Achieving Health for All: A Framework for Health Promotion
Health Policy and Communications Branch
Health Canada
2001
Table of Contents
Introduction
A New Vision of Health
National Health Challenges
Health Promotion as a Response
The Health Promotion Framework
Conclusion
Introduction
Canada has built a strong health care system, and has achieved for
its people a level of health of which we are all proud. We want to
continue in this tradition. While it is true that the prospects for
health of the average Canadian have improved over recent decades,
there nevertheless remain three major challenges which are not
being adequately addressed by current health policies and
practices:
- disadvantaged groups have significantly lower life
expectancy, poorer health and a higher prevalence of disability
than the average Canadian;
- various forms of preventable diseases and injuries continue
to undermine the health and quality of life of many
Canadians;
- many thousands of Canadians suffer from chronic disease,
disability, or various forms of emotional stress, and lack
adequate community support to help them cope and live
meaningful, productive and dignified lives.
The times in which we live are characterized by rapid and
irreversible social change. Shifting family structures, an aging
population and wider participation by women in the paid work force
are all exacerbating certain health problems and creating pressure
for new kinds of social support. They are forcing us also to seek
new approaches for dealing effectively with the health concerns of
the future.
This paper proposes an approach that is intended to help Canadians
meet emerging health challenges. We are calling this approach
"health promotion". It is an integration of ideas from several
arenas of public health, health education and public policy þ and
it represents an expansion of the traditional use of the term
"health promotion". We regard health promotion as an approach that
complements and strengthens the existing system of health care.
A New Vision of Health
In the past, when infectious disease was the predominant cause of
illness and death, health was defined in terms of the absence of
disease. By the mid 1900s, however, we had reduced the incidence of
many of these infections, and health had come to mean more than
simply not being ill. It was now defined as a state of complete
physical, mental and social well-being. In 1974, a federal
publication entitled A New Perspective on the Health of Canadians
put forward the view that people's health was influenced by a broad
range of factors: human biology lifestyle, the organization of
health care, and the social and physical environments in which
people live. `This representation of the factors contributing to
health legitimized the idea of developing health policies and
practices within a broader context.
Today we are working with a concept which portrays health as a
part of everyday living, an essential dimension of the quality of
our lives. "Quality of life"in this context implies the opportunity
to make choices and to gain satisfaction from living. Health is
thus envisaged as a resource which gives people the ability to
manage and even to change their surroundings. This view of health
recognizes freedom of choice and emphasizes the role of individuals
and communities in defining what health means to them.
Viewed from this perspective, health ceases to be measurable
strictly in terms of illness and death. It becomes a state which
individuals and communities alike strive to achieve, maintain or
regain, and not something that comes about merely as a result of
treating and curing illnesses and injuries. It is a basic and
dynamic force in our daily lives, influenced by our circumstances,
our beliefs, our culture and our social, economic and physical
environments.
This new vision of health does not represent a sudden or dramatic
shift in our thinking. It is a view which revisits and embraces
earlier ideas, and seeks to make them relevant to contemporary
problems.
National Health Challenges
As we broaden and deepen our understanding of health, we begin to
perceive with greater clarity the importance and magnitude of the
challenges now looming in the field of health. We also draw the
conclusion that our system of health care as it presently exists
does not deal adequately with the major health concerns of our
time.
The challenges we face today are not new. They have been
identified separately on various occasions in the past. However,
looking at these challenges together enables us to discern certain
trends. These trends suggest that we move toward the approach we
call health promotion.
Before exploring the practical meaning of health promotion, let us
examine in more detail the nature of the health challenges facing
Canadians. For the purposes of this document, we shall confine our
attention to those challenges deemed to be of national importance.
It is anticipated, however, that some communities may find these
generic national challenges overridden by problems of a uniquely
regional or local character.
Challenge I: Reducing Inequities
The first challenge we face is to find ways of reducing inequities in the
health of
low-versus high-income groups in Canada.
