s existing problems. Such an increase has subsequently contributed to a rise in chronic diseases, namely, cardiovascular diseases, diabetes, cancer, and mental ill health – particularly amongst those at the lower end of the social gradient. Going forward, such crises should lead us to take a critical look at our health systems and examine the way in which our society is designed, providing health promoters with new opportunities to engage and contribute towards decision-making.

However, all is not lost. The power of health promotion is already being witnessed across Europe through the many innovative initiatives that are taking place and from which we can learn and scale up.

With an extensive knowledge base to draw upon that encompasses the risk factors relating to ill health such as smoking, excessive alcohol use, unhealthy diets, and sedentary lifestyles, health promotion can take such factors and present solutions to tackle the underlying social, environmental, cultural, and economic conditions that affect society.

We as health promoters need to step up and impact policies that help people take control of their health and adapt to socioeconomic realities. Health promotion is back on the agenda.

Portrait of Jan De Maeseneer, Chair of the Expert Panel on Effective Ways of Investing in Health of the European Commission
Photo: private

Jan De Maeseneer is a Belgian family physician, has been Head of the Department of Family Medicine and Primary Health Care of Ghent University, and is Chair of the Expert Panel on Effective Ways of Investing in Health of the European Commission.

The great potential of health promotion for improving the health of populations and reducing costs of health systems had not been used before the COVID-19 pandemic, and the pandemic, the war in Ukraine, the energy crisis and also their economical impact have altogether aggravated its starting position. Nevertheless, the most important measures for using this potential have not changed. These measures were already expressed in the “Options to foster health promoting health systems” in November 2019 by the Expert Panel on Effective Ways of Investing in Health (EXPH), which was established by the European Commission. 15 experts from 13 countries and from a variety of disciplines like clinical care, health system organisation, health economics and patient empowerment are members of the EXPH.

The necessary actions include:

*       to establish policy structures and processes for the implementation of a Health in All Policies approach

*       the integration of health promotion within health services, with a particular focus on strengthening health promotion within primary care

*       sustainable financing for health promotion

*       and mobilising wider community participation and engagement.

Health promotion is an essential strategy for improving health equity and a key action underpinning the reform of health systems in Europe. Serious implementation implies shifting the focus of health systems from disease to health, which can be considered “a disruptive innovation”. It is up to the academic community and civil society to demand this, and a matter for decision-makers to finally realise it. Right now this is more necessary than ever.

Portrait of Martin Dietrich, Acting Director of the Federal Centre for Health Education (BzGA) in Germany
Photo: Carsten Kobow/BzGA

Martin Dietrich is Acting Director of the Federal Centre for Health Education (BzGA) in Germany and President of EuroHealthNet, the European umbrella organisation of public health institutes and health-promotion agencies.

Among the most important measures that will allow us to exploit the potential of health promotion are innovative approaches by governments to shift the focus of health systems to disease prevention and health promotion. This includes, for example, community-based provision of care, social prescribing, and using insights from behavioural and cultural sciences to provide information for policies. We need to enable people across the social gradient to better manage their own health, e.g. by facilitating forms of active mobility such as walking and cycling. To achieve this, the continuous task for all of us is to empower the people and make them health literate. We also know that an intersectional approach is crucial to preventing diseases and reducing inequalities. Despite that, multi-level, multi-stakeholder approaches to Health in All Policies remain a major challenge for policymaking in practice. The general goal remains: societies themselves need to both develop and internalise the value of health promotion. Such long-term societal learning processes lead to greater health literacy, higher awareness and a health-related mindset that empower people to make health-conscious decisions.