413
Global Programme on Health Promotion Effectiveness
Coordinated by the International Union for Health Promotion and Education
The Global Programme for Health Promotion Effectiveness (GPHPE) is a multi- partner initiative, coordinated by the International Union for Health Promotion and Education (IUHPE) in collaboration with the World Health Organization, and supported by a number of partners from across the world. The work carried out under the GPHPE is guided by a Global Steering Group (GSG) made up of representatives from each region and from major partner organisations.
The rationale of the Global Programme on Health Promotion Effectiveness is to focus on the principles, models and methods that relate to the evaluation of effective health promotion practice, taking regional and cultural variations into consideration.
The GPHPE aims to raise the standards of health promoting policy-making and practice world-wide by reviewing, building and translating evidence of effective- ness while stimulating debate on the nature of evidence of health promotion effectiveness.
Fundamentally, the GPHPE is concerned with how to:
• stimulate the evaluation of effectiveness,
• champion the development of appropriate tools and methods to do so, and
• support the implementation of this body of knowledge for use in practice and for advocacy.
Why is Evidence of Health Promotion Effectiveness Needed?
We need evidence:
• to identify the best possible ways to promote health;
• to make decisions for policy development and funding allocation;
• to demonstrate to decision-makers that health promotion works and is an effec- tive strategy in public health;
• to support practitioners in project development and evaluation;
• to show the wider community the benefits of health promotion actions;
• to advocate for health promotion development.
Distinguishing features of the GPHPE include that it:
➢ operates as a world-wide programme;
➢ advocates the importance of effectiveness to researchers, practitioners and decision-makers;
➢ cultivates regionally specificity, encouraging input from the developing world with a larger focus on non-Western views of effectiveness;
➢ promotes the development of unique evaluation approaches to accomodate emerging areas of interest; and
➢ employs the diversity emanating from the regional projects to foster opportun- inties for regions to exchange and learn from each other.
Volume I of the GPHPE Monograph series Global Perspectives on Health Promotion Effectivness aims to :
■ Provide a broad overview of issues of evidence, evaluation and effectiveness in health promotion.
■ Compare and contrast regional variations.
■ Codify commonality where warranted and emphasize differences where indi- cated.
■ Underline some key areas considered critical to health promotion throughout the world.
■ Serve as a background and companion document to the various regional proj- ect products.
Some Indicators of Achievement by the GPHPE
1. Representativeness
䊊
䊊 the extent to which health promotion initiatives from a diversity of countries, cultures, languages and peoples is represented in the monograph series and throughout the overall programme;
䊊
䊊 the extent to which health promotion interventions and projects are distinc- tively recognised.
2. Quality of reflection
䊊
䊊 the ability of the monographs to propose analyses developed to distinguish the specific features of effective health promotion;
䊊
䊊 the ability of an adequate number of critical examples from practice and other contexts to be sought out and presented, as well as the reviews of effectiveness which will take place.
414 Global Programme on Health Promotion Effectiveness
3. Relevance of knowledge for use
䊊
䊊 the extent to which the knowledge obtained from the programme is docu- mented in the monograph series and then translated into use by practitioners in the field;
䊊
䊊 the extent to which the knowledge obtained influences research priorities, as well as impact on advocacy for policy and decision making;
䊊
䊊 the general improvement in the knowledge-base for better education, training and capacity buildcing of health promotion professionals.