There is disturbing evidence which shows that despite Canada's
superior health services system, people's health remains directly
related to their economic status. For example, it has been reported
that men in the upper income group live six years longer than men
with a low income. The difference is a few years less for women.
With respect to disabilities, the evidence is even more startling.
Men in upper income groups can expect 14 more disability-free years
than men with a low income; in the case of women, the difference is
eight years.
Among low-income groups, people are more likely to die as a result
of accidental falls, chronic respiratory disease, pneumonia,
tuberculosis and cirrhosis of the liver. Also, certain conditions
are more prevalent among Canadians in low-income groups; they
include mental health disorders, high blood pressure and disorders
of the joints and limbs.
Within the low-income bracket, certain groups have a higher chance
of experiencing poor health than others. Older people, the
unemployed, welfare recipients, single women supporting children
and minorities such as natives and immigrants all fall into this
category More than one million children in Canada are poor. Poverty
affects over half of single-parent families, the overwhelming
majority of them headed by women. These are the groups for whom
"longer life but worsening health" is a stark reality.
So far, we have not done enough to deal with these disparities. As
we search for health policies which can take this country
confidently into the future, it is obvious that the reduction of
health inequities between high- and low-income groups is one of our
leading challenges.
Challenge II: Increasing the Prevention Effort
Our second challenge is to find new and more effective ways of
preventing the occurrence of injuries, illnesses, chronic
conditions and their resulting disabilities. Prevention
involves identifying the fac
tors which cause a condition and then reducing or
eliminating them. Immunization and the
chlorination of drinking water are prime examples of measures
introduced to prevent and reduce the incidence of infectious
disease. In the last century, through the efforts of public
health, the practice of prevention gained wide acceptance. In
fact, many prevention measures we take for granted today were
initiated during the 19th century
In recent years, the preventive effort has been extended into the
area of individual lifestyle and behaviour. The realization that
smoking, alcohol consumption and high-fat diets were contributing
variously to lung cancer, cirrhosis of the liver, cardiovascular
disease and motor vehicle accidents, led us to turn our attention
to reducing risk behaviour and trying to change people's
lifestyles.
Unfortunately, the causal relationships between behaviour and
health are not nearly as clear-cut as they are between "germs" and
disease. Today's illnesses and injuries and the disabilities to
which they give rise are the result of numerous interacting
factors. This means that prevention is a far more complex
undertaking than we may at one time have imagined.
In spite of this, there is considerable scope for prevention.
Already, children have been among the main beneficiaries. In
prenatal and neo- natal care, preventive measures have brought
about a marked reduction in infant mortality Notable progress has
also been achieved in preventing learning disabilities, and
preventive measures are helping, for example, to overcome the
difficulties associated with dyslexia, hyperactivity and speech and
hearing impairments. With regard to adults, it is estimated that
the use of preventive measures can lead to a future 50 per cent
reduction in the incidence of lung cancer and heart disease.
Challenge III: Enhancing People's Capacity to Cope
In this century, chronic conditions and mental health problems
have replaced communicable diseases as the predominant health
problems among Canadians in all age groups. Our third challenge is
to enhance people's ability to manage and cope with chronic
conditions, disabilities and mental health problems.
Conditions such as arthritis, hypertension, respiratory ailments,
dependence on drugs and chronic depression can all limit people's
capacity to work, to take care of themselves, to perform the
activities of daily living and to enjoy life.
Canada is experiencing an "age boom", and the number of older
people in this country will more than double within the next
thirty-five years. Thus, for Canada's older population, coping with
chronic conditions and the disabilities to which they give rise, is
a particular concern. It is often hard for those seniors who are
incapacitated by disabilities to function independently Everyday
tasks, such as taking a shower or opening a jar, become difficult
or even unmanageable.
