avec les programmes de promotion, en developpant les evaluations des campagnes et actions conduites par les acteurs de la sante publique, en produisant des referentiels de qualite, en etablissant des partenariats, en promouvant la formation en education pour la sante et en education therapeutique et en participant a des travaux europeens de promotion de la sante. Les politiques de promotion de la sante restent plus modestes globalement dans les pays du Sud (2). Les chercheurs de ces pays essaient de developper des programmes de recherche. Ils souhaitent construire leurs propres capacites d’evaluation, de developpement et d’adaptation aux besoins locaux en fonction de leur propre agenda. Des partenariats Nord/Sud existent, mais ils necessitent des approches inter-culturelles delicates (3) et restent souvent subordonnes aux agendas de recherche des pays industrialises. Les articles rassembles dans ce numero hors-serie de « Promotion & Education », constituent le prolongement du travail de reflexion qui a ete a amorce lors du colloque francophone international intitule « Promotion de la sante et education pour la sante : Etat des connaissances et besoins de recherche » realise au Grand Duche du Luxembourg les 8 et 9 fevrier 2007 (4) Cette publication collective va de soi. Elle contribue a la dynamique scientifique de l’espace francophone en favorisant le partage de la reflexion et l’ouverture a la diversite des realites et des perspectives. Comme pour le colloque, ce numero hors-serie vise a interroger les probleDepuis plusieurs annees, sur les grandes priorites de sante publique, partout dans le monde de maniere differenciee, les Ministeres de la Sante menent de nombreuses campagnes d’information, de sensibilisation, et de formation vers les professionnels de sante et vers les populations. A l’instar de nombreux pays du Nord, comme dans plusieurs pays du Sud, au Grand Duche du Luxembourg, l’intervention en sante publique sous l’angle de « la promotion de la sante » est desormais largement reconnue. En 2005, par exemple, c’est au total plus de 60 interventions en promotion et education reparties en plus de 13 thematiques de sante publique qui ont ete organisees ou soutenues par le Ministere de la sante luxembourgeois (1). En revanche, partout dans le monde, d’une maniere generale, l’activite de recherche n’est pas suffisamment developpee et ainsi laissee hors des politiques publiques prioritaires. De ce fait le lien entre les actions menees, leur legitimite, leur efficacite, leur coherence et leur evaluation reste tres peu documente et ne fait pas l’objet de suffisamment de travaux de reflexion et de recherche specifiques. Combler progressivement ces lacunes represente un enjeu scientifique. Mais cela constitue surtout un enjeu operationnel de sante publique : des pays tels que la Belgique (communaute francaise) et le Quebec placent la prevention et l’education pour la sante au coeur des politiques de sante publique. Ces pays notamment ont developpe leur expertise en poursuivant des travaux de recherche en lien
The concepts of community participation, empowerment and capacity building are central tenets of contemporary health promotion theory. They reflect the view that health and well-being are shaped by a wide range of social, economic, political and organisational forces that are outside the control of individuals.Despite its theoretical appeal, the practice of Community Empowerment is ethically contentious and can produce ethical dilemmas for health promotion practitioners. In this paper we relate these dilemmas to theoretical considerations, and argue that the empowerment of communities should be understood as a means rather than an end . This leads us to argue for the adoption of what we call a Reflective Equilibrium Community Empowerment approach, which draws on both "top-down" and "bottom-up" methods to help resolve the ethical tensions in health promotion programmes.
This paper focuses on methodological innovations used in the National Health Educator Competencies Update Project (CUP) in the United States. The CUP was a six-year research study designed to delineate the role of the health educator in the USA. Individuals who self-identified as health educators were included in the study. To provide context, the background for the research is presented, followed by a brief overview of the research process. Some of the key methodological innovations discussed are: selecting a representative sample when the total population of those working as health educators was not easily identified or readily accessible; assessing response methodology preferences through pilot studies; enhancing the response rate through accurate, up-to-date mailing lists and incentives; and exploring new approaches to large-scale data analyses. Insights gained are included for other researchers who may wish to undertake similar studies or draw from the CUP dataset for secondary analyses.
