Lesson 15 · What are the opportunities for improving young people's health?
Health promotion in Australia I: approaches to health and the global policies behind them
Lesson 14 asked who advocates and whether it works. This lesson asks a prior question that most students skip straight past: what does Australia actually think health promotion is? The answer has changed twice in fifty years, and each change was driven by evidence that the previous approach had stopped delivering. Getting this history right is what separates an answer that describes health promotion from one that explains its nature — which is the word the syllabus uses, and the word that decides the marks.
In 1970, around 37 per cent of Australian adults smoked. Today it is under 10 per cent. That is one of the largest changes in health behaviour ever recorded in this country, and it did not happen because Australians were told that smoking is bad for them. They already knew. Surveys from the 1970s show that most smokers knew, and said so.
So write down your answer to this. If the information was already there, what actually changed? List as many things as you can think of that are different about smoking in Australia now compared with 1970 — and for each one, say whether it was aimed at the individual smoker or at something else entirely.
Then a second question, which is the one this lesson is really about: if you had to explain that list to someone in a single sentence, what would you say Australia had learned?
- Define health promotion using the WHO wording, and explain why the word "control" is the load-bearing part of it.
- Distinguish the biomedical, behavioural and socio-ecological approaches, and identify which one a given strategy belongs to.
- Explain why the approach shifted, using the evidence that forced each shift rather than asserting that one approach is better.
- Describe the global policies behind Australian practice: Alma-Ata, Ottawa, Jakarta and Bangkok, and what each one added.
- Explain what primary health care means, and why it is not the same thing as seeing a GP.
- Explain the nature of health promotion in Australia as a system with levels of responsibility, rather than as a list of campaigns.
- Health promotion — the process of enabling people to increase control over, and to improve, their health.
- Biomedical approach — an approach focused on diagnosing and treating disease in the individual body, delivered by health professionals.
- Behavioural approach — an approach that seeks to change individual lifestyle choices, usually through education and persuasion.
- Socio-ecological approach — an approach that treats health as the product of the interaction between individuals and their social, economic and physical environments.
- Prevention — action taken to stop a health problem arising, or to limit it once it has. Usually divided into primary, secondary and tertiary.
- Primary health care — essential, affordable, accessible care provided as close as possible to where people live, including prevention and education, not only treatment.
- Declaration of Alma-Ata — the 1978 World Health Organization declaration that made primary health care the basis of "Health for All".
- Ottawa Charter — the 1986 WHO charter that set out five action areas for health promotion. The subject of Lesson 16.
- Jakarta Declaration — the 1997 statement that added partnerships and the private sector to health promotion thinking.
- Bangkok Charter — the 2005 statement that addressed health promotion in a globalised world.
- Health inequity — a difference in health between groups that is avoidable and unjust, as distinct from an unavoidable difference.
- Victim blaming — holding an individual responsible for a health outcome that was substantially produced by conditions outside their control.
The World Health Organization defines health promotion as the process of enabling people to increase control over, and to improve, their health. Students reproduce that sentence accurately and then write an answer that contradicts it, so it is worth slowing down on two words.
"Control" is the point. The definition is not "the process of improving people's health", which is what a hospital does. It is about who holds the power to affect it. A campaign that tells a young person what to do, without changing anything about their circumstances, has not increased their control over anything — it has increased their information, which is a different quantity and, as Card 01 shows, frequently not the limiting one.
"Process" matters too. Health promotion is ongoing and structural rather than a single event. An awareness week is an event. Removing the cost barrier to a service is a process, because it keeps working after everyone has stopped paying attention.
The distinction the syllabus is really testing
Health promotion is not the same as health education, and it is not the same as health care. Health care treats people who are already unwell. Health education informs. Health promotion includes education but goes further, because it also changes the conditions that decide whether the education can be acted on. A student who can hold those three apart will not write the most common weak answer in this topic, which is to describe a poster campaign and call it health promotion.
