EWLES AND SIMNETTS HEALTH PROMOTION

Ewles and Simnetts five approaches to health promotion

Ewles and Simnetts five approaches to health promotion

Introduction

The province of Ontario is in the process of reforming its system of health care delivery. One of the options being considered by the Ministry of Health is the development of “integrated health systems (IHSs)”. This development provided the opportunity for the Center for Health Promotion at the University of Toronto to consider the critical role that health promotion can and should play in such systems. In 1996, a working group consisting of organizations and practitioners interested in health promotion was established to formulate recommendations for the government on the role of health promotion within integrated health systems.

The paper also argues that while IHSs must first and foremost be concerned with meeting the health needs of their clients and communities, efforts should also be directed towards empowering the agencies or organizations and employees that work within the IHS and therefore recommends that:

* should be committed to creating work environments that are supportive of employees' health as stated in Health Canada's Corporate Health Model.

* Structures should reduce power and income hierarchies and health providers' dependence on physicians by moving to collaborative, multidisciplinary work teams and empowering accountability structures.

* should be held accountable for actively working to achieve parity between the salaries or financial compensation of IHS employees working in institutional or community settings and those in health or health-related social services.

* should be held accountable for demonstrating, to the greatest extent possible, the use of sustainable environmental resources.

The three sets of recommendations presented constitute almost all of the recommendations regarding empowerment. The paper makes a similar number of recommendations in relation to each of the other core health promotion values, a selection of which is presented below.

The position that significant levels of public participation be incorporated into the design and ongoing operations of IHSs is supported by the following recommendations:

* should be held accountable for ensuring that meaningful participation of their rostered members exist during the designing and planning of the IHS. We suggest that this requires rostered members to initially hold 40 percent of the seats on IHS governance boards and eventually occupy the majority of the seats on governance bodies (which should be representative of the characteristics of the rostered community).

To ensure that participation is meaningful, the paper recommends that:

* should be accountable to develop a formal process which would provide members who are elected or selected to sit on governance boards with the tools, skills and resources necessary for meaningful participation. Prior skills or experiences should not be barriers to public participation in decision making.

With regard to “addressing the impact of the broader determinants of health”, the paper argues that IHSs be required to allocate resources to support interventions and collaborative partnerships which recognize and act on the socio-environmental conditions that affect health. The following are among the recommendations that support this position:

* provincial standard be established regarding the minimum budgetary proportion that IHSs must allocate to health ...