A comprehensive Swedish public health policy was adopted by the Swedish Parliament, the Riksdag, in April 2003. It pushes health up on the political agenda and affords equity in health high priority. The first phase of implementation of the policy, 2003-5, is described in the 2005 Public Health Policy Report published by the Swedish National Institute of Public Health (SNIPH). For the purpose of investigating the implementation, SNIPH has monitored the development of 42 determinants and used reports from 22 central agencies and eight county administrative boards together with interviews with all Sweden's county councils (21) and a questionnaire sent out to all municipalities (290). The experiences from the implementation of the policy are that: the determinants approach-focusing on structural factors in society, people's living conditions, and health behaviors that affect health-is in general well understood and emphasizes the role of other sectors in public health; the use of indicators to follow up exposures to determinants is of key importance; the support to actors outside the health service is needed to identify their public health role; a continuous steering from the government and other political bodies is of vital importance; public health promotion on the regional level needs a higher level of coordination; municipalities need more skills development. Sweden has a new government that was elected in September 2006; the new government has retracted the former government's public health policy communication submitted to the Riksdag in the spring of 2006, but does not intend to change the public health policy.
L'évaluation des interventions en promotion de la santé est de plus en plus répandue, répondant ainsi à deux besoins cruciaux dans le domaine, soit: 1) justifier les ressources investies en démontrant ses effets et 2) soutenir les processus innovants nécessaires pour aligner les interventions avec les principes, valeurs et engagements de la Charte d'Ottawa pour la promotion de la santé, document fondateur du champ. Dans cet article, nous proposons que dans un cas comme dans l'autre, cet alignement que nous défendons comme inhérent à la promotion de la santé, pose des problèmes cruciaux pour l'évaluation. Ces problèmes se traduisent en trois défis de pertinence auxquels l'évaluateur en promotion de la santé doit confronter sa pratique: 1) définir l'intervention à évaluer de façon à élaborer des questions d'évaluation pertinentes; 2) mettre en œuvre des méthodologies de recherche adéquates et rigoureuses; et 3) produire des connaissances pertinentes pour l'action. (Promot Educ 2008; Supp(1): 17-21)
This important research builds on past projects in Australia and internationally that have sought to define and clarify competencies required to work in health promotion. The paper briefly explains the process undertaken in 2005 to update the Australian health promotion competencies as a collaboration of several leading health promotion agencies. The article reports findings from research undertaken in 2001 and 2005 and compares trends in perceptions of health promotion competencies across time. This dialogue among researchers, health promotion academics and practitioners can help to further the impact of competencies research on professional practice in health promotion globally. This project placed a priority on methodology that engaged the health promotion workforce in Australia. A two-stage process was employed including expert consultation with 39 senior health promotion professionals, followed by a modified Delphi process to engage 400 practitioners. Space was allowed for comment on the competencies including suggested word changes, and respondents were also invited to add additional competencies. The research involved a modified Delphi study where participants were invited to rate each competency as “essential”, “desirable” or “not relevant”, and to suggest changes to wording, as well as additions to the list. Responses were received from 400 practitioners and the results were presented and compared with the 2001 survey results. Results indicate a substantial shift in perceptions about health promotion practice in Australia during the initial years of the 21 st century.The overall significant changes in perceptions indicate that by 2005 the Australian health promotion workforce had substantially moved away from an individual behaviour-dominated perception of health promotion practice. Increasing recognition was given to competencies that reflect environmental, economic and policy influences on health, and increased recognition that these processes are legitimate and essential components of the health promotion process. (Promot Educ 2008;15(2): 21—26)
This paper reviews the status of health education in urban schools in three cities in Liaoning province, China. The cities represent the upper, middle and lower levels of city economy based on the GDP per person within the province. A self-administered questionnaire was provided to 500 primary and secondary schools and 436 questionnaires (87.2%) were returned completed. The questionnaire assessed health education offerings in the schools, permitting the comparison of similarities and differences in school practices, and the identification of obstacles that prevent schools becoming health promoting. The analysis revealed that 0.7% of schools fulfilled criteria for good status of health education. The negative attitudes of school management, teachers and pupils towards health education, as well as the lack of in-service training for staff, were perceived as key obstacles to school health education. Few provincial and school-based policies mentioned pupil involvement in health policy development and only a small number of schools acknowledged the need to improve community and parental involvement. In this paper we discuss the challenges facing provincial education and health authorities, and make recommendations about how to assist Chinese schools to develop and implement high quality health education initiatives. (Promot Educ, 2008; 15(4): pp. 44-49)