Quick check: In the WHO definition of health promotion, the word that distinguishes it from health care is:
Australia has not held one view of health promotion. It has held three in succession, and all three are still present in the system today. The cleanest way to tell them apart is by the question each one asks when a health problem appears.
| Approach | The question it asks | Typical action | What it is good at | What it misses |
|---|---|---|---|---|
| Biomedical | What is wrong with this body, and how do we fix it? | Diagnosis, treatment, surgery, medication, vaccination | Acute illness and injury, infectious disease, dramatic individual outcomes | Everything upstream of the clinic. It waits for people to become unwell, and it is expensive |
| Behavioural | What is this person doing wrong, and how do we get them to stop? | Education campaigns, advertising, warnings, advice from professionals | Raising awareness quickly and cheaply across a whole population | That knowing and doing are different things, and that choices are constrained by circumstances |
| Socio-ecological | What conditions are producing this pattern, and who can change them? | Legislation, taxation, redesigning environments, funding communities, building partnerships | Whole-population change, and change that reaches people who were never going to be reached by a campaign | It is slow, politically difficult, and hard to attribute to any single actor |
Two things to notice before moving on, because both are examinable.
These are not ranked. A broken leg needs the biomedical approach, and no amount of environmental redesign will set it. The argument is not that biomedicine failed; it is that biomedicine answers a question that most of Australia's current health burden does not pose, because chronic conditions develop slowly in conditions of living rather than arriving suddenly in a body.
The behavioural approach is the one that produces victim blaming, and it does so structurally rather than by accident. If your first question is what the person is doing wrong, then the answer to a health inequity is that some groups make worse choices — which, as Lesson 5 established, gets the causation backwards. Determinants shape choices; choices do not independently generate determinants.
Match each tobacco control strategy to the approach it belongs to.
- Excise
- Campaign
- Therapy
- Venues
- Socio-ecological — raising the tax changes the price everyone faces
- Behavioural — a television advertisement persuading the individual to stop
- Biomedical — prescribing nicotine replacement to a dependent patient
- Socio-ecological — legislating smoke-free workplaces and licensed venues
An answer that says "Australia moved to a socio-ecological approach because it is better" has asserted the conclusion and skipped the reasoning. Each shift was forced by something that stopped working.
The first shift, from biomedical to behavioural, was forced by a change in what was killing people. In the early twentieth century, infectious disease dominated, and the biomedical approach — sanitation, vaccination, antibiotics — was extraordinarily effective against it. By the 1970s the leading causes of death in Australia were cardiovascular disease and cancer: conditions that develop over decades and are strongly associated with smoking, diet, alcohol and physical inactivity. Treatment alone could not turn that around, because by the time such a condition presents, much of the damage is already done. Attention moved to the behaviours.
The second shift, from behavioural to socio-ecological, was forced by the inequity data. Education campaigns did work — but they worked unevenly. Rates fell fastest among people who were already advantaged, who had the money, time, housing stability and social support to act on the advice. Among people without those things, rates fell slowly or not at all. The overall average improved while the gap widened, which is the same pattern Lessons 10, 12 and 14 have now each shown in a different setting. A strategy that improves the average while widening the gap has not solved a health inequity; it has deepened one.
Smoking, which answers Card 01
The fall in Australian smoking is the standard worked case because all three approaches are visible in it. Biomedical: nicotine replacement therapy and cessation support through GPs. Behavioural: the graphic television campaigns from the 1980s onwards, and the warnings on packets. Socio-ecological: excise increases that made cigarettes among the most expensive in the world, advertising and sponsorship bans, smoke-free workplaces, pubs and clubs, plain packaging from 2012, and restrictions on sale to minors.
The point Card 01 was pushing you towards is that most of the items on that list are not aimed at the smoker at all. They are aimed at the price, the advertising, the packaging and the places where smoking is possible. The information had been available since the 1960s. What changed was the environment around the decision — and that is what the socio-ecological approach means in one example. It is also why smoking rates fell among groups that no campaign had successfully reached: a tax increase and a venue ban do not require you to have seen anything.
True or false: A health campaign that lowers the rate of a behaviour across the whole population has necessarily reduced health inequity.
