Principles of practice
These principles reinforce a holistic approach to health promotion. They are all equal in value and are often interdependent on one another. They are important because they:
- come from national and state policies, directions and strategic plans, and consultation with health and community services staff
- are essential to health promotion because they provide actions for preventive health and health promotion interventions.
The principles have their foundations in the:
- is used to design health-promoting initiatives using information about what works.
- a way to evaluate your own practice and programs in an ongoing way to demonstrate if anyone is better off.
- joins research with patient values and knowledge.
- connects local practitioner experience with other expertise.
Using evidence informed practice allows the support of health promotion practice with theory while remaining flexible, innovative, and responsive.
We need evidence about:
- the health issue we are addressing
- why action is needed.
- what achieves the outcomes we want
- how to put what works into practice successfully
- who to involve, including partners, communities and key stakeholders
- how best to work together.
When using evidence in health promotion practice, we:
- consider the best data available from reliable and high-quality sources
- use the evidence to plan and implement actions
- consider both short-term and long-term effective outcomes
- take into account the capacity of the individual, organisation or community
- are sensitive to the specific context in which the health issue occurs (for example, setting, culture, history and available resources)
- recognise that moral, ethical, cultural and spiritual values may affect actions to improve health, as a client or a practitioner
- apply it in a systematic way for high quality evaluation
- use different measures such as quantitative data (for example the number of people affected) and qualitative data (for example information gathered from interviews or open-ended questions).
Where to go for evidence
Evidence used in health promotion could come from:
- service data or evaluations
- broad research base
- population health statistics, scientific journals and other publications (for example, the Australian Bureau of Statistics, local government reports or national policies or discussion papers).
Determinants of health
Health is not simply about behaviour. Social, environmental, economic, commercial, and cultural factors all shape our health and wellbeing. These are conditions in which people are born, grow, live, work and age. The determinants of health can create inequitable differences in health outcomes.
- The main factor is our position on the social ladder. Whether measured by income, education, place of residence or occupation, those people at the top of the gradient on average live longer and healthier lives. People at the lower end of the social gradient have at least twice the risk of serious illness and premature death as those at the top.
- Other determinants are stress, early life, social inclusion, work, unemployment, social support, addiction, food, housing, and transport.
- In Australia, living in rural and remote areas can also be a determinant of health due to isolation from services and older populations living in these regions.
- We also need to think about the way we build our cities and towns, grow and distribute our food and advertise products to children as other determinants of health.
Cultural determinants of health
The cultural determinants of health are important to understanding and improving the health and wellbeing of Aboriginal and Torres Strait Islander people. These include:
- connection to family, community, country, language and culture
- early childhood development, education and youth
- interactions with government systems and services
- law and justice
- health choices
- food security.
When we promote health and wellbeing, focus on the issues most relevant to people. For example, if a person is struggling, is unemployed or has poor housing, changing behaviours like smoking, poor nutrition or inactivity may be a low priority for them.
For vulnerable people or those with complex needs, the most immediate need is usually from the social determinants of health. Making sure our services and programs are culturally respectful and inclusive is important to help people with their health and wellbeing. We also need to work in partnership with other sectors to address the broader determinants of health.
Equity is about having the right services provided in the right ways and in the right places. This is achieved by removing unfair and avoidable barriers that compromise health and wellbeing and by supporting fair access, fair chances and fair resource distribution to alleviate any disadvantage experienced by some people. Priority population groups at risk of poor health include:
- Aboriginal and Torres Strait Islander people
- socio-economically disadvantaged
- living in rural or remote areas
- living with a mental illness, physical or intellectual disability
- living with the effects of abuse or neglect as a child
- affected by discrimination, social exclusion, incarceration
- people from culturally or linguistically diverse backgrounds, particularly refugees and survivors of torture and trauma.
An equitable approach in health promotion will:
- prioritise at-risk groups and those most in need and ensure access to services
- focus health promotion activities on the social determinants of health
- use community participation to strengthen all aspects of that community
- reduce social inequities to ensure every individual, family and community group may enjoy living, learning and working in a health-supporting environment
- work in partnership with other organisations.
Other equity considerations
- Health equity is not the same as health equality. Health equality does not exist—we do not and cannot have the same experience of health and wellbeing. We are all subject to vast individual differences, including biological factors such as genetics, sex and age.
- Health inequities are avoidable. They result from decisions that are out of the general public's control, such as unfair policy, legislation, welfare and healthcare funding allocation.