Programme Leaders and Contact Persons
Global Programme management team:
䉴
䉴 David McQueen (Global Programme Leader)
IUHPE Vice-President for Scientific and Technical Development E: dvmcqueen@cdc.gov
䉴
䉴 Catherine Jones (Global Programme Coordinator) IUHPE Programme Director
E: cjones@iuhpe.org
䉴
䉴 Global Programme Secretariat:
IUHPE
42 Boulevard de la Libération 93203 Saint-Denis Cedex, France T: +33 (0)1 48 13 71 20
F: +33 (0)1 48 09 17 67 W: www.iuhpe.org
GPHPE Regional Effectiveness Project Coordination:
䉴 䉴 Africa
Leader & Coordinator: Mary Amuyunzu-Nyamongo E: mnyamongo@aihd.org
䉴
䉴 Europe
Co-Leaders: Viv Speller and Ursel Broesskamp-Stone
E: viv.speller@healthdevelopment.co.uk / ursel.broesskamp@promotionsante.ch
䉴
䉴 Latin America
Leader & Coordinator: Ligia de Salazar E: lsalazar@emcali.net.co
䉴
䉴 North America
Co-leaders: Steve Fawcett and Marcia Hills E: sfawcett@ku.edu/mhills@uvic.ca Coordinator: Marilyn Metzler E: mom7@cdc.gov
Global Programme on Health Promotion Effectiveness 415
䉴
䉴 Northern Part of the Western Pacific Leader & Coordinator: Albert Lee E: alee@cuhk.edu.hk
䉴
䉴 South East Asia
Leader & Coordinator: Alok Mukhopadhay E: vhai@vsnl.com
䉴
䉴 South West Pacific
Leader & Coordinator: Jan Ritchie E: j.ritchie@unsw.edu.au
GPHPE supporters
• Health Promotion Switzerland
• Ministry of Health and Social Services, Quebec
• National Institute for Health and Clinical Excellence, England (NICE)
• The Netherlands Institute for Health Promotion and Disease Prevention (NIGZ)
• Public Health Agency of Canada
• Spanish Ministry of Health and Consumption
• United Kingdom Department of Health
• US Centers for Disease Control and Prevention (an agency of the Department of Health and Human Services)
• World Health Organization (WHO Geneva) GPHPE collaborators
• African Institute of Health and Development
• African Medical and Research Foundation
• Brazilian Association of Post-graduate studies in Collective Health (ABRASCO)
• Canadian Consortium for Health Promotion Research (CCHPR)
• Center for the Development and Evaluation of Public Health Policy and Technology (CEDETES), Colombia
• Center for Health Promotion and Health Education, The Chinese University of Hong Kong
• French Health Directorate
• French Institute for Prevention and Health Promotion (Inpes)
• NHS Health Scotland
• Oswaldo Cruz Foundation - National School of Public Health, Brazil
• Pan-American Health Organization (PAHO)
• University of Bergen, Norway
• Victorian Health Promotion Foundation (VicHealth)
• Voluntary Health Association of India (VHAI)
• WHO Collaborating Centre for Community Health and Development, University of Kansas
• World Health Organisation African Region (WHO/AFRO) 416 Global Programme on Health Promotion Effectiveness
GPHPE interested parties
• Cochrane Collaboration Health Promotion and Public Health Field The Community Guide
• Getting Evidence into Practice European Evidence Consortium
• IUHPE/EuroHealthNet Joint Special Interest Group on Health Promotion Evidence, Effectiveness and Transferability
Scientific and Technical consultants to the GPHPE
• Hiram Arroyo
• Anne Bunde Birouste
• Simon Carroll
• Spencer Hagard
• Saroj Jha
• Maurice Mittelmark
• Michel O’Neill
• Louise Potvin
• Marilyn Rice
• Valéry Ridde
• Hans Saan
• Kwok-cho Tang
• Elizabeth Waters
• Mabel Yap
• Pat Youri
Global Programme on Health Promotion Effectiveness 417
Index
Accountability and governance, 271–272 ACE-Obesity project, 142
Adaptive systems, 212
Advocacy, 14, 23, 33, 38, 39, 75, 76, 101, 102, 133, 134, 159, 172, 193, 194, 216, 218, 334, 345, 408–409
African Institute for Health & Development (AIHD), 227–228
Alcohol, licensing, 166 Alcohol Accords, 167
Alcohol related harm prevention, health promotion in, 163–165
economic interventions, 165–166 health education, school and community
interventions
community mobilization, 171–172 mass media campaigns, 171 school programs, 170–171 tertiary institution programs, 171 organizational interventions, 166–167 policy interventions, 167–170 Alcohol-related harm reduction, multiple policy to, 168–169 Allocational policies, 52
American Regional Project teams, 29 ANGELO (Analysis Grid for Elements
Linked to Obesity) workshop, 143 Anti-smoking laws, 158
