Health Promotion International, Vol. 4, No. 4, 357-369, 1989
© Oxford University Press 1989
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Target setting for the health of populations: some observations
Mersey Regional Health Authority Liverpool, United Kingdom* This article is the result of a World Health Organization (WHO) Travelling Fellowship, looking at target setting for health promotion. At first sight, target setting for the health of populations appears to be a logical process whereby broad goals for health are broken down into specific objectives and interventions, with success measured by achievement of the broad health goals. The evidence reviewed indicates, however, that achievement of broad health goals can happen without many of the supposedly contributory interventions, suggesting that success in target setting can be more a matter of predicting trends in public health than influencing those trends. One major consequence of relying upon existing trends for success in achieving broad health goals is that the problem of inequalities will not be addressed since the natural tendency of inequalities is not to diminish. It is concluded that in setting targets, a clear distinction should be made between what seems to be going to happen anyway and what incremental benefits are anticipated from particular interventions; and that a special emphasis should be placed upon the reduction of inequalities not only as a matter of principle, but also as a check against spurious claims of success in achieving broad health goals.
Where target setting is handled at sub-national level, this can only ever be a supplement and not a substitute for national action. At sub-national level, one increasingly common approach appears to be to look at inequalities in health between small geographical areas and to use localized health promotion methods. It is concluded that this is one valid approach, but it has limitations, and should not lead to the neglect of other dimensions of inequality and other health promotion interventions that require a wider, for example regional or city-wide, base. Healthy Cities may need to clarify aims and objectives, in particular European Healthy Cities may need to clarify the extent to which they see themselves as local agents for the WHO Europe targets.