Copyright © 2008 IUHPE Publier devient sans cesse plus important pour le developpement du domaine de la promotion de la sante. Pour une grande part, on trouve la definition d’un domaine dans ce qu’il publie (1). Il est donc essentiel de garantir que les publications respectent les regles ethiques internationales les plus elevees. C’est pour effectivement s’assurer de bonnes pratiques dans ce domaine que notre revue Promotion & Education, avec le soutien de SAGE Publications, a rejoint recemment le Comite d’ethique des publications (COPE). Le COPE est un forum mis a la disposition des redacteurs, qui cherche des manieres pratiques de prevenir tout manquement a l’ethique dans le cadre des publications scientifiques (2). Depuis 1997, le COPE collabore avec des redacteurs en chef de revues soumises a l’expertise de pairs afin d’encourager la discussion des questions ethiques autour de la publication, de meme que des actions pour garantir le respect des regles ethiques. Afin d’aider les redacteurs, les membres des comites de redaction, les auteurs, les lecteurs et les editeurs a considerer l’ethique de la publication, en 1999 le COPE a publie une serie de Directives sur les pratiques exemplaires en matiere de publication. Les membres du COPE, plus de 3,500, sont principalement des revues biomedicales ou en rapport avec ce domaine. Neanmoins, les questions ethiques auxquelles sont confrontes ces types de revues sont pertinentes pour beaucoup d’autres disciplines, en particulier lorsqu’il s’agit de sensibiliser sur d’eventuelles inconduites et de trouver des solutions qui, Tableau 1. Normes et aspirations du redacteur
The topic of the above title has vividly interested the author for many years. Regretfully, the issues at stake have not changed for the last 25 years. As proof of this - and on purpose - references dug up and quoted are only those published before 1986. The end result has been the (re)construction of a scenario that has been stubborn to change and that looks into most of the burning questions of then and now pertaining to the title.The materials here presented are an informal, non-systematic review of the literature on the ethical, ideological and political implications of health as a science and as a praxis. The materials here collected are, in a way, "out of the box" and, in the author's view very needed. The article sheds some light on the major issues at the core of this universal discussion that - whether we like it or not - was and continues to be at the very base of our daily work as health professionals.
The year 2007 saw the birth of a new IUHPE baby: ISECN — the IUHPE Student and Early Career Network. This commentary presents some of the work that has been undertaken by ISECN this past year. We have appointed regional contacts, presented a poster about our network in a conference in Osaka, Japan, initiated a working group for communication with a specific focus on increasing equity in the way ISECN communicates with its members, launched a website (www.isecn.org), and held two global conference call meetings, connecting members from almost every corner of the planet. Also addressed in this Commentary is our role as Stream Managers for the IUHPE's new online offering, “Views on Health Promotion Online” and the formation of a working group to start developing a Code of Ethics for health promotion. These new projects will benefit ISECN, and contribute to the betterment of health promotion generally. All IUHPE members who are at the early stages of their careers are urged to join us. (Promot Educ 2008;15(2): 44-45)
The article presents the work plan of the Vice President for the Northern Part of the Western Pacific Region of the IUHPE. The highlights of the plan include, firstly, the organization of the First Asia-Pacific Conference on Health Promotion and Health Education, which will take place in July 2009. Secondly, the plan proposes the establishment of a liaison office and an Internet journal to facilitate collaboration among individuals, groups and organizations working in health promotion and education in this culturally and linguistically diverse region. (Promot Educ 2008; 15(3): 39-40)
• esforzarse por satisfacer las • solicitar activamente la opinion de necesidades de lectores y autores autores, lectores, revisores y del consejo • mejorar constantemente la revista; de redaccion para mejorar su proceso • cerciorarse de la calidad del material de elaboracion de la revista; que publican; • fomentar y conocer los estudios sobre • defender la libertad de expresion; la revision por pares y la “revistologia” y • mantener la integridad del historial reevaluar el proceso de elaboracion de academico; la revista a la luz de nuevos descubrimientos; • impedir que las necesidades del • trabajar para convencer a su editor de negocio comprometan los estandares que aporte los recursos adecuados, y la intelectuales; orientacion por parte de expertos (p.ej.: • Estar siempre dispuestos a publicar disenadores, abogados) y formacion correcciones, aclaraciones, adecuada para que desempenen su rectificaciones y disculpas en funcion con profesionalidad y eleven caso necesario. la calidad de su revista; • apoyar iniciativas para educar a los investigadores en cuanto a la etica de las publicaciones; • evaluar los efectos de las politicas de su revista en los comportamientos de autores y revisores y revisarlas, si es preciso, para fomentar conductas responsables y desalentar las faltas de etica profesional; • garantizar que todas las notas de prensa que emite su revista reflejen el mensaje del articulo al que se refieren y lo situen en su contexto.
