Health Promotion International, Vol. 15, No. 2, 143-154,
June 2000
© Oxford University Press 2000
Health promotion development in Europe: achievements and challenges
1 World Health Organization Regional Office for Europe in Copenhagen, Copenhagen, Denmark, 2 London School of Hygiene and Tropical Medicine, London, UK and 3 Health Promotion Wales, Cardiff, UK
Address for correspondence: WHO Regional Office for Europe 8 Scherfigsvej DK-2100 Copenhagen Denmark
INTRODUCTION
Fifteen years ago, a set of possible concepts and principles for health promotion was put forward for discussion by the WHO Regional Office for Europe WHO (WHO, 1984). Those concepts and principles informed and underpinned the Ottawa Charter 2 years later (WHO, 1986
) and have provided the basis for the many health promotion innovations emanating from Europe ever since. These have included projects, e.g. Healthy Cities, Health Promoting Schools, Health Promoting Hospitals and, more recently, the Investment for Health approach to implementing health promotion. All have had their origins in the European Region (Ashton, 1992; WHO, 1991; WHO, 1992; WHO, 1994b; WHO, 1996b; WHO-EC-CE, 1992; WHO-EC-CE, 1997).
However, there is evidence that the overall impact of these innovations has been relatively limited in the region [see, e.g. (De Leeuw, 1989; Tsouros, 1990; Grossman and Scala, 1993; Jensen and Schnack, 1994;
TAKING STOCK OF PROGRESS— THE OVERALL PICTURE
Determinants of health: knowledge and action
Oversimplified approaches
Infrastructure deficits
Lack of healthy public policies
Summary of trends
SUSTAINING THE VISION BUT REVISITING THE MEANS
Social and political difficulties
Ottawa Charter principles
Hastening policy change
Investment for health
STRATEGIES TO ENCOURAGE INVESTMENT FOR HEALTH
Meaning of investment for health
Influencing policies towards investment for health
CONCLUSIONS: LESSONS LEARNT AND PRIORITIES FOR FUTURE ACTION
REFERENCES
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