It is particularly important to ensure that people are supported
in the area of mental health. Obviously, we cannot afford to
diminish our efforts to assist those who are suffering from serious
mental illness; however, it is essential that we assign equal
priority to helping people remain mentally healthy
Surveys indicate that many Canadians find their lives stressful.
Women are more vulnerable in this regard. The fact that women are
prescribed tranquillizers and anti-depressants more than twice as
often as men is a telling sign of the emotional strain women are
experiencing. For some, it may be the changing and uncertain nature
of their role that is unduly stressful. Others may be overwhelmed
by the burden of caring for family members, particularly those who
are chronically ill or disabled. For both men and women, job
burnout is taking an increasing toll. The changing nature of social
roles and factors such as unemployment have also had a bearing on
the emotional well-being of men, who may encounter health problems
including ulcers, dependence on alcohol and depression.
We know that anxiety, tension, sadness, loneliness, insomnia and
fatigue are often symptoms of mental stress which find expression
in many forms, including child abuse, family violence, drug and
alcohol misuse and suicide. Problems associated with mental stress
may occur in times of crisis, or be the result of accumulated life
circumstances.
Our challenge is to provide the skills and the community support
needed by people with disabilities and mental health problems if
they are to manage effectively lead stable lives and improve the
quality of their lives. We must also recognize the importance of
ensuring that informal care-givers have access to the support they
need. Many people, especially women, care for others on a regular
basis. The health and capacity of these individuals to manage is no
less important than the health of those for whom they care.
Homemakers, home care nursing, respite care and postal alert are
services which enhance the coping capacity of both those with
disabilities and their care-givers.
Reducing inequities, widening the prevention effort and enhancing
people's ability to cope are the principal challenges confronting
us as Canada enters the 21st century. It is toward these challenges
that we must dedicate our efforts and resources.
Health Promotion as a Response
So far, we have described a global, positive vision of health and
outlined three health challenges of major national importance. Our
ultimate responsibility is to ensure that the health of Canadians
is preserved and enhanced, a goal which can only be achieved if
each of us can be assured of equitable access to health. It is
clear, however, that existing policies and practices are not
sufficiently effective to ensure that Canadian men and women of all
ages and backgrounds can have an equitable chance of achieving
health.
In our quest for solutions to this problem, we asked ourselves two
questions: "What mechanisms are needed to effectively respond to
the emerging challenges?" and "What strategies or processes can we
implement in order to meet these challenges?"
We conclude that these questions can best be answered by a wider
application of health promotion. A health promotion approach would,
with the necessary effort and resources, integrate easily into the
present health system. We believe that just as health care is
acknowledged as a cornerstone of the Canadian health system, health
promotion is positioned to become another, equally important
cornerstone of that system.
People often associate health promotion with posters and
pamphlets. This is a simplistic view akin to associating medical
care with white coats and stethoscopes. In the words of the World
Health Organization, "health promotion is the process of enabling
people to increase control over, and to improve, their health". It
"represents a mediating strategy between people and their
environments, synthesizing personal choice and social
responsibility in health to create a healthier future".
It is quite true that, until recently, health promotion has relied
heavily upon the dissemination of health information, targeting
health messages to the public in the expectation that this would
somehow bring about the desired changes in people's lifestyles.
Although this approach did produce some shifts in attitudes and
health behaviour, these have been slight and slow. It became
increasingly evident that to be effective, information campaigns
should not take place in isolation; they had to be combined with a
variety of other activities. Health promotion became a multifaceted
exercise which included education, training, research, legislation,
policy coordination and community development. This perspective
gained fairly wide acceptance with many professionals and the
voluntary community By the mid 1970s, health promotion activities
were becoming more visible in schools, community health service
s,
drug and alcohol commissions and in the workplace.
Less than a decade later, several programs of national scope were
in operation. Covering a variety of themes, these major initiatives
were the result of cooperative efforts among several levels of
government and the voluntary sector. They included Dialogue on
Drinking; the Breast- Feeding Program; It's Just Your Nerves, a
program on women's use of alcohol and tranquillizers; Time to Quit,
a smoking-cessation program; Stay Real a drug information program;
and Break Free, a recent collaborative initiative aimed at reducing
smoking among young people.