see also Tobacco control programs AusAID see Australian Agency for
International Development (AusAID) Australian Agency for International
Development (AusAID), 247 Australian SunSmart efforts, 58–59
Ban, smoking, 158
see also Tobacco control programs
Blood alcohol concentration (BAC) limits, 167–168
Breastfeeding promotion, 136
Canada, public health initiatives actors, multiple, 61–62
implementation, diffusion of, 60–61 impossibility/implausibility of control
groups, 60
time frames, compressed, 59–60 Causal field models see Policy ontologies CBPR see Community-based participatory
research (CBPR) Centers for Disease Control
and Prevention (CDC), 16, 89, 95, 287, 299, 409
Child mental health promotion
and prevention capacity mapping project, 16
“Circle of Life”, 393, 397 Classical utilitarian model, 370 Collaborative policy dialogue, 34 Communication challenges and GPHPE,
24, 45–46
Community-based participatory research (CBPR), 228
Community interventions on social determi- nants of health, 225–227
Complexity theory, 342–343 Concentration curve and index, 377 Coordinated School Health (CSH), 108 Corporate governance, 272–273 Corruption, 274
Critical realism and critical realist evaluation, 340–341
CSH see Coordinated School Health (CSH) Cultural sensitivity, 252–253
419
Developing country, urbanization in, 90–91 Dialogue
definition, 33 effectiveness, 38 forms of, 34
and health promotion, 34 and IUHPE blueprint, 35–38
Diet, Physical Activity and Health (DPAS), 89 DPAS see Diet, Physical Activity and Health
(DPAS) Drink driving
legislation, 167 penalties for, 168 Drinking age, 168 Drug abuse, 75–76
EBM see Evidence-based medicine (EBM) Ecological model
of health promotion, 237 of human development, 69 Ecosophy postulates, 394 Effectiveness indicators, 315–317 Egalitarian model, 370
Empowerment, 76 dimensions of, 388, 389 effectiveness concept, 390–394 as health promotion outcome, 386–390
responsiveness, 394–395 of women, 76–77
ENHPS see European Network for Health Promotion Schools (ENHPS) EuroHealthNet, 23
European Network for Health Promotion Schools (ENHPS), 108
European Regional Effectiveness Project, 25, 35–38
Evidence-based medicine (EBM), 70–71
FCTC see Framework Convention on Tobacco Control (FCTC)
Filter’s companion manual conflict sensitivity, 251, 252 cultural sensitivity, 251, 252 good governance, 251, 252 social cohesion, 251, 252 social justice, 251, 252
Framework Convention on Tobacco Control (FCTC), 191–192
GAPA see Global Alliance for Physical Activity (GAPA)
Getting Evidence into Practice (GEP), 23 Global Alliance for Physical Activity
(GAPA), 98
Globalization
obesity prevention and, 143–145 and health promotion, 181–187 Global Programme on Health Promotion
Effectiveness (GPHPE), 13–29 aim of, 42
communication challenges, 24 component, global, 14
effectiveness and diversity, 13–15 European conference series, 27 European efforts, 288–289 evidence
debate, 295–296
and effectiveness, 293–294 evaluation, 284–286
methodologies and values, 292–293 field, 298–299
funding, 44
and Global Steering Group, 15, 29, 43 health promotion effectiveness, evidence of,
296–297
health promotion, evidence and conceptual challenges for, 289–291
history, 42–43
opinion, judgment, expertism and evidence, 294–295
organized efforts to discover evidence of, 286–288
partnership research in communication, 45–46 input, 44
leadership, 45 output, 46 processes, 44–45 products, 43–44
reduction versus complexity, 291–292 regional approach, strengths and weaknesses,
29–30
regional assessment and questionnaire, 15 accomplishment and resources, 26–27 attributes, 15–22
elements, rendered the task difficult, 24–25
feasibility, utility and productivity, factors contributed to, 23
vision, 28–29
regional effectiveness presentation Africa, 18, 22
Europe, 18–19, 22
Latin America, 17, 19, 22, 24–25 North America, 19–20
South East Asia, 21 South West Pacific, 16, 21 Western Pacific, northern, 17, 20–21 420 Index
Index 421
significance, 13–14 structure, 43 theory, 293–294
Global Steering Group (GSG), 43
Governance in health promotion effectiveness, 259–260
accountability, 261–262 corporate governance, 272–273 defined, 259–260
deliberative democracy, 271 effectiveness measurement