Utilizing ethnographic research methods, this case study examines the experiences of an NGO-sponsored health care program in rural Mali. The findings indicate that while, in principle, the organization operates from an alternative development base, it has been unable to decentralize the decision-making process and facilitate community dialogue and participation. Numerous problems resulted, including superficial forms of local participation, lack of community ownership, non-remuneration of health workers and midwives, inadequate training, and ultimately, limited program gains. The analyses highlight the complexity and dynamic nature of health program implementation in a developing context, and suggest several factors important to project success. These include drawing on diverse local perspectives, promoting broad-based participation, and providing culturally appropriate ways to include all community members, particularly women.
This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational “will” to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational “will”, while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action. (Promot Educ 2008;15(2): 6—14)
notions d’ « empowerment » et de participation. Nous voulons cependant nous assurer que le lien entre les deux noms de la revue soit bien clair dans l’esprit des abonnes, et nous souhaitons maintenir la reference a l’education dans le nom existant. Ainsi, la phrase ‘Anciennement Promotion & Education’ sera mentionnee sur la couverture de Global Health Promotion, juste en dessous du nouveau nom. L’affiliation de la revue a l’UIPES sera egalement clairement mentionnee sur la couverture de Global Health Promotion. Comme les lecteurs habitues le savent, ces derniers temps, la revue a fait peau neuve et son profil ainsi que son format ont egalement subi des changements. Il y aura encore quelques ajustements a faire au niveau du format a l’avenir, pour ameliorer l’efficacite du processus de publication, mais aucune modification supplementaire n’est planifiee dans un avenir proche en ce qui concerne le profil de la Revue. Ceux qui soumettront des articles pour les publier dans Global Health Promotion connaitront bientot Sagetrack, un systeme de soumission et de revision par les pairs base sur Internet et gere par le service ‘Manuscript Central’ de ScholarOne. Apres ce passage a SageTrack et les changements de format qui auront lieu au cours de l’annee 2009, nous envisageons une periode sans grand changement, avec deux exceptions notables cependant. Du fait de l’entree de Global Health Promotion dans la famille des Publications Sage, nous nous attendons a une augmentation constante du nombre d’abonnes ainsi que du nombre d’articles soumis pour etre publies dans la revue. Une tendance positive est deja visible – au cours des six premiers mois de l’annee 2008, nous avons connu une augmentation du taux de soumissions de 400% par rapport a celui de 2007 ! Editorial
This article reviews the implementation of the community component of the Integrated Management of Childhood Illness (IMCI) strategy in Chao, Peru (2001 to 2004) and San Luis, Honduras (2003 to 2005). An evaluation was conducted in 2005 and included a project documentation review, key-informant interviews, and a household level baseline and follow-up survey of the WHO/UNICEF key family practices in each intervention site. The promotion of the key family practices in Chao and San Luís demonstrated measurable success. In comparison with the initial survey in 2002, the percentage of participant mothers ( N = 78) in Chao in 2004 who knew that they should breastfeed exclusively for at least six months increased from 33% to 94%; the presentation of complete vaccination records for one-year-old children increased by 19%; the recognition of danger signs for pneumonia increased 18% and for diarrhea by 8%; and the percentage of mothers who received four or more prenatal check-ups increased by 25%. A dramatic reduction in malaria cases was also attributed to the intervention in Chao. In San Luis, a quasi-experimental, random household sample ( N = 300) showed that the incidence of diarrheal disease among children under five years old declined by 18% between survey rounds (from 44% in August 2004 to 26% in December 2005). Social mobilization has promoted inter-sector consensus-building around community health issues, especially those related to maternal and child health. The promotion of the participation of representatives from various organizations via the community IMCI social-actor methodology has led to increased civic cooperation. Positive changes in health behaviors have been documented through an increase in preventive health practices, greater demand for primary health care services, and concrete community actions to improve public health. (Promot Educ 2008;15(2): 15—20)
