The conditions in which we live, work and play influence our health behaviour and lifestyle choices. In 2015, 38% of disease burden was preventable and due to modifiable risk factors, such as tobacco use, overweight and obesity, high blood pressure or poor diet (AIHW 2019).

Health promotion is a broad term. It focuses on preventive health—preventing the root causes of ill health—rather than on treatment and cure, so that people remain as healthy as possible for as long as possible. Health promotion encompasses a ‘combination of educational, organisational, economic and political actions’ (Howat et al. 2003) to enable individuals and communities to increase control over and improve their health. This occurs with consumer participation through attitudinal, behavioural, social and environmental changes (Howat et al. 2003).

In health promotion, a mix of interventions are often used for greater effectiveness. For example, actions to address obesity use a mix of behavioural and structural approaches. These aim to target physical activity and food intake at an individual level, and to change the environment that promotes obesity (Jancey et al. 2016). Examples include policy, economic and environmental actions such as restrictions on fast food advertising to children, availability of fresh fruit and vegetables, and taxes on sugary drinks (Jancey et al. 2016; Victorian Department of Health and Human Services 2019). Health promotion through urban planning and design can increase physical activity opportunities by access to green spaces, cycling pathways and use of public transport (Giles-Corti et al. 2019). See Built environment and health.  

Tangible health promotion strategies are apparent in the COVID-19 pandemic response, for example in the development of educational resources and social marketing campaigns to promote hand hygiene and social distancing (Smith and Judd 2020). This kind of messaging must instruct, inform and motivate individual self-protective behaviours, with the quality of the societal response being dependent on meeting the specific communication needs of all sub-populations (Vaughan and Tinker 2009). See Health literacy.

Health promotion success stories

Australia has a long history of health promotion. Memorable campaigns such as ‘Slip Slop Slap’, ‘Life. Be in It’ and ‘Every cigarette is doing you damage’ are examples of population-targeted health promotion (AIHW 2018). The compulsory wearing of seatbelts in motor vehicles, random breath testing and 50 km/h residential street limits have been part of a more comprehensive health promotion road safety strategy. Road deaths have reduced from 30 per 100,000 population in 1970 to 4.6 per 100,000 in 2018 (BITRE 2010, 2018).

The following topics highlight some excellent examples of successful health promotion in Australia. An emphasis on the need for national-level action to complement local-level implementation is repeatedly highlighted in health promotion (WHO 2016).

Tobacco control

The tobacco control measures of all Australian governments and public health organisations have been key to Australia’s success in tobacco control. Smoking rates have declined to historically low levels, particularly among children and youth. Between 1984 and 2017, the proportion of 16 and 17 year olds smoking at least once in the previous week declined from 30% to 10%, and from 20% to just 3% among 12–15 year olds (White & Williams 2016; Guerin & White 2018).

The latest data from the National Health Survey (NHS) 2017–18 estimates that 13.8% of Australians aged 18 and over are daily smokers. Rates have declined steadily over the last 30 years and after adjusting for age, the proportion of adults who are daily smokers has halved since 1989–90. For more information on Australia’s smoking rates see Tobacco smoking.

In recent decades, Australia has progressively implemented a comprehensive suite of tobacco control measures including (Figure 1):

  • staged tobacco excise increases
  • smoke-free laws and policies
  • social marketing campaigns
  • measures to minimise the illicit tobacco trade
  • plain packaging of tobacco products
  • labelling tobacco products with graphic health warnings
  • prohibiting tobacco advertising, promotion and sponsorship
  • providing support for smokers to quit (Department of Health 2018a).

These measures form part of Australia’s National Tobacco Strategy (NTS) 2012–2018. The NTS provides a national framework for all Australian governments and non-government organisations to work together to improve the health of Australians by reducing tobacco use and its associated harms.
 

This chart shows the decline over time of daily smoking rates for those aged 18 and over by sex. After adjusting for age, between 1989-90 and 2017-18 the rate of daily smoking declined from 31% to 17% in males and 24% to 11% in females. The chart highlights dates from 1990 to 2020 when key tobacco control measures were introduced in Australia. For example, an advertising ban in print media in 1990.

HIV prevention and treatment

Australia’s response to HIV is an example of effective health promotion (Smith et al. 2016). Since the 1980s, health promotion and prevention principles have been integral to 8 National HIV Strategies, such as partnerships between government and non-government organisations, clinicians, researchers and political parties and ‘active participation from affected communities’ (Smith et al. 2016).

This approach has helped Australia to achieve a relatively low HIV prevalence, by international standards (Brown et al. 2014). At the end of 2018, the estimated prevalence of HIV in Australia was 0.14% (Kirby Institute 2019). Australia’s current National HIV Strategy 2018–2022 prioritises access to quality prevention, testing, treatment, care and support services for all people with HIV and those at risk (Department of Health 2018b). The strategy also prioritises addressing HIV-related stigma and discrimination. More recently, Australia has made significant steps towards providing equitable access to Pre-Exposure Prophylaxis for those at medium and high risk.