Australian health promotion did not invent its own framework. It adopted a sequence of World Health Organization agreements, and Australian policy documents cite them directly. Each one added something the previous one lacked.
| Statement | Year | What it added |
|---|---|---|
| Declaration of Alma-Ata | 1978 | Made primary health care the foundation of "Health for All", and named health as a fundamental human right. Established that health is produced outside the hospital and requires action across many sectors, not only the health sector |
| Ottawa Charter | 1986 | Turned that principle into five action areas and three strategies, giving health promotion a practical structure. The single most used framework in Australian practice, and the whole of Lesson 16 |
| Jakarta Declaration | 1997 | Added partnerships across sectors, including the private sector, and emphasised increasing community capacity and investing in health infrastructure rather than one-off programmes |
| Bangkok Charter | 2005 | Addressed health promotion in a globalised world — trade, marketing across borders, communications technology and urbanisation — and pressed for health to be a core responsibility of government as a whole, and a requirement of good corporate practice |
Primary health care is the term most often misused. It does not mean "the first doctor you see", and it is not a synonym for general practice. Alma-Ata defined it as essential health care that is affordable, accessible, and delivered as close as possible to where people live and work — and it explicitly includes education, prevention, nutrition, clean water, maternal and child health, and the supply of essential medicines. A community health centre that runs a nutrition programme, a free clinic in a school, and an Aboriginal Community Controlled Health Organisation from Lesson 14 are all primary health care. So is a GP, but a GP is not the definition.
The reason this matters for the exam: Alma-Ata is where the idea that health is produced across sectors first became international policy. Transport, housing, education and employment are health policy. That is the intellectual foundation of everything in Lesson 16, and of the Sustainable Development Goals in Lessons 17 and 18.
Fill the gaps. Type one word in each box.
The 1978 Declaration of made primary health care the foundation of Health for All. The approach that treats health as the product of interaction between people and their environments is called the approach. Holding a person responsible for an outcome produced by conditions outside their control is known as victim .
The dot point asks you to explain the nature of health promotion in Australia. That word is asking for its characteristics as a system. Four features are worth being able to state.
- It is shared across levels of government. The Commonwealth funds and sets national strategy and controls the instruments that work nationally, such as excise and advertising regulation. States and territories run the health system, schools and most legislation affecting daily life. Local government controls the built environment — footpaths, lighting, parks, pools and grounds. A strategy usually needs more than one level, and stalls when one of them does not move.
- It is shared across sectors. Non-government organisations, community-controlled organisations, schools, workplaces, sporting bodies and the private sector all act. Lesson 14 examined what each can do that the others cannot.
- It is increasingly directed at prevention, though prevention remains a small share of total health spending — a well-documented tension in Australian policy, since the treatment system absorbs the overwhelming majority of the budget while most of the disease burden is preventable.
- It is explicitly targeted at equity. Australian strategy documents identify priority populations, including Aboriginal and Torres Strait Islander peoples, people in rural and remote areas, people of low socioeconomic status, and young people. Closing the Gap is the most prominent example, and its partnership structure — agreed with Aboriginal and Torres Strait Islander representatives rather than designed for them — is the practical application of the community control principle from Lesson 14.
Put those together and you have the answer to the dot point: health promotion in Australia is a multi-level, multi-sector, prevention-oriented and equity-targeted system, built on international frameworks, and progressively less reliant on persuading individuals to behave differently.
Text description
- A timeline running top to bottom, and a layered diagram beneath it.
- The timeline runs from 1978 to 2005 and marks four World Health Organization statements: the Declaration of Alma-Ata in 1978 which established primary health care, the Ottawa Charter in 1986 which set out five action areas, the Jakarta Declaration in 1997 which added partnerships, and the Bangkok Charter in 2005 which addressed globalisation.
- Below the timeline, three nested bands show the three approaches to health: an inner band labelled biomedical asking what is wrong with this body, a middle band labelled behavioural asking what is this person doing wrong, and an outer band labelled socio-ecological asking what conditions are producing this pattern.
- An arrow beside the bands, pointing from the inner band to the outer band, shows the direction of historical movement outward.
Activities · put the method to work
Choose one current Australian health issue affecting young people — vaping, alcohol, road trauma, mental health, physical inactivity, or another of your choice.
Find five things currently being done about it in Australia. Use government health department pages, an NGO site and a news source, and record where each one came from.
Sort them into biomedical, behavioural and socio-ecological. Some will not sort cleanly, and where that happens say which two approaches it draws on and why.
Count the columns. Which approach dominates your list? Then ask the harder question: is that because it is the most effective for this issue, or because it is the easiest to fund and announce?
Propose one addition from whichever column is thinnest, and name which level of government or which sector would have to act. A proposal with no named actor is a wish.
