Background

The practice of health promotion, with it’s long standing focus and concern to address health inequalities using participatory and enabling processes1, has drifted towards an individualistic and deficit -orientated focus in recent years; a locus of actions more associated with its predecessor – health education. During an informal consultation with public health managers and professionals working within NHS Grampian in early 2010, it emerged that some of this drift was associated (by them), with a perceived need for regional Health Boards to deliver government health improvement targets2. Some also argued that the use of the contemporary term ‘health improvement’ may have led to a dilution of the main tenets of health promotion, and had contributed to a decline in health promotion specialist skills and knowledge in the region3. Moreover, there was a general concern and perceived need to address the social determinants of health more explicitly in our work following the Marmot reviews4,5.

Aims To develop a strategic Health Promotion Framework that will:

a. reinvigorate and strengthen health promotion work to address existing and emerging complex public health challenges arising from the current economic crisis, and;

b. will guide NHS Grampian and its partners in striking a balance between deficit and asset-based approaches to improve population health overall within the region6,7,8.

Methods

The development process has involved a range of methods including:

a) a review of the health promotion literature;b) consultation with national and international health promotion experts; c) dialogue with local (mainly NHS Grampian) specialists and

practitioners; d) review and discussion of the emerging framework (see Figure 1) with

the larger Grampian public health workforce at stakeholder event.

Findings

Stakeholder event participant comments included:

Developing A Framework To Promote Health & Reduce Inequalities In Grampian

Suggested improvements for the framework included:

more explicit connect between strategic and operational planning; definition of key terms, reducing jargon and simplifying the language

for mixed audiences; engage fully with Community Planning Partnerships; acknowledge that some partners are already active and delivering; engage with those partners not fully engaged; assure the NHS commitment to wider determinants of health and a

non-healthcare focus if applying an asset-based approach; practical examples are required to demonstrate application of the

delivery model (below).

Figure One

ConclusionThis development process has served as a reminder of the need for sustained action to address the social determinants of health. The practice of health promotion provides a framework for action that is focused on improved health and social outcomes. NHS Grampian Board has approved the mainstreaming of this approach within Grampian. Achieving a balance between the asset and deficit approach will be tested as part of this process. Work is ongoing to refine and develop the framework, develop ways of working and workface competence that are consistent with asset-based approach to health improvement.

Authors: Gillian Lewis, Head of Health Promotion, NHS Grampian. gillianlewis@nhs.netDr Flora Douglas, University of Aberdeen. f.douglas@abdn.ac.uk

References1. Ottawa charter for health promotio: http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf2. http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/17273/targets/Health3. Royal Society of Health, Faculty of Public Health, UK Public Health Register, Institute of Health Promotion and Education (1998) Shaping

the future of Public Health in the NHS. Specialised health promotion where are we two years on? www.rsph.org.uk4. The World Health Organisation Global Commission on Social Determinants of Health (2008) Closing the gap in a generation: Health

equity through action on the social determinants of health. World Health Organisation: Geneva.5. Marmot (2010) Fair Society Healthy Lives. Final Report and Executive Summary Review6. Improvement and development agency (2010) A glass half-full: How an asset approach can improve community health and wellbeing.

Local Government Association. London.7. Glasgow Centre for Population Health (2011) Asset based approaches for health improvement: redressing the balance. Briefing paper 9

concept series.8. NHS Health Scotland (2011) Asset based approaches to health improvement.

“The Framework is comprehensive and

clearly written. (It) will help others to

understand what we do”.

“The Framework is comprehensive and

clearly written. (It) will help others to

understand what we do”.

“Helps to set out a broader concept of health promotion – brings Ottawa Charter concepts

back to the forefront of our thinking. This has to an extent (been) lost in recent years with

emphasis on HEAT targets”

“Helps to set out a broader concept of health promotion – brings Ottawa Charter concepts

back to the forefront of our thinking. This has to an extent (been) lost in recent years with

emphasis on HEAT targets”

“Some communities were considered to be

doing some of the health promotion work in the way that this paper

describes already”

“Some communities were considered to be

doing some of the health promotion work in the way that this paper

describes already”

“…the framework provided the legitimacy for the work (some of

which is happening a present and some of which would like to happen). It provides validation

for the work.”

“…the framework provided the legitimacy for the work (some of

which is happening a present and some of which would like to happen). It provides validation

for the work.”

“Health education role: need to redress the shift from health

education to genuinely address health inequalities”

“Health education role: need to redress the shift from health

education to genuinely address health inequalities”