influence, 275–276 representation, 274–275 voice, 275
elements, 263–264
financial management and administrative systems, 274
governance and population health, pathways between, 262–264
indicators, 271
institutions and their roles, 272 legitimacy, 270
organisational structures, representation in, 272
power, 265–267
limitation and separation of, 273 reconceputalising participation, 267–270 GPHPE see Global Programme on Health
Promotion Effectiveness (GPHPE) GSG see Global Steering Group (GSG)
HCP see Healthy Cities Program (HCP) Health, risk factor for, 93–94
“Health for All”, India, 230
Health, social determination of, community initiatives and, 237–241
Health and Peace-Building Filter, 16 Health and social determinants of vulnerable
communities Delhi and Shiv Puri, India, 230
Khoj, 231–232
Voluntary Health Association of India (VHAI), 231
Health-enhancing physical activity (HEPA), 87–88
Health impact assessment (HIA), 74, 218 Health in urban environments, historical context
of, 203–204 Health policy
case studies, Canada, 61 definition, 53
effectiveness, 51–53, 57, 64–65 factors, 61
impact on health, 53–54 meta-review of, 55–59
Health promoting globalization interventions, 191 International Framework Convention on
Tobacco Control (FCTC), 191–192 polyphony of possibilities, 194–195 in theory, 195–197
treatment action campaign, 192–194 Health Promoting Schools (HPS), 108 Health promotion, 164–165
developing countries and effectiveness evaluation in, 363–364
ecological model of, 331 equity in, 367–369
effectiveness in health promotion and distributive justice, 369–370 redistribution, difficulties regarding, 370–372
evidence and conceptual challenges for, 289–291
feasibility for, 353–354 future research, 340
complexity theory, 342–343 critical realism and critical realist evaluation, 340–342
and globalization, 181–187 and health inequalities, 372–376
implementation process, associated with, 375
intervention effects, associated with, 376–377
intervention impacts, associated with, 377–378
planning process, associated with, 373–375 international context and its influence on
local practice, 356–357 in Latin-America, 359–360
evidence of effectiveness, 360–363 in practice, 356–358
settings approach, 329–331 challenges, 337–340 conceptualizing, 330–331 rationale for, 329–330 virtual settings, 334–335 socio-political context, 354–356 systems perspective, 331–332 and urbanization, 201–218 whole system organisation, 332–335 Health promotion effectiveness, 308–309
evidence of, 296–297, 358–359 governance see Governance in health
promotion effectiveness indicators, 315–317
measurement process, 306–308, 314–315 operationalization, 306, 308–309 systematic review, 311
transformation of data to information through analysis, 314–315
search for evidence of, 358–359 surveillance, 323–326
data analysis, 327
methodological aspects of, 318–319 as tool for measuring, 317
Health promotion, effectiveness and quality of challenges, 402–403
IUHPE initiatives for quality, effectiveness and equity, 401–402
IUHPE in new communications age, 405–416
IUHPE’s accountability, 406–407 effectiveness, 407–408 faith, 410–411
health promotion and for equity in health, 410–411
learning, 409–410
research using the resources of members, 407
problem of exclusion, 404 technologies, 403–404
Health promotion and obesity prevention, 125–128
evidence needs, 145
globalisation, effects of, 143–144 interventions, creating a portfolio of,
140–143
obesity, evidence on the burden and determinants of, 128–129 opportunities for action, 129–130
caveats, 134–135
settings and sectors, 131–133 strategies, 133–134 target groups, 130–131
potential interventions, effectiveness of, 135–136
breastfeeding promotion, 136 community settings, 139–140 cost effectiveness, 140
family-based and pre-school settings, 136–137
school-based settings, 137–139 workplace settings, 139
Health promotion and peace-building, 247–248 framework development, 248–249
concepts, 249–250
draft tool, preliminary trials of, 250–252 future directions, 256–257
health in fragile setting, 248–249 impact, attempting to measure, 248 learning from field
appraising conflict sensitivity, 253 cultural sensitivity, 252–253 good governance, 254–255 social cohesion, 254 social justice, 253–254