- Poverty, gender, sexuality, race and ethnicity all contribute significantly to inequities in health and in access to healthcare services. In Australia, there is a gap between Indigenous and non-Indigenous Australians because of the social disadvantage experienced by Indigenous people.
- Men and women have different health needs, so health service providers need to consider gender when planning for service delivery.
Working in partnerships can lead to better outcomes than working alone. Successful partnerships strengthen the capacity of projects and services to broaden their reach, engage more stakeholders and achieve shared objectives. Partnerships may be either strategic and concerned with the broad program concept or scope; or operational and concerned with resources, incentives, engagement and communication. Partnerships can be formal or informal and one-off, short-term or ongoing.
Benefits of partnerships
Partnerships are good for working in health promoting ways because they:
- help to reduce service gaps
- make systems easier for our community to understand and access.
- share resources, workloads, ideas, information, skills and knowledge
- increase the number of people we can reach
- increase what we can do
- can improve the quality of program
- involve people with different strengths and perspectives to improve planning, implementation and evaluation processes
- empower communities to achieve their well-being goals
- promote a shared approach to addressing areas that impact on health
- foster the sharing of resources, differing ideas, experiences, and strengths
- give our work a stronger voice
- allow us to better understand our community’s needs and how we can better support them
- help us be more creative and implement diverse strategies
- produce outcomes that are often more sustainable and long-lasting
- are a proven way to work with hard-to-reach groups by working with agencies they already trust
- help us work better with other services building understanding and trust
- improve referral processes.
Successful partnerships require:
- honesty and open communication.
- respectful negotiation.
- clear purpose and agreed expectations.
- a welcoming and supportive space so all partners can contribute to shared goals respectfully
- commitment and respect for the partners involved.
Health promoting partnerships occur when we:
- work in a person-centred way with consumers, their families and carers
- meet to plan coordinated strategies
- support the work of communities to achieve their health and well-being goals
- welcome and include consumers' views and contributions in planning, delivery and evaluations
- work as a team either within our service or across services
- have informal or formal arrangements with other agencies around sharing resources, knowledge, data or referrals
- formalise relationships and goals in memorandums that agree how to work together (for example, contracts, referral protocols, project plans and terms of references)
- network with others to stay up to date and invest in building improved relationships
- come together to achieve a project, set-up a new service, or lobby for change
- share information and knowledge about our work and our communities’ needs
- share skills and resources across teams and organisations
- coordinate our health promotion activities so we can add value to the work of others
- collaborate to combine our effort to reach shared goals.
A connected approach
To have the best health promotion impact, we can connect with others who are working on the same issue from another angle. Let’s take the example of healthy eating. To connect what you are doing with the individual to what others are doing, you could:
- connect with local groups who do cooking classes (health education and skill development)
- share recipes and information from the Dietitian’s Association of Australia or connect with an event in Nutrition Week (social marketing and health information)
- support a local group starting or running a farmer’s market (community action for social and environmental change)
- speak with management about having healthy food options in vending machines at work (settings and supportive environments).
Using a connected approach from different angles is the most effective way to make a difference. Having these different strategies running at the same time in your community ensures people are getting the same healthy message in many ways. It is our ongoing efforts that will make the most difference in the long term. The table below shows the continuum of health promotion interventions and capacity building strategies from the individual to the whole population.
Screening and individual risk assessment
Clinical testing to detect early signs of cardiovascular disease
Health education and skill development
Community-based healthy cooking demonstrations
Social marketing and health information
Population-wide campaigns to promote healthy eating and physical activity
Community action for social and environmental change
Parent advocacy for increased promotion and availability of healthy options in school canteens
Settings and supportive environments
Local government planning for increased physical activity opportunities in the community
This approach needs the support of a strong and well-resourced system to be effective. Investing in capacity building through developing organisations and the workforce is important.
Focusing on health promotion and prevention requires change in organisational systems and practices. Individuals and population groups need to be considered. A health system that has embraced systems change and is working in health promoting ways will:
- engage with clients to promote health and wellbeing at every chance
- address the determinants of health
- use several health promoting actions
- address health inequities
- ensure people who need the services the most get them
- use appropriate evidence
- work in partnerships with others
- engage with clients and community in a way that is meaningful to them
- seek to create environments that support health and wellbeing
- create and embed an ongoing culture of promoting health and wellbeing
- create partnerships to improve the determinants of health outside the scope of the health sector.