Communities and voluntary groups committed to undertaking health
promotion activities at the local level were able to tap into
financial resources, including federal funding through New
Horizons, sustaining grants for voluntary associations, and the
Health Promotion Contribution Program. Across Canada, organizations
and groups as diverse as the Canadian Institute of Child Health,
the Disabled Individuals' Alliance, Le Centre des Femmes de
l'Estrie, the Alzheimer Society of Canada and many more contributed
significantly to this country's growing record of achievement in
health promotion.
The experience of the past ten years has confirmed our view that
health promotion provides an avenue for dealing with emerging
challenges, an approach which supports Canadians in improving the
quality of their health. In summary, it offers a means of achieving
health for all Canadians.
The Health Promotion Framework
We have taken a backward glance at our efforts in health and
assessed our progress. We have looked ahead and seen trends toward
serious inequities in health, particularly for disadvantaged groups
and coming generations of seniors. We have reviewed ten years of
experience in health promotion. Our conclusion is that the health
promotion approach offers considerable potential and scope to meet
the complex health challenges that face Canadians.
The Framework for Health Promotion described here provides a means
of linking the ideas and actions we regard as fundamental to the
achievement of health for all, the aim to which we aspire.
Earlier, we identified the national health challenges which need
to be overcome as we pursue this aim. Other key components of the
framework are a set of health promotion mechanisms and a series of
implementation strategies. We now present these mechanisms and
strategies, elaborating on their relationship to each other and to
the health challenges within the Framework for Health
Promotion.
For a visual representation of all these components and the
relationships among them, the reader is referred to the diagram
entitled `A Framework for Health Promotion"
We believe that the three mechanisms intrinsic to health promotion
are: - self-care, or the decisions and actions individuals take in
the interest of their own health; - mutual aid, or the actions
people take to help each other cope; and - healthy environments, or
the creation of conditions and surroundings conducive to
health.
When we speak of self-care, we refer to the decisions taken and
the practices adopted by an individual specifically for the
preservation of his or her health. An older person using a cane
when the sidewalks are icy a diabetic self-injecting insulin, a
person choosing a balanced diet, someone doing regular exercises:
these are all examples of self-care. Factors such as beliefs,
access to appropriate information, and being in surroundings that
are manageable play an important role in such situations. Simply
put, encouraging self-care means encouraging healthy choices.
The second health promotion mechanism, mutual aid, refers to
people's efforts to deal with their health concerns by working
together. It implies people helping each other, supporting each
other emotionally and sharing ideas, information and experiences.
Frequently referred to as social support, mutual aid may arise in
the context of the family the neighbourhood, the voluntary
organization, or the self-help group.
Informal networks are recognized as a fundamental resource in the
promotion of health. There is strong evidence that people who have
social support are healthier than those who do not. The value of
such support lies in its emotional and practical nature: it enables
people to live interdependently within a community while still
retaining their independence. A parent with a handicapped child, an
older person enduring arthritic pain, an adolescent using drugs:
these are people who need not only professional services, but
understanding and the sense of belonging that comes with being
socially supported.
A Framework for Health Promotion
In Canada, the "self-help movement" provides us with an abundance
of illustrations of mutual aid in action. Alcoholics Anonymous
(AA), One Voice of Seniors, Block Parents, the Coalition of
Provincial Organizations of the Handicapped (COPOH), and rape
crisis centres are some examples. Through self-help, people come
together to deal with the consequences of being unwell,
overburdened, bereaved, disabled, or in a situation of crisis.
The third health promotion mechanism is the creation of healthy
environment. This means altering or adapting our social, economic
or physical surroundings in ways that will help not only to
preserve but also to enhance our health. It means ensuring that
policies and practices are in place to provide Canadians with a
healthy environment at home, school, work or wherever else they may
be. It means communities and regions working together to create
environments which are conducive to health.
