Within this collaborative process, properly coordinated health promotion campaigns, first, identify the target population or populations, taking care to include disadvantaged groups, such as minority ethnic groups, women, people living with a disability, and people with low socioeconomic status. These campaigns use epidemiology to determine a community's health status and health needs. Researching the health status of each population group allows one to address the particular prevention needs of each group from before birth to old age, ensuring that social, economic, and structural conditions are built into the strategy from the beginning.
Second, a health promotion program should identify the risk factors that threaten the achievement of these needs -- risk factors associated with noncommunicable diseases, such as illness caused by smoking, using alcohol and other drugs, or by maintaining a poor diet, with little exercise; risk factors for communicable diseases, such as those caused by incomplete immunization coverage and sexual risk-taking; risk factors for injuring mental health, such as substance abuse, and living and working under stressful conditions; and risk factors for disturbing environmental health, such as food contamination and pollution.
Modern health promotion models tackle all of these areas with an integrated program, since risk factors do not operate in isolation. Psychosocial factors, such as mental health status, lead to behaviors that affect noncommunicable and communicable disease risk factors, and environmental health conditions have a structural impact on communicable disease risk factors and mental health status.
A third health promotion campaign device is to identify relevant settings or organizations that can develop healthy and supportive environments, such as health promoting hospitals, schools, workplaces, and towns, and to match these to population groups. Organizations should provide for the occupational health and safety of their members or employees. They should be supportive of health in the people that they deal with, and they should be healthy themselves, that is, they should provide a supportive, rewarding, and fulfilling environment for those who work there.
Fourth, health promotion campaigns should identify methods to support people who are combating health problems in these settings. These methods can include social marketing (including mass media advertising and sponsorship of sports and arts by health agencies), community development projects to built capacity at the local level, and legislative and fiscal activities, such as the banning of cigarette advertising or the implementation of an increased tax on cigarettes.
Health promotion establishes epidemiological baselines for mortality, morbidity, and behavior patterns, enabling health outcomes to be plotted and compared with predicted effects. Outcome evaluations, however, have to take account of the fact that the timelines for health promotion are much longer than those for crisis care. If a cancer is surgically removed, one knows within a day whether the patient will live; if a young girl is dissuaded from beginning to smoke, it will be 30 years before she shows up in the statistics as a fraction of a death avoided. The reduction in male lung cancer rates since the antismoking campaigns began, however, and the fall in cardiovascular deaths following the move to lower-fat diets, show that when behavioral change can be embedded in the culture it can be very effective indeed.
Health promotion is also highly cost effective; in one Australian study, antismoking activities alone returned Aus$212 million for an outlay of $19 million. Some progressive governments around the world have followed the lead of the Australian state of Victoria and the Victorian Health Promotion Foundation. The foundation is funded by an increased tax on cigarettes, as life-threatening items of consumption, and it invests the extra money thus gained in specialized health-promotion agencies.
As the World Bank has made clear, investment in health promotion and disease prevention strategies represent the most efficient way to improve the health of the world's people, yet in many countries funds for health promotion are still hard to find. Victoria's model is a way of taxing one of the most harmful disease-creating products to promote wellness. The tax is possible electorally because of its association with health, so the government is able to raise the price of cigarettes much higher, which in turn acts as a disincentive to smokers (especially younger smokers). Health promotion areas unrelated to tobaccopromotion of a healthy diet and exercise, campaigns for safe drinking, anti-skin cancer campaigns, encouragement of Pap smears for women, and the promotion of mental health, safety, and safer sex-all benefit because the agency is able to support these programs from the tobacco tax.
Green, Lawrence, and Marshall Kreuter, 1991. Health Promotion Planning: An education and environmental approach. Mountain View, CA: Mayfield Publishing Company.
Downie, Robert, Carol Fyfe, and Andrew Tannahill, 1991. Health Promotion: Models and Values. Oxford and New York: Oxford University Press.
HEARSAY. Evidence offered at an adjudicative hearing regarding a statement made outside the hearing when offered to prove the truth of matters asserted in the statement; a secondhand account of an event offered into evidence to prove that the event occurred.
Whether particular evidence constitutes hearsay depends upon the purpose for which the evidence is offered. If offered to prove the truth of matters asserted in the state-