Healthy Settings, the settings-based approaches to health promotion, involve a holistic and multi-disciplinary method which integrates action across risk factors. The goal is to maximize disease prevention via a "whole system" approach. The settings approach has roots in the WHO Health for All strategy and, more specifically, the Ottawa Charter for Health Promotion. Healthy Settings key principles include community participation, partnership, empowerment and equity.
The Healthy Cities programme is the best-known example of a successful Healthy Settings programme. Initiated by WHO in 1986, Healthy Cities have spread rapidly across Europe and other parts of the world. Building on this experience, a number of parallel initiatives based on similar principles were established during the late 1980s and early 1990s within a number of smaller settings such as villages, schools, or hospitals.
This web site is the first step towards a comprehensive resource to support users of the Healthy Settings approaches for disease prevention and health promotion. It is the primary source of information for:
- Definition of Healthy Settings
- Types of Healthy Settings
- Activities in the WHO regions
- Selected intiatives
- News and events
- Publications
Introduction to Healthy Settings
The World Bank
History of the Healthy Settings movement
The Healthy Settings movement came out of the WHO strategy of Health for All in 1980. The approach was more clearly laid out in the 1986 Ottawa Charter for Health Promotion. These documents were important steps towards establishing the holistic and multifaceted approach embodied by Healthy Settings programmes, as well as towards the integration of health promotion and sustainable development.
Building on the Ottawa Charter, the Sundsvall Statement of 1992 called for the creation of supportive environments with a focus on settings for health. In 1997, the Jakarta Declaration emphasized the value of settings for implementing comprehensive strategies and providing an infrastructure for health promotion. Today, various settings are used to facilitate the improvement of public health throughout the world.
Definition of a setting
A setting is where people actively use and shape the environment; thus it is also where people create or solve problems relating to health. Settings can normally be identified as having physical boundaries, a range of people with defined roles, and an organizational structure. Examples of settings include schools, work sites, hospitals, villages and cities.
Action to promote health through different settings can take many forms. Actions often involve some level of organizational development, including changes to the physical environment or to the organizational structure, administration and management. Settings can also be used to promote health as they are vehicles to reach individuals, to gain access to services, and to synergistically bring together the interactions throughout the wider community.
Development of Healthy Settings
Following the Ottawa Charter and Jakarta Declaration, healthy setting programs took off predominantly in Europe and the Americas. The primary form of implementation has been the Healthy Cities program; however, via pilot projects and expansion efforts, many other Healthy Settings have been established throughout the two regions. Today, efforts have been made in all WHO regions to expand the movement.
Place of Healthy Settings today
The successes of settings-based approaches have been validated through internal and external evaluation and experiences. Healthy Settings provides a cross-over approach that is applicable to many intervention efforts covered by the WHO mandate. Thus, given appropriate and accessible information sharing to guidance and program development, Healthy Settings stands to be a strong tool in to protect public health and foster responsible development. Healthy Settings remains a useful, dynamic method to integrate risk factors and address disease prevention aiming to improve overall quality of life.
Types of Healthy Settings
The World Bank
Overview of approaches
Healthy Setting approaches have been implemented many different ways in multiple areas. A list of all existing Healthy Settings projects, including initiatives and documented activities, can be found below. Each link includes a description of the approach, describes the fundamental theory of the programme, and provides information on implementation, existing networks, and available resources for each application.
- Cities
- Villages
- Municipalities and Communities
- Schools
- Workplaces
- Markets
- Homes
- Islands
- Hospitals
- Prisons
- Universities
- Ageing
Types of Healthy Settings
Healthy Workplaces
Background
The World Bank/Anvar Ilyasov
With the global trend of increasing hours spent at the workplace over recent decades, the importance of protecting and promoting health at the workplace is becoming pivot to a fully functioning global economy. The programme aims to improve public health conditions and awareness through multisectoral cooperation and to directly involve the workers and employers in introducing a health-promoting culture at the workplace.
Workplace health has taken on renewed impetus after the 60th World Health Assembly in 2007, which endorsed the WHO Global Plan of Action on Workers' Health 2008-2017. The Plan stipulates the need to address all aspects of workers' health, including primary prevention of occupational hazards, protection and promotion of health at work, and improved response from health systems to workers' health. Additionally, focus is placed on the establishment of specific guidelines for health services and surveillance mechanisms for health, environmental, and disease hazards.
Examples of implementation
The World Bank/Thomas Sennett
Several fundamental principles underpin action on workers' health. First, the workplace should not be detrimental to health and well-being. Second, priority should be given to prevention of occupational health hazards over treatment and rehabilitation. Furthermore, an integrated response to the specific health needs of working populations should encompass all components of health systems and all representatives of the workplace community.