From this perspective, the environment is all-encompassing; the
concept of boundaries is inappropriate when we speak of the
promotion of health. The environment includes the buildings where
we live, the air we breathe and the jobs we do. It is also, for
example, the education, transportation and health systems. Because
of the breadth and scope of the environment thus understood,
environmental change becomes by far the most complex and the most
difficult of the three mechanisms or kinds of action required for
the promotion of health.
The public sector and others are already engaged, to varying
degrees, in encouraging people to care for themselves, to come
together for mutual support, and to change the circumstances and
surroundings which act as barriers to the achievement of health.
Yet, to the extent that there are in place policies and practices
which support the concept of health promotion, these tend to be
implicit rather than explicit. In most instances, they are not the
result of deliberate strategic planning. In our view, it is time to
clearly articulate a direction which is designed expressly to
promote the health of Canadians.
To do so means establishing a set of strategies, the
implementation of which will enable us to attain our aim of
achieving health for all. At the 77th Annual Conference of the
Canadian Public Health Association, we presented six strategies for
health promotion: ensuring access to health information;
encouraging consensus about particular health ideas; initiating
research in support of health promotion; fostering public
participation; advocating a strong role for the health care system,
particularly for community health services; and coordinating
policies between sectors.
Of these six strategies, there are three which provide a central
focus, and under which the others can be subsumed. In our view, the
leading strategies or processes whereby we can act decisively in
response to the health challenges confronting Canada are: -
fostering public participation; - strengthening community health
services; and - coordinating healthy public policy
Let us explore the strategies which we are proposing as a basis
for action in the field.
Strategy I: Fostering Public Participation
Health promotion means ensuring that Canadians are able to act in
ways that improve their own health. In the national quest for
health, people constitute a major resource, both individually and
in groups. Our experience confirms that people understand and are
interested in the circumstances and events that influence their
health. We know that they are seeking opportunities to take
responsibility
Encouraging public participation means helping people to assert
control over the factors which affect their health. We must equip
and enable people to act in ways that preserve or improve their
health. By creating a climate in favour of public participation, we
can channel the energy skills and creativity of community members
into the national effort to achieve health.
The enduring impact of public participation on health is well
documented. In the Vancouver "Be Well" program, a network of
seniors established a self-help model to encourage participants to
preserve their own health. Crocus Co-operative in Saskatoon offers
programs and counselling for post-mentally ill adults. In Quebec, a
multi-ethnic association provides information and assists
handicapped children and adults in making use of services. The
Canadian Sickie Cell Society has grown from a handful of volunteers
into a national organization dedicated to educating, testing and
counselling Canadians affected by sickie cell anemia. In a small
rural Ontario community, seniors came together to organize meal
services, friendly visiting and home help for their less able older
neighbours.
These examples illustrate how fostering public participation can
help us respond to one of our leading challenges, that of enhancing
people's capacity to cope. We could, in fact, take any of the
national challenges and produce evidence that endeavours initiated
by the public can provide effective responses to health concerns.
The conclusion is inescapable: public participation is not only
valuable, but essential to the achievement of health for all
Canadians.
Strategy II: Strengthening Community Health Services
Community health services are already playing an indispensable
role in preserving health. We believe that there should be an
expansion of this role and that it should be expressly oriented
toward promoting health and preventing disease. At the same time,
we recognize that adjusting the present health care system in such
a way as to assign more responsibility to community-based services
means allocating a greater share of resources to such services.
A health promotion and disease prevention orientation means that
community health services will have to focus more on dealing with
the major health challenges we have identified. For example, it
assumes that there will be a greater emphasis on providing services
to groups that are disadvantaged. It further takes for granted that
communities will become more involved in-planning their own
services, and that the links between communities and their services
and institutions will be strengthened.
