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Health Promotion International, Vol. 15, No. 1, 35-47, March 2000
© Oxford University Press 2000

Policy, competence and participation: empirical evidence for a multilevel health promotion model

Alfred Rütten, Thomas von Lengerke, Thomas Abel1, Lasse Kannas2, Günther Lüschen3, Josep A. Rodríguez Diaz4, Jan Vinck5 and Jouke van der Zee6

Chemnitz University of Technology, Germany, 1 University of Berne, Switzerland, 2 University of Jyväskylä, Finland, 3 University of Alabama at Birmingham, USA, 4 University of Barcelona, Spain, 5 Limburg University Center, Belgium, and 6 Netherlands Institute of Primary Health Care, The Netherlands

Address for correspondence: Alfred Rütten, Chemnitz University of Technology, Sport Science III, Research Centre for Regional Health Promotion, D-09107 Chemnitz Germany, E-mail: alfred.ruetten{at}phil.tu-chemnitz.de

This paper uses data from a European health promotion evaluation study (MAREPS) to empirically test some fundamental assumptions of health promotion theory. Analysis shows that both the competence of individual actors and the opportunities provided for by health-promoting policies are significant predictors of participation in health promotion action. It also demonstrates effects of health promotion values on such action. Moreover, people's perception of their own political efficacy, e.g. their influence on community decisions that effect their health, turns out to be a significant predictor of self-rated health. In conclusion, the paper encourages further research to investigate the effectiveness of health-promoting policy strategies within a multilevel health promotion framework. As the present results indicate, effective health-promoting policies may create opportunities that enable individuals and communities to increase control over the determinants of health, and thereby improve their health.

Key words: collective efficacy; community participation; cross-national comparison; health promotion policy


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