Then the test of whether the sorting was real: for each socio-ecological measure on your list, name the group it would reach that a campaign would not. If you cannot name one, it probably belongs in the behavioural column after all.
Odd one out. Three of these are features of primary health care as Alma-Ata defined it. Which one is not?
You are given $10 million to reduce vaping among 14 to 17 year olds in New South Wales. Three advisers each want the whole budget.
The clinician wants it spent on cessation support through GPs and school nurses, plus subsidised nicotine replacement for dependent students.
The communications specialist wants a social media campaign built with young people, running for two years on the platforms they actually use.
The policy officer wants it spent on enforcement against retailers selling to minors, import controls, and funding councils to act on vape shops near schools.
Write the decision. Say what each proposal would achieve and what it would miss, then allocate the money and defend the split. A defensible answer almost certainly funds more than one, so the real work is justifying the proportions — and saying which group each portion is intended to reach. Finish by naming the one measurement you would use in three years to tell whether the money worked, and explain why that measurement and not a simpler one.
Explain the nature of health promotion in Australia, referring to the approaches taken and the global policies that shaped them.
Explain means make the relationship clear — why as well as what. And "nature" asks for characteristics, not a list of campaigns. So the answer must describe what kind of thing health promotion in Australia is, and account for why it is that kind of thing.
Plan: define health promotion; name the three approaches and the shift between them with its cause; anchor to Alma-Ata and Ottawa; then state the four system features and close on equity.
Health promotion is the process of enabling people to increase control over, and to improve, their health. The emphasis on control rather than information is what distinguishes it from health education, and what explains why Australian practice has moved progressively away from strategies aimed at persuading individuals.
Australia has held three approaches in succession. The biomedical approach treats disease in the individual and was highly effective against infectious disease, but could not address chronic conditions that develop over decades. The behavioural approach targeted lifestyle through education, but its gains fell disproportionately to people already advantaged, so averages improved while the gap between groups widened. The socio-ecological approach asks what conditions produce a pattern, and acts on those conditions through legislation, taxation and environmental change.
Health promotion is the process of enabling people to increase control over, and to improve, their health. The emphasis on control rather than information is what separates it from health education, and it explains the direction Australian practice has taken. Australia has held three approaches in succession, and all three remain present in the system. The biomedical approach asks what is wrong with the individual body and answers with diagnosis and treatment; it was decisive against infectious disease but cannot address chronic conditions that develop over decades and present only once damage is established. The behavioural approach asks what the individual is doing wrong and answers with education and persuasion; it raised awareness cheaply and quickly, but its benefits accrued disproportionately to people who already had the money, time and stability to act on the advice, so population averages improved while the gap between advantaged and disadvantaged groups widened. That evidence forced the shift to the socio-ecological approach, which asks what conditions produce a health pattern and acts on those conditions through legislation, taxation, environmental redesign and community partnership. Australian tobacco control is the clearest illustration: information about the harms of smoking was public from the 1960s, yet the sharpest falls followed excise increases, advertising and sponsorship bans, smoke-free venues and plain packaging — measures aimed not at the smoker but at the price, the marketing and the setting, and which therefore reached groups no campaign had successfully reached. This approach is built on international frameworks that Australian policy cites directly. The Declaration of Alma-Ata in 1978 made primary health care the foundation of Health for All and established that health is produced across sectors rather than within the health system alone; the Ottawa Charter of 1986 converted that principle into five practical action areas; the Jakarta Declaration of 1997 added partnerships, including with the private sector; and the Bangkok Charter of 2005 extended health promotion to a globalised world of cross-border marketing and urbanisation. The nature of health promotion in Australia therefore has four characteristics. It is shared across levels of government, with the Commonwealth holding national instruments such as excise, the states running health services and schools, and local government controlling the built environment. It is shared across sectors, with non-government and community-controlled organisations acting where government cannot. It is oriented towards prevention, although prevention still receives a small share of total health expenditure, which remains a recognised tension in Australian policy. And it is explicitly targeted at equity, identifying priority populations including Aboriginal and Torres Strait Islander peoples, rural and remote communities, people of low socioeconomic status and young people. Health promotion in Australia is therefore best characterised not as a set of campaigns but as a multi-level, multi-sector, prevention-oriented and equity-targeted system, progressively less reliant on persuading individuals and progressively more willing to change the conditions in which their choices are made.
