Health promotion's record card: how principled are we 20 years on?

1 This year marks the 20th anniversary of the original paper on Health Promotion: Concepts and Principles, and the 10th anniversary of the International Union of Health Education including 'health promotion' in its title. Surely historians would rate the exponential growth of this new public health movement as extraordinary? Across the world there are government health promotion strategies and reviews, statutory authorities and foundations, consumer interest groups, professional associations and journals. University departments and professors proudly bear the name, Masters and Bachelor degrees are in abundance and a new textbook seems to appear every few months. Millions of dollars are now increasingly being invested in health promotion programmes by governments and international organizations such as the World Bank, as well as through voluntary contributions from people themselves (Catford, 2003). It is quite remarkable that this has all happened in just two decades. But how true is the practice of health promotion to those principles developed in 1984? The International Union for Health Promotion and Education (IUHPE) World Conference in Melbourne in April 2004 provides us with an opportunity to examine our record card and to build for the future. The origins of health promotion are complex and no single driver is responsible. However, most commentators would agree that the shift in thinking began to occur around an important global meeting of the World Health Organization (WHO) at Alma Ata in the state of Kazak in the former Soviet Union in 1978. The declaration that resulted crucially recognized that health improvements would not occur just by developing and financing health services, which had been the focus for investment since the Second World War (WHO, 1978). It provided the seedbed for the development of health promotion in the following decade to reach out to other sectors. Most notably, The Declaration of Alma Ata formally adopted primary health care (PHC) as the principle mechanism for health care delivery. This was a vital signal to developing countries that were increasingly investing in high-cost hospital systems, which were only available to a limited few, i.e. those in urban centres who could pay. Alma Ata heralded the shift in power, which is fundamental to health promotion, from the providers of health services (the doctors, nurses and health administrators) to the consumers of those health services and the wider community who ultimately pay for them. The consequence of the Alma Ata Declaration was that the majority of …