In these ways, community health services will become an agent of
health promotion, assuming a key role in fostering self-care,
mutual aid and the creation of healthy environments. This will
involve coordinating programs much more closely with those of
social services in order to maintain momentum in the health
promotion effort. Given the present range of their
responsibilities, it is only logical that community health services
should play this expanded role in promoting the health of
communities.
We consider it especially important that community health services
become more active in helping people to cope with disabilities. If
people are to manage effectively, there must exist a continuum of
care which is flexible enough to meet their needs for support þ
whether temporary or long term þ without making unnecessary and
perhaps unsettling changes in their lives. To accomplish this, it
is vital that there be coordination of available services.
Community health services provide a natural focal point for
coordinating services such as assessment, home care, respite care,
counselling and the valuable work of volunteers.
People who are trying to cope with mental health problems would
also benefit from the strengthening of community health services.
While psychiatric treatment services clearly remain appropriate for
the seriously ill, those who are finding it difficult to manage
because of life circumstances could be assisted and supported by
community health services.
For all those seeking to take responsibility for their own health,
whether in groups or as individuals, community health services are
well situated to assume a far more prominent role in the health
promotion effort.
Strategy III: Coordinating Healthy Public Policy
The potential of public policy to influence people's everyday
choices is considerable. It is not an overstatement to say that
public policy has the power to provide people with opportunities
for health, as well as to deny them such opportunities. All
policies, and hence all sectors, have a bearing on health. What we
seek is healthy public policy.
We believe that health promotion is an appropriate way of
achieving our ultimate aim, that of equitable access to health. We
know that self- care, mutual aid and healthy environmental change
are integral to health promotion, and that they are mow likely to
occur when healthy public policies are in place. Policies that are
healthy help to set the stage for health promotion, because they
make it easier for people to make healthy choices.
All policies which have a direct bearing on health need to be
coordinated. The list is long and includes, among others, income
security, employment, education, housing, business, agriculture,
transportation, justice and technology It will not be an easy
undertaking to coordinate policies among various sectors, all of
which obviously have their own priorities. We must bear in mind
that health is not necessarily a priority for other sectors. This
means that we have to make health matters attractive to other
sectors in much the same way that we try to make healthy choices
attractive to people.
Conflicting interests may exist between sectors. Such conflicts
are intrinsic to our society. Take the example of tobacco. We are
proponents of a smoke-free environment. On the other hand, there
are Canadian farmers who cultivate this product for their
livelihood. Changes in tobacco policies have implications for
farmers and smokers alike. In this instance the creation of healthy
public policy necessitates responding to a situation with serious
health as well as economic implications.
The federal government has already begun the process of creating a
healthy public policy on tobacco. In October 1985, a cooperative
national program to reduce smoking was endorsed by the federal and
provincial/territorial Ministers of Health and seven non-government
organizations. There have also been consultations with the federal
departments responsible for agriculture, justice, transport,
revenue, and with the Treasury Board. As a result, several of these
departments are now reviewing their policies in relevant areas,
such as smoking in the workplace, crop substitution, tobacco
marketing practices and smoking on public transportation.
Impaired driving is another issue which is leading to
inter-governmental coordination at the provincial and federal
levels. From a health promotion perspective, the responsibility is
to make it socially unacceptable for people to drive while under
the influence of alcohol, and to reduce the often tragic
consequences of doing so. Other equally important responsibilities
include amending the criminal code, improving road safety, making
police enforcement more efficient and controlling the availability
of a
lcohol. In this context, coordinated changes to public policy
are being achieved through consultation and consensus among the
federal departments of Health and Welfare, Justice, Transport and
the Solicitor General, and their provincial counterparts.
Tobacco and impaired driving are only two examples of attempts to
ensure that public policy is coordinated. The fundamental point is,
however, that for public policies to be healthy, they must respond
to the health needs of people and their communities. This is so
whether they are developed in government offices, legislatures,
board rooms, church halls, union meetings or centres for
seniors.