Analyse why a behavioural approach to health promotion can improve the health of a population while increasing health inequity.
Analyse means show the relationships between components. Here the components are two outcomes that sound incompatible — the population gets healthier, and the inequity gets worse. An answer that argues the behavioural approach is simply bad has not analysed anything, because it has explained away one half of the question instead of accounting for both.
Plan: establish that both outcomes are real; identify the mechanism, which is differential capacity to act; show how that produces both results simultaneously; give the Australian evidence; then state what follows for strategy design.
A behavioural strategy supplies information and encouragement equally, but the capacity to act on it is not distributed equally. Acting on advice to eat better, exercise more or stop smoking requires money, time, secure housing, transport, safe surroundings and social support — the determinants of health from earlier in this module. Where those are present, the advice converts into behaviour change. Where they are absent, it does not.
Because the advantaged group does change, the population average improves and the strategy can be reported as a success. Because the disadvantaged group changes less, the distance between the two groups grows. Both statements are consequences of the same mechanism, which is why the improvement and the widening are not in tension: an average is not a distribution, and a strategy evaluated only on the average cannot detect what it has done to the distribution.
A behavioural approach to health promotion seeks to change individual lifestyle choices through education, advice and persuasion, and it distributes that information broadly and more or less equally. The capacity to act on the information, however, is not distributed equally, and that single asymmetry produces both of the outcomes in the question. Acting on advice to eat more fresh food, to exercise regularly or to stop smoking requires resources that are themselves unequally held: disposable income, discretionary time, secure and adequate housing, transport, a safe environment in which to be active, and social support that makes a sustained change possible. These are the determinants of health, and they decide whether information converts into behaviour. Among people who hold them, a campaign produces real change, and because that group is large enough to move a national statistic, the population average improves and the strategy is reported as effective. Among people who do not hold them, the same campaign produces little change, because the barrier was never the absence of information — most smokers in the 1970s already knew smoking was harmful. The result is that the gap between the two groups widens at the same time as the average improves, and both are genuine consequences of one mechanism rather than a contradiction. The deeper problem is one of measurement: an average is not a distribution, so a strategy evaluated on population-level change alone is structurally incapable of detecting that it has widened an inequity, and may be renewed on the strength of the very figure that conceals the harm. Australian experience supports this. Smoking rates fell overall from the 1970s, but remained substantially higher among people of low socioeconomic status, people experiencing mental illness, and Aboriginal and Torres Strait Islander peoples, and the steepest whole-population falls followed structural measures — excise increases, advertising bans, smoke-free venues and plain packaging — rather than the education campaigns that preceded them, because those measures did not require the individual to have the capacity to respond. Two consequences follow for how strategies should be designed and judged. First, behavioural strategies are not worthless but are incomplete, and they work best alongside structural measures that alter the conditions in which choices are made, which is the reasoning behind Australia's shift towards a socio-ecological approach. Second, and more practically, any health promotion strategy should be evaluated by measuring change within priority populations separately, not only in the population as a whole, since an inequity that is not measured separately cannot be seen at all.
Multiple choice · 5 questions
MC 1. The World Health Organization defines health promotion as the process of:
- A. treating disease as early as possible after diagnosis
- B. enabling people to increase control over, and to improve, their health
- C. informing the public about the risks of unhealthy behaviour
- D. providing hospital services free of charge at the point of use
MC 2. Raising the excise on tobacco products is best classified as:
- A. a biomedical strategy, because it reduces disease
- B. a behavioural strategy, because it aims to change what individuals do
- C. a socio-ecological strategy, because it changes the conditions in which the choice is made
- D. not a health promotion strategy, because it is a taxation measure
MC 3. The 1978 Declaration of Alma-Ata is significant because it:
- A. established the five action areas used in Australian health promotion
- B. first addressed the effects of globalisation on health
- C. made primary health care the foundation of Health for All
- D. introduced partnerships with the private sector
MC 4. A campaign reduces the smoking rate in every group, but the rate falls further among high-income groups than low-income groups. The effect on health inequity is that it has:
- A. reduced inequity, because every group improved
- B. widened inequity, because the gap between the groups has grown
- C. had no effect on inequity, because the direction of change was the same
- D. eliminated inequity, because the average improved
MC 5. Which of the following is the strongest evidence that Australian health promotion now takes a socio-ecological approach?