maximum impact, consolidating for, 255–256
Health promotion in school, 107–109 achievements of, 111–112 challenges in evaluating
convincing the health sector, 117–118 dissemination of the evidence of effectiveness, 117
empowerment and its evaluation, 120 equity and social justice, 119–120 outcomes, 120–121
concept, 108 effectiveness, 121
evidence of effectiveness of, 109–111 gaps in evidence
costs and benefits, evidence about, 116–117 education sector, evidence from the, 115–116
low-income countries, evidence from, 115 shared and participatory evaluation, 115 uncertainty, 114
priorities, 121
research and evaluation in, 112–114 Health promotion interventions, 15–22
Latin American regions, 17 South West Pacific region, 16 Western Pacific, northern, 17 Health promotion relevant to urbanism,
209–210
Health sector and school health promotion, 117–118
Healthy Child Development at Mitumba informal settlement Nairobi, Kenya, 227–229 additional activities, 229–230 Healthy Cities Program (HCP), 216–219 Healthy People 2010, 367
Healthy public policy, 53, 61–62, 189, 197 Healthy Settings approach, 17
HIA see Health impact assessment (HIA) HIV/AIDS prevention, 52
HIV in Zambia, 187–189 Hogares Comunitarios de Bienestar
Programme, Columbia., 77 HPS see Health Promoting Schools (HPS) HPS/CSH, 109, 111, 115, 116, 117, 119, 120 422 Index
Human development, ecological models of, 69
Hypothetical effect and policy, 56
ICBF see Institute of Family Wellbeing (ICBF) ID see Index of dissimilarity (ID)
Index of dissimilarity (ID), 387, 388 Indo/European Union dialogue, 37 INGO see International non-governmental
organizations (INGO)
Institute of Family Wellbeing (ICBF), 233 Integrated Child Development Scheme, India, 77 Integrated Pan Canadian Healthy Living
Strategy, 367
Integrated Programme for Child and Family Development, Thailand, 77
International non-governmental organizations (INGO), 405
International Obesity Taskforce (IOTF), 126 International Union for Health Promotion and
Education (IUHPE), 3, 13, 42, 78, 288, 401, 407
Interrupted time series approach, 323 Intervention, 110
and urbanization, 210–211
IOTF see International Obesity Taskforce (IOTF)
IUHPE Report to the European Commission, 42–45, 288–289
IUHPE’s accountability, 406–407 effectiveness, 407–408 faith, 410–411
health promotion and for equity in health, 408–409
learning, 409–410
research using the resources of members, 407
Kahnawake Schools Diabetes Prevention Project, 393
Khoj, 231–232
Leadership, 45
“Least coercion rule”, 56 Legitimacy and governance, 270
Maximin theory, 370 Mental health promotion, 67
challenges of evaluating, 70–73 communicating messages about, 77–78 community, 74–75
concept, 71–72
in developing countries, 75–77 effectiveness of, 67–68
demonstration, 69–70
evidence
for best practice, communication, 79–80 for policy making, communication, 78–79 to public, communication, 78–79 field of, 73
implementation, 78–79
low income countries, evidence base in, 75–77 policy interventions, 73, 74
policy makers and, 79
strengthening the evidence base for, 73–74 in workplace, 72
Milio’s assertion, 53–54 Mitumba, 227, 228 Modern urbanization
emerging economies / developing countries, 205–207
western / post-industrialized cities, 204–205 Move for Health, the Agita Mundo, 98
National-level / regional-level interventions, case studies, 98–101
Needs-based model, 370
Norway’s farm-food nutrition policy, 58–59
Obesity prevention and health promotion, 125–128
evidence, 126–128, 145 globalization, effects of, 143–145
interventions, creating a portfolio of, 140–143 obesity, evidence on the burden and
determinants of, 128–129 opportunities for action, 129–135 potential interventions, effectiveness of,
135–140
Operationalization, 306, 308–310
Ottawa Charter 6, 7, 38, 53, 65, 68, 95, 108, 160, 181, 183, 216, 217, 225, 238, 247, 283, 294, 328, 370, 378, 387
Ownership/libertarian theory, 370
Panchayati raj institutions (PRI), 17 PANDAI (Child Development and Mother’s
Care) Project, Indonesia, 77
PAPH see Physical Activity and Public Health (PAPH)
Participation and governance, 264–270 Partnership inputs and GPHPE, 44 Partnership research in GPHPE
