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Health Promotion

Health Promotion

Health shouldn’t be considered simply a necessary condition for living, but a resource to preserve and nurture in everyday life.


What is “health promotion”?

“Health promotion is the process of enabling people to increase control over, and to improve, their health.”

The World Health Organization (WHO) used these words in the Ottawa Charter of 1986 to define the concept of health promotion, marking a turning point that was historic in certain ways: we should stop considering health simply as a necessary condition for living and start seeing it as a resource to preserve and nurture in our everyday lives.

Today, 35 years later, the guidelines featured in this document continue to be a fundamental point of reference that is still extremely relevant for health promotion policies and initiatives.

These initiatives follow two main directions. One is more connected to lifestyle and it involves information and awareness campaigns or projects aimed at promoting healthy behaviors among individuals and groups of people. The other one acts on a more general level, involving political, social, economic, and environmental actors in supporting the development of the many prerequisites needed to ensure and promote health.

The objectives are clearly indicated in the Ottawa Charter and were later reinforced in 1997 with the Jakarta Declaration to “address the challenges of promoting health in the 21st century.” They target five main action areas:

  • Building public policy that promotes health.

  • Creating supportive environments for health.

  • Strengthening community action.

  • Developing personal skills.

  • Reorienting health services by focusing their attention on the individual.

But how can these objectives be achieved in practical terms? And what are the so-called determinant factors that affect our health the most, both positively and negatively?

The determinants of health

Some of the factors that affect our state of health cannot be changed, like age and genetics, which are in fact called “non-modifiable determinants.”

Nevertheless, there are many other determinants (actually the majority of them) that are easily affected by changes and corrections: for instance, people’s lifestyle, their home and work environments, but also their political, social, and economic contexts.

Health promotion initiatives should focus in particular on the latter factors, starting from everything related to personal well-being, both mental and physical. Its importance is emphasized in the very definition of health, which the WHO inserted in its Constitution: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

Personal well-being stems above all from each individual’s lifestyle and habits with regard to factors like nutrition, physical activity, smoking, all the way to alcohol and drug abuse.

These are personal choices for which we are all individually responsible. Nonetheless, policies and social factors that foster health promotion can significantly impact people’s adoption of good behaviors. 


An example

A classic example of this is smoking and second-hand smoke. In 2003, Italy was one of the first European countries to adopt an anti-smoking law that banned smoking in all indoor public places, including private workplaces, stores, restaurants, gyms, and sports centers. 

The result was a marked decline in tobacco consumption, especially in the years immediately after the law came into effect. But, above all, it considerably reduced the health risks for non-smokers, limiting their exposure to second-hand smoke to a minimum.

Our Group also pays attention to the challenge of promoting health, as shown by the various projects supported by Enel Cuore. Among these:

  • Women for Haiti, a project for the prevention and diagnosis of breast cancer in this Caribbean country, where this disease is one of the leading causes of death among women. The project, developed in collaboration with the Fondazione Francesca Rava, led to the creation of the first hospital ward dedicated to the prevention, diagnosis, and treatment of breast cancer at the Saint Luc Hospital in Haiti. 

  • Itaca, a three-year project created by the Itaca foundation in 2019 to provide information on mental health disorders to high school students, teachers, and families. The objective in this case is to raise awareness of the risk factors and symptoms of mental distress, as well as ways to ask for and receive help.

Health at school

This project highlights a crucially important environment when it comes to health promotion: school.

The connection between school and the healthcare system was recently consolidated in Italy by a 2019 agreement between the State and the Regions called “Indirizzi di policy integrate per la scuola che promuove salute” (lit. “integrated policy guidelines for health promotion in schools”). The document incorporates the WHO’s recommendations with the objective of transforming health promotion in schools from a study topic into an integral part of daily educational activities. Health, in fact, is an essential prerequisite for the effectiveness of education.

This goal is also shared by the European network foundation Schools for Health in Europe (SHE): created in 1991 and supported by the WHO and the European Union, this network has been promoting the adoption of specific health promotion policies in schools for quite some time.

This is an endeavor that should start in early childhood: many scientific studies confirm that the cognitive, social, and physical skills developed in the first few years after birth will condition the entire course of a person’s life.

From this perspective, there has already been an ongoing transition aimed at changing kindergartens and supplementary services for early childhood from simple care facilities into actual educational centers that offer services and learning opportunities (following the so-called Nurturing Care Framework).

The WHO recently published some guidelines on this topic for policymakers as well as healthcare and education professionals. In particular, the 2020 Framework on Early Childhood Development in the WHO European Region identified the most important intervention areas to facilitate the adaptation of this approach to the European context.


Health at work

Another key environment for health promotion policies is, of course, the workplace.

In this case, the European point of reference is the so-called Workplace Health Promotion (WHP). This series of joint strategies aimed at improving workers’ health and well-being is based on the three pillars highlighted by the Luxembourg Declaration of 1997 (later updated in 2007): improving the work organization and working environment, promoting the active participation of workers, and encouraging personal development. Health and safety at work is regulated in Italy by the legislative decree no. 81/2008 (and subsequent modifications) called “Testo unico sulla salute e sicurezza sul lavoro.” (lit. “consolidated occupational health and safety act”)

The topic is very broad, and doesn’t just concern the physical safety of workers; it also addresses their well-being in the most general sense.

In this case, health promotion initiatives have to focus on the individual before the worker, paying special attention to situations and categories that are at greater risk.

Age is certainly one of the factors to be considered. Aging is strongly correlated to higher risks of health problems, often chronic, which could become debilitating or even incapacitating in certain workplaces if they are not taken into careful consideration. This is why health promotion becomes particularly important for anyone over 55 years old.

Naturally, the conversation should also include gender: women’s health conditions, especially in the over 55 category, need to be safeguarded. This is particularly true in a system where the organization of work and family in certain contexts is still strongly anchored in the patriarchal model.

All this without forgetting nationality and ethnicity: the rate of accidents in the workplace in Italy is higher among foreign workers.

Aside from the importance of thoroughly understanding the reasons for this asymmetry (some of which are already well-known, like communication difficulties and employment in high-risk sectors), we shouldn’t forget that every culture has a different perception of the meaning of health and, therefore, of risk conditions.


Community involvement

Naturally, the effectiveness of health promotion is directly proportional to its ability to get the community fully involved.

The COVID-19 pandemic was an example of community action. In early 2020, political and health authorities asked the entire population to adopt, in a very short time, a series of measures aimed at protecting their health and the health of the communities in which they live, with special attention to the most vulnerable groups. Despite major differences between one country and another, the response of the majority of the population was positive.

Generally speaking, prominent scientific studies have identified four essential conditions under which people actually respond to health warnings, with specific reference to the current pandemic: people have to believe they are personally susceptible to develop the disease; they have to perceive it as severe; they have to recognize the effectiveness of preventive action; and they have to believe they are capable of performing the preventive action.


Between health promotion and disease prevention

“An ounce of prevention of worth a pound of cure”, as Benjamin Franklin once said. But we could also add that “promotion is better than prevention.”

Even though health promotion and disease prevention are considered synonymous, they adopt very different approaches. The former aims to improve a person’s physical fitness, their well-being, and their quality of life, starting from their individual resources and abilities. The latter, instead, focuses more on risk factors and the health hazards represented by diseases and disorders.

In a nutshell, promotion aims to strengthen the strong points, while prevention weakens the weak ones. In any case, both are useful and mutually complementary approaches to achieving the same goal: taking care of everyone’s health.