At the regional level, the WHO European and Western Pacific Regions have the most solidified networks for research, distribution, and corroboration. The WHO European Region initiative for Management of Health, Safety and the Environment in Enterprises (HESME) provides a framework linking healthy workplace activities to interventions promoting human and environmental health. The WHO Western Pacific Region has developed regional guidelines for healthy workplaces that were successfully implemented in several countries. In the Americas, Canada, has also etched out a solid programme notable for its integrated approach to tackling the major components of a healthy workplace programme (physical environment, psycho-social work conditions, and health behaviours of individual workers).
Resources
- WHA Resolution 60.26 Workers' Health: Global Plan of Action
- WHO Regional Office for the Western Pacific Healthy Workplaces Guide
- WHO Regional Office for the Western Pacific Healthy Settings - Occupational Health
- WHO Regional Office for Europe Healthy Workplaces Resource
Networks
- European Union Network (27 member states plus EEA)
- WHO Western Pacific Regional Network for Health Promoting Workplaces (11 participating countries)
Selected publications
- Burton J. (2006) Creating Healthy Workplaces. Industrial Accident Prevention Association.
- Chu et al. (2000) Health-promoting workplaces - International settings development. Health Promotion international. 15(2): 155-167.
Healthy Villages
Background
The World Bank/Curt Carnemark
The Healthy Villages programme addresses similar directives as the Healthy Cities programme simply in rural areas as opposed to urban areas. Health is again defined by the area's residents; however, the generally accepted definition of a healthy village includes a community with low rates of infectious diseases, access to basic healthcare services, and a stable, peaceful social environment.
Programmes attempt to foster a holistic approach to health management through fostering communication among community leaders and members. Communication throughout the various social ranks of the village and a village health plan are necessary components of all programmes. Thus, the programme is vulnerable to similar issues as the Healthy Cities programme, such as providing the necessary resources and maintaining momentum to succeed.
Examples of implementation
The World Bank/Eric Miller
Programmes have been implemented in all six WHO regions.
In the WHO African Region, approximately 30 Healthy Villages have been set up. Programme initiatives continue to be established, often with the support of the recent Healthy Villages publication to facilitate implementation.
In the WHO South-East Asia and Eastern Mediterranean Regions, initiatives have been widespread and relatively successful at improving local awareness and improving health and social conditions. For example, Egypt, Nepal, Pakistan, and Sudan have Healthy Village initiatives. In addition, countries like Malaysia and Sri Lanka have adopted policies, bringing the estimated number of Healthy Villages throughout the world in between 50 to 100.
Resources
- Healthy Villages: A guide for communities and community health workers
- WHO African Region Healthy Villages
Selected publications
- Khosh-Chashm, K. (1995) Healthy Cities and Healthy Villages. Eastern Mediterranean Health Journal. 1(2): 103-111.
- Kiyu A. et al. (2006). Evaluation of the Healthy Village Program in Kapit District, Sarawak, Malaysia. Health Promotion International 21(1): 13-18.
Health Promoting Hospitals
Background
The Health Promoting Hospitals (HPH) project and network began in 1988 and 1993, respectively, to promote the total quality management of hospitals. The project also aims at addressing the health of staff and the link of the hospital to its community. The programme objectives are:
- To improve the inter-disciplinary nature and transparency of decision-making in hospital care;
- To evaluate and compile evidence on healthy promotion activities in the health care setting;
- To better incorporate health promotion into quality management systems at the hospitals and nationally.
The World Bank/Eric Miller
Examples of implementation
More than 650 member hospitals and 34 National/Regional Networks are established over 30 states in Europe. Yet, the majority of available literature demonstrates a more limited impact than anticipated.
Many of the European HPH initiatives have struggled to move beyond the "project" phases. Main dilemmas faced in implementing HPH are the lack of government-related policy support, the lack of individual organizational management commitment, the lack of resources set aside for health promotion, and other problems related to the level and degree of organizational change that occurs in hospitals. Eventually, a more concerted evaluation of European HPH progress is needed to accurately measure its impact and progress.
Resources
- WHO Regional Office for Europe Health Promoting Hospitals
- WHO Collaborating Centre for Health Promotion in Hospitals
- WHO Collaborating Centre - Secretariat for Health Promoting Hospitals
Selected publications
- Whitehead, D. (2004) The European Health Promoting Hospitals (HPH) project: How far on? Health Promotion International. 19(2): 259.
- Whitehead, D. (2005) Health Promoting Hospitals: The role and function of nursing. Journal of Clinical Nursing. 4: 20
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