communication, 45–46 input, 44
leadership, 45 output, 46 processes, 44–45
Index 423
Peace-building principles, 250 Physical activity
and health risk factor, 93–94
health promotion interventions, 88–89 in relation to government, media and
community agendas, 103
US Surgeon General’s report on, 94–95 Physical Activity and Public Health (PAPH),
training courses in, 95, 98 Physical activity effectiveness
challenges in demonstrating, 101–103 indicators of, 92
Physical activity promotion chronology
emergence of inactivity, 93–94 scientific evidence and health promotion policy and practice, relationship between changing, 94–95
criteria for good practice, eleven, 91–93 effectiveness in, 88–91
national-level / regional-level interventions, case studies, 98–101
Physical inactivity on disease burden, impact of, 94
Policy
entrepreneurs, 58 instruments, 52
mental health promotion, 74, 79 ontologies, 56
on population level mental health, 73–74 Population attributable risk (PAR), 377, 378 Population level mental health, policy interven-
tions on, 73–74 Power, 265–267
limitation and separation of, 273
Pricing policies and alcohol consumption, 165 PROAPE Programme, Brazil, 77
Promotion & Education, 43, 44, 401, 402 PRONOEI Programme, Peru, 77 Public policy, healthy
success of, 61–62
RAFA/PANA, 98
Randomised Controlled Trials (RCT), 68,113, 211, 296, 299, 307, 310, 337
RCT see Randomised Controlled Trials (RCT) Regional networks for physical activity
promotion, 98
Regional projects, development of, 14 Relative index of inequality (RII), 377 Rescue, theory to, 63–64
School, health promotion in, 107–109 achievements of, 111–112
challenges in evaluating
convincing the health sector, 117–118 dissemination of the evidence of effectiveness, 117
empowerment and its evaluation, 120 equity and social justice, 119–120 outcomes, 120–121
ways of persuading the education sector about values of, 118–119
concept, 108 effectiveness, 121
evidence of effectiveness of, 109–111 gaps in evidence, 114–117
costs and benefits, evidence about, 116–117 education sector, evidence from the, 115–116 low-income countries, evidence from, 115 shared and participatory evaluation, 115 uncertainty, 114
priorities, 121
research and evaluation in, 112–114 School health interventions, types of indicators
for, 120–121
School Nutritional Strengthening Program (SNSP)
Valle de Cauca, Columbia, 233–235 successes and challenges, 233–235 Server intervention and drinking environments,
166–167 Server litigation, 167 Setting for health, 329–330 Seven generations, 393
Slope index of inequality (SII), 377 Smoking, 378
ban, 158
see also Tobacco control programs Smuggling, tobacco taxes and, 155–157 SNSP see School Nutritional Strengthening
Program (SNSP) Sobriety checkpoints, 168 Social stratum, 359
Surveillance, 321–322, 323–324 data analysis, 323
measurement and effectiveness, 321–325 methodological aspects, 318–319
Swedish Health on Equal Terms Public Health Policy, 367
Swedish overall health policy, 58–59
Tackling Heath Inequalities: A Program for Action, 367
Theory-driven evaluation methods, 69–70 Tobacco control programs, 151–153
in Africa, 155–157 in Americas, 153–154 424 Index
in Europe, 154–155 other region, 158–159 in Southeast Asia, 157–158 Tobacco taxes and smuggling, 155–157 Tobacco use, health promotion against, 151
measuring effectiveness, issues in, 159–160
Training, translation of evidence,
dissemination and workforce development and, 95–98
Urban environment, 201–203 Urban health paradox, 357
Urbanism and health promotion, 214–216 Urbanization
and challenge to health promotion, 208–209
evidence, effectiveness and, 211–212 and health promotion, 201–218 intervention concepts in, 210–211
Urbanization, 357
Urbanization in developing country, 90–91
Valle de Cauca, Colombia, 233 VHAI see Voluntary Health Association
of India (VHAI)
Violence reduction programs, 76–77 Voluntary Health Association of India
(VHAI), 231
Western-based university system, 282 WHO, 13, 42, 89, 333, 336, 367, 368 WHO Healthy Cities project, 333–334 Whole system approach
ecological complexity, 339 healthy setting, 329, 334–345 integration and visibility, 339–340 Women empowerment, 76–77
World Health Organization (WHO) see WHO Index 425