The mutually-reinforcing strategies, taken together with the
mechanisms, comprise the basic elements of the Health Promotion
Framework. It is important to state that one strategy or mechanism
on its own will be of little significance. Only by putting these
pieces together, assigning resources, and setting priorities, can
we be certain that health promotion carries meaning and comes
alive. We believe the approach we propose allows us to respond
effectively and ethically to current and future health concerns.
Conclusion
This, then, is our proposal for a health promotion framework: a
vision of health as a dimension of the quality of life; an
articulation of the current and future health challenges
confronting this country; an understanding of health promotion as a
process enabling people to increase control over their health; an
identification of three mechanisms which can "energize" health
promotion, and, finally, an elaboration of the three implementation
strategies which we believe will make it possible for all Canadians
to achieve equitable access to health.
In summary health promotion implies a commitment to dealing with
the challenges of reducing inequities, extending the scope of
prevention, and helping people to cope with their circumstances. It
means fostering public participation, strengthening community
health services and coordinating healthy public policy Moreover, it
means creating environments conducive to health, in which people
are better able to take care of themselves, and to offer each other
support in solving and managing collective health problems.
There is a certain timeliness about health promotion. The signs
are evident across the country. Regional boards of health,
professional organizations, provincial and national councils and
voluntary associations are all articulating policies that support
the concept of health promotion. The most convincing evidence is
the voice of public support. People everywhere are demonstrating a
willingness to act on matters of health. Each year, for example,
federal funding programs receive thousands of applications for
resources to be used in community health projects. Low-income
women, seniors, native people, the disabled, immigrant groups and
many others are expressing their own ideas on the health needs of
their communities, as well as their eagerness to find ways of
meeting those needs.
We are aware that there are certain dilemmas inherent in health
promotion. For example, we cannot invite people to assume
responsibility for their health and then turn around and fault them
for illnesses and disabilities which are the outcome of wider
social and economic circumstances. Such a "blaming the victim"
attitude is based on the unrealistic notion that the individual has
ultimate and complete control over life and death.
Secondly, there is the question of allocating resources during
times of scarcity. The availability of financing is obviously a
critical question for each of us. Canada has performed fairly well
in controlling the growth of health care costs; however, cost
control is a matter of continuing concern. The pressures created by
an aging population and the growing incidence of disabilities in
our society will take a heavy toll on our financial resources. We
believe, however, that the health promotion approach has the
potential over the long term to slow the growth in health care
costs.
Every day, individual Canadians face difficult situations. We see
unhappy pregnant teenagers, abused children, women who are
depressed, seniors who are lonely, men in midlife incapacitated by
heart disease, and people suffering from incurable diseases such as
multiple sclerosis or arthritis. There is, however, another side to
this story We also see transition homes, family counselling, drug
treatment centres, self-help groups, efforts in the workplace to
hire the disabled and, above all, people moving voluntarily to help
themselves and to reach out to others. This is what we want to see
and this is what we want to encourage.
The Health Promotion Framework helps us formulate ways of dealing
with day-to-day health issues. We can use it to visualize the kinds
of mechanisms and strategies that are needed to support and
encourage Canadians as they strive to live healthy, full lives. The
framework links together a set of concepts, providing us with a
particular way of thinking about and taking action toward achieving
our aim of health for everyone in this country. Above all, health
promotion is an approach which can develop alongside and be
integrated into our sophisticated system of health care. Already,
in our private and professional lives, many of us are thinking and
behaving in ways that are consistent with the concept of health
promotion.
It will take time to give meaning to health promotion. A vital
element in the process will be nationwide discussion. This will
enable Canadians to assess the implications of health promotion.
The body of knowledge and experience is accumulating rapidly:
individuals and groups in many parts of the country are already
familiar with the approach we are calling health promotion.
We have the foundations upon which to build. Let us continue our
efforts to achieve health and improve the quality of life of the
people and communities of Canada.
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