After successful pilot projects in 10 schools (four schools with tobacco control and six schools with nutrition interventions, plus 10 control schools), Health and Education officials in Zhejiang Province, China, decided to scale up Health-Promoting Schools (HPS) systematically over the entire province, starting with an initial cohort of 51 additional schools, reaching from primary to vocational schools. Interviews with school personnel during the first phase of scaling up illuminated the key pre-implementation, implementation, and monitoring and evaluation activities. Pre-implementation activities included choosing an entry point, setting up a special HPS committee, and establishing a work plan. Implementation activities included conducting mobilization meetings, prioritizing health, popularizing the HPS concept, ensuring community cooperation and participation, acting as role models, offering training, and using new teaching and learning methods. Monitoring and evaluation activities included process, baseline, and final evaluations and changing standards of evaluation to a more holistic evaluation that schools go through to become Health-Promoting Schools. Schools also reported that they faced — and overcame — a number of challenges including understanding and integrating the HPS concept and lack of professional development and support. Results revealed that schools transitioned from a passive model of education to interactive pedagogy put priority on health and viewed it as a co-responsibility, reshaped assessment to a more holistic approach and called for more training and technical support. Participants mentioned that they gained knowledge and skills and developed a deeper understanding about health. Health impact was also demonstrated, for instance in reduced injuries and reduced smoking, and educational impact was demonstrated, for instance in improved relationships of children to parents and teachers, improved social qualities, and improved teacher satisfaction. (Promot Educ, 2008; 15 (1): pp. 24-29)
salud, las politicas publicas sanas, el empoderamiento y la participacion. No obstante, deseariamos estar seguros de que nuestros suscriptores asocian mentalmente los dos nombres de la revista, y de mantener la referencia a la educacion presente en el nombre original. Por ello, en la portada de Global Health Promotion y debajo del nuevo nombre figurara la leyenda “conocida como Promotion & Education”. Tambien se expresara claramente en la portada de Global Health Promotion la afiliacion de esta revista a la UIPES. Como habran comprobado nuestros lectores habituales, ultimamente se ha realizado una modernizacion visual de la revista, y tambien se han introducido cambios en el perfil y en el formato de la misma. Proximamente se llevara a cabo algun ajuste mas en el formato, para mejorar la eficiencia del proceso de publicacion, pero no se preven mas cambios en el perfil de la revista a corto plazo. Los que soliciten la publicacion de articulos en Global Health Promotion encontraran en breve a Sagetrack, un sistema de presentacion de textos y de revision por pares en la red impulsado por la Central de Manuscritos de ScholarOne. Tras la adopcion de Sagetrack y de los cambios de formato que se verificaran a lo largo de 2009, prevemos pocas modificaciones en el periodo posterior, salvo en dos aspectos importantes. Gracias a que la publicacion de Global Health Promotion esta en manos de Sage Publications, esperamos un crecimiento sostenido del numero de suscriptores y del numero de personas que solicitaran la publicacion de sus articulos. Ya esta consolidada una tendencia positiva: ien los seis primeros meses de 2008 hemos experimentado un aumento del 400% en el numero de solicitudes de publicacion de articulos, si lo comparamos con 2007! Global Health Promotion es la revista que reciben los miembros de la UIPES y Editorial