Health in All Policies

As a concept, Health in All Policies (HiAP) takes into account the health implications from policies across all levels of government and sectors to improve population health and health equity. It recognises that many of the determinants of health and health inequities originate beyond just the health sector and health policies (WHO 2014). That is, health and wellbeing are determined by a range of factors including age, sex and genetics, and individual behaviours as well as the social, cultural and economic contexts within which we live (SA Health 2020). See Social determinants of health

HiAP has been tested across a number of countries (WHO 2010). Some of the tools that have been ‘shown to be useful at different stages of the policy cycle include:

  • inter-ministerial and inter-departmental committees
  • community consultations
  • cross-sector action teams
  • integrated budgets and accounting
  • Health Lens Analysis
  • cross-cutting information and evaluation systems
  • impact assessments
  • joined-up workforce development and legislative frameworks’ (WHO 2010).

Established in 2007, the South Australian HiAP approach is a whole of government initiative. It aims to achieve better public policy outcomes, deliver shared benefits for all agencies and improve population health and wellbeing. ‘By incorporating a focus on population health into the policy development process of different agencies, the government is able to better address the social determinants of health in a systematic manner’ (SA Health 2020).

The successful implementation of HiAP in South Australia has been supported by a strong evaluation process (SA Health 2020).

Evaluating health promotion initiatives

Health promotion activities have been shown to be cost saving, whereby the cost of implementing the intervention is offset by savings associated with reductions in treating disease (Vos et al. 2010). Monitoring and evaluation are important to assess the performance of health promotion initiatives and provide the evidence that researchers, policy makers and service providers need on what works.

Evaluating the impact and cost of community and nationwide initiatives can be difficult. Directly attributing health outcomes to a specific initiative itself is a challenge, and this is further complicated when multiple strategies are being applied at once (for example, legislation, taxation and promotion campaigns). Evidence to support the effectiveness of health promotion initiatives may not be available for many years as health impacts and benefits may not manifest until years after the intervention has been implemented.

Where do I go for more information?

For more information on health promotion, see:

References

ABS (Australian Bureau of Statistics) 2018. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.0.55.001. Findings based on Detailed Microdata analysis. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2018. Australia’s health 2018. Australia’s health series no. 16. Cat. no. AUS 221. Canberra: AIHW.

AIHW 2019. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian burden of disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.

BITRE (Bureau of Infrastructure, Transport and Regional Economics) 2010. Road deaths in Australia 1925–2008. Canberra: BITRE.

BITRE 2018. Road trauma Australia 2018 statistical summary. Canberra: BITRE.

Brown G, O’Donnell D, Crooks L, Lake R 2014. Mobilisation, politics, investment and constant adaption: lessons from the Australian health-promotion response to HIV. Health Promotion Journal of Australia 2014 25:35–41. http://dx.doi.org/10.1071/HE13078

Department of Health 2018a. Tobacco control—key facts and figures. Fact sheet.

Department of Health 2018b. Eighth National HIV Strategy. Canberra: Department of Health.

Giles-Corti B, Badland H, Hooper P, Timperio A, Sugiyama T & Foster S 2019. Action area 1: Built environments. In: Blueprint for an Active Australia. 3rd edn. Melbourne: National Heart Foundation of Australia.

SA Health 2020. South Australia’s HiAP approach. Government of South Australia. Viewed 28 April 2020.

Guerin N & White V 2018. ASSAD 2017 Statistics & Trends: Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances. Cancer Council Victoria.

Howat P, Maycock B, Cross D, Collins J, Jackson L, Burns S & James R 2003. Towards a more unified definition of health promotion. Health Promotion Journal of Australia 14(2):82–5.

Jancey J, Barnett L, Smith J, Binns C & Howat P 2016. We need a comprehensive approach to health promotion. Health Promotion Journal of Australia 27:1–3. http://dx.doi.org/10.1071/HEv27n1_ED.

Kirby Institute 2019. HIV. What’s new in 2018? https://data.kirby.unsw.edu.au/hiv Sydney: Kirby Institute, UNSW Sydney.

Smith JA, Crawford G & Signal L 2016. The case of national health promotion policy in Australia: where to now? Health Promotion Journal of Australia 27:61–65. http://dx.doi.org/10.1071/HE15055.

Smith JA & Judd J 2020. COVID-19: Vulnerability and the power of privilege in a pandemic. Health Promotion Journal of Australia 31:158-160. https://doi.org/10.1002/hpja.333

Vaughan E & Tinker T 2009. Effective Health Risk Communication About Pandemic Influenza for Vulnerable Populations. American Journal of Public Health 99: S2.  https://doi.org/10.2105/ajph.2009.162537

Victorian Department of Health and Human Services 2019. Local government and place-based approaches for primary prevention of obesity—lessons from Victoria. Presentation at the National Obesity Summit, Canberra 15 February 2019.  

Vos T, Carter R, Barendregt J, Mihalopoulos C, Veerman JL, Magnus A et al. 2010. Assessing cost-effectiveness in prevention (ACE–Prevention): final report. Brisbane: University of Queensland, and Melbourne: Deakin University.

White V, Williams, T. 2016. Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2014. Cancer Council Victoria.

WHO (World Health Organization) 2010. Adelaide statement on health in all policies: moving towards a shared governance for health and well-being. Geneva, Switzerland. Viewed 6 November 2019. 

WHO 2014. Health in all policies—Helsinki Statement Framework for Country Action. Geneva, Switzerland. Viewed 6 November 2019. 

WHO 2016. Promoting health in the Sustainable Development Goals: report on the 9th Global Conference for Health Promotion, Shanghai, China, 21–24 November 2016: all for health, health for all. Geneva: World Health Organization 2017 (WHO/NMH/PND/17.5). Licence: CC BY-NC-SA 3.0 IGO.