Population Health Promotion:

An Integrated Model of Population Health and Health Promotion

Measures of Success

Past measures of success have focused on mortality and morbidity. In addition, changes in health knowledge, attitudes and behaviours have been considered intermediate indicators of success. While such indicators are still important, the PHP model demonstrates the need for additional indicators related to the determinants of health. For example, measuring the success of a Healthy Public Policy initiative requires two sets of indicators: indicators that show the effects of our policy actions on the determinants of health and indicators that show the subsequent effects of these changes on health status.

If we are serious about our intention to focus on the Determinants of Health as the objects of policy and program interventions, indicators on the entire range of health determinants will be required. In addition, appropriate methods will be needed to adequately evaluate population health promotion strategies. WHO is currently facilitating a tripartite initiative with its Euro Region, Canada and the United States to explore the research methods needed to evaluate health promotion activity. To complement this initiative, Health Canada's Health Promotion Development Division is assembling evidence on the effectiveness of health promotion activity in Canada.

Where To From Here: Concluding Remarks

This paper places recent discussions on population health in the context of previous work in health promotion that has explored how health is created. It integrates the Population Health Framework and the Ottawa Charter on Health Promotion into the Population Health Promotion Model.

The PHP model draws on a population health approach by showing that, in order to improve the health of the people, action must be taken on the full range of health determinants. The model draws on health promotion by showing that comprehensive action strategies are needed to influence the underlying factors and conditions that determine health. Both population health and health promotion recognize that this approach is imperative if we are serious about addressing health inequities in Canada.

In constructing the PHP model, we have drawn upon accepted sources like Strategies for Population Health and The Ottawa Charter on Health Promotion. However, in so doing, we acknowledge the need for ongoing examination of both the factors that determine health and the strategies by which the determinants can be influenced. We also recognize the need for developing appropriate, and perhaps new, change indicators and evaluation methodologies. These are but a few of the challenges currently facing the development of the health field. We hope the PHP model will help provide an avenue for addressing some of them. It is intended as a planning tool and a departure point for developing other models designed for specific needs.

Prepared by: Nancy Hamilton and Tariq Bhatti

References

• Epp, J. Achieving Health for All: A Framework for Health Promotion. Ottawa, Ontario: Health and Welfare Canada, 1986.Evans, R.G., Barer, M.L., Marmor, T.R. (Editors).
• Why Are Some People Healthy and Others Are Not? New York: Aldine De Grayter, 1994.
• Evans, R. and Stoddart, G. "Producing Health, Consuming Health Care", Social Science and Medicine, Vol. 31, No. 12, 1990.
• Lalonde, M. A New Perspective on the Health of Canadians. Ottawa, Ontario: Health and Welfare Canada, 1974.
• Minister of Supply and Services Canada. Strategies for Population Health: Investing in the Health of Canadians. Ottawa, Ontario: Minister of Supply and Services Canada, 1994.
• World Health Organization. Ottawa Charter on Health Promotion. Copenhagen: World Health Organization Regional Office for Europe, 1986. (available from CPHA Ottawa).