Systems thinking is a way of helping you better understand and make sense of complex situations.
Tips to engage in systems thinking
Questions to ask
Step back to see the bigger picture and explore what else might be influencing a situation.
What else is going on here?
Be aware of your mental model and how it influences your perspectives and actions.
What beliefs and values inform how I see, engage, and react to this situation?
See yourself in the system and how you engage, contribute and influence it.
What is my role in this situation? What can I influence?
Engage diverse perspectives to see a situation from different vantage points.
Who has a different perspective from my own on this situation and how might they see it?
Whose voice is not being heard?
Be present in the moment and listen deeply, without trying to ‘fix’ a problem.
Am I listening or wanting to talk?
Am I suspending judgement and criticism?
Am I being open to new information?
Question assumptions to surface what has informed them and to question if they are true.
What assumptions am I making about this situation and how can I test them?
Uncover unintended consequences before committing to a decision or action.
What else might happen if we do this?
What adaptations need to be made as a result?
Use visual modelling to make sense of, or explain a complex situation, which may reveal new insights.
Can I draw or illustrate this situation with diagrams, metaphors, relationships or symbols?
Look for connections and relationships between parts to gain new insights about the whole.
Which parts have a connection?
What is their relationship?
Is there an emerging or recurring pattern?
Reflect regularly on a situation, interpret and give it deeper learning.
What did I intend to happen and what actually happened?
What does it tell me about the system?
How can I work with this new insight?
Source: Australian Prevention Partnership Centre and Tasmanian Government
Making healthy choices isn’t just about having self-discipline. In some communities, it is easy to get fresh and affordable produce, while in other communities, people are limited to fast food outlets and convenience stores with less healthy choices. The most supportive environments make healthy choices the easiest choices. We need to turn places where people live, learn, work and play into supportive environments. When these environments are supportive, they foster participation in health and offer people protection from factors that can threaten good health.
Creating supportive environments may include:
- direct action to create policies, such as tobacco control legislation
- providing financial incentives or disincentives, for example, sponsoring alcohol-free events
- advocacy for change, for example, supporting community groups to advocate for banning junk food advertising to children
- providing education and empowerment, for example, teaching people in a disadvantaged community the skills to research local health needs
- strengthening links between health and environmental strategies, for example, implementing walking or cycling programs
- ensuring equitable access to supportive environments by mediating between conflicting interests in society, for example, promoting sexual health and wellbeing for people with disabilities being inclusive in planning, for example, consulting community members to identify the best approaches to health and wellbeing
- creating supportive settings for people using health services, for example, making waiting rooms feel welcoming
- promoting health in the workplace, for example, helping staff quit smoking.
Having those who have lived experience be part of the decisions and solutions will improve their health and wellbeing. We need to understand what matters most in people’s lives. This requires us to engage in ways that allow people to have ownership and involvement in all stages of health promotion activities.
Health promotion research shows that when people have control over their health decisions they have better and longer-term health outcomes.
People are more likely to engage when health promotion actions:
- are carried out by people and with people, rather than on people or to people.
- involve community development, person-centred care, self-management, peer-led and co-designed practices.
- seek and support people’s participation by sharing power, knowledge, resources, and decisions.
- include learning conversations about people’s health.
- provide opportunities for people to speak about their experiences, ideas, and hopes.
- acknowledge that good health is a shared responsibility, and the expertise and commitment of consumers makes a difference.
- commit to building relationships with the people and communities we work with.
- communicate and listen respectfully.
Empowerment occurs when tailored health promotion actions ensure people can:
- manage their health and prevent illness and be able to care for themselves, their family and friends.
- build knowledge, skills and resources that help them stay well, act early, and manage illness.
- develop a deeper understanding of health.
- realise what matters to them and understand what impacts their health.
- access services that match their needs and capabilities.
- have power and control over their health and wellbeing to improve their capacity, motivation, hope and confidence.
- make choices that improve their health.
To achieve this, we must support people to be active participants in decisions and actions about their health by:
- asking what matters, what helps and what hinders people and communities from making healthy choices
- ensuring service delivery matches people's health goals
- recognising we don’t all have the same life experiences
- empowering people to ensure their needs are met
- building individual and community knowledge, skills, resources and capacities
- giving power and control to people to build their ability, motivation, hope and confidence
- empowering people and communities to make better health choices which lead to better outcomes.