- A. Health warnings are printed on cigarette packets
- B. Nicotine replacement therapy is available from pharmacies
- C. Governments fund advertising campaigns about the harms of smoking
- D. Smoking is prohibited in workplaces and licensed venues by legislation
Short answer · exam style
SA 1. Remember Band 3 Outline the difference between the biomedical, behavioural and socio-ecological approaches to health. (3 marks)
SA 2. Understand Band 5 Explain the nature of health promotion in Australia, referring to the global policies that have shaped it. (5 marks)
SA 3. Analyse Band 6 Analyse why a behavioural approach can improve population health while increasing health inequity, using an Australian example. (6 marks)
📖 Comprehensive answers (click to reveal)
Multiple choice: 1 → B. 2 → C. 3 → C. 4 → B. 5 → D.
Activity 1 guidance: The counting step in part 3 is what makes this activity work, and it usually produces the same result whichever issue is chosen: the behavioural column is the longest, because campaigns are cheap, fast, visible and politically safe, while structural measures are slow, contested and often opposed by an industry. That is a finding about how health promotion gets funded rather than about what works, and saying so is the analytical move. On part 4, the commonest weak proposal is a better campaign, which adds to the column that is already longest. The strongest proposals name a specific instrument and a specific actor — a council amending a planning rule, a state government changing a licensing condition, the Commonwealth altering an import control. On the final test, a socio-ecological measure should reach people who never saw the campaign, who did not believe it, or who believed it and could not act; if the measure only helps people who were already persuaded, it is behavioural in structure whatever it is called.
Activity 2 guidance: There is no single correct allocation, and an answer that gives the whole budget to one adviser is almost always weaker than one that splits it, because each proposal addresses a different group. The clinician's proposal reaches students who are already dependent and already want to stop — a small group with the greatest individual need, and the only group for whom the other two proposals do nothing. The campaign reaches students who have not started, where prevention is cheapest, but it will be least effective among those most likely to vape, which is the inequity mechanism from Card 06 appearing in the budget. The policy proposal addresses supply and is the only one that works without requiring any young person to do anything, so it is the one that reaches everyone including those no campaign reaches; its weakness is enforcement capacity and displacement to other sources. A strong answer allocates the largest share to supply-side measures on those grounds, funds cessation support as the only route for those already dependent, and treats the campaign as a supporting element rather than the centrepiece — and then, on the measurement question, chooses a disaggregated measure such as vaping prevalence by socioeconomic group rather than overall prevalence, precisely because an overall figure cannot detect a widening gap. That final choice is the strongest single indicator that Card 06 has been understood.
SA 1 (3 marks): One mark for each approach, correctly distinguished. Biomedical — focuses on diagnosing and treating disease within the individual body, delivered by health professionals [1]. Behavioural — seeks to change individual lifestyle choices, usually through education and persuasion [1]. Socio-ecological — treats health as the product of the interaction between individuals and their social, economic and physical environments, and acts on those environments [1]. An answer that describes all three as "ways of improving health" without distinguishing the level each acts on scores one at most.
SA 2 (5 marks): Health promotion defined as enabling people to increase control over and improve their health [1]. The three approaches named, with the shift towards the socio-ecological identified [1]. At least two global policies named with what each contributed — Alma-Ata and primary health care, Ottawa and the five action areas, Jakarta and partnerships, Bangkok and globalisation [1]. The multi-level and multi-sector nature described, with an example of what a level or sector uniquely holds [1]. The equity orientation identified, naming at least one priority population [1]. Note that the question says "nature", so a list of three campaigns with no characterisation of the system cannot reach full marks however accurate the campaigns are.
SA 3 (6 marks): The behavioural approach described as distributing information broadly and equally [1]. The capacity to act identified as unequally distributed, with determinants named — income, time, housing, transport, safety, social support [1]. The improvement in the population average explained as real, arising from change among the advantaged group [1]. The widening gap explained as arising from the same mechanism rather than a separate one [1]. The measurement point made, that an average conceals a distribution and so cannot detect the widening [1]. An Australian example supplied with evidence, most commonly tobacco: overall rates falling while remaining high among low socioeconomic groups, people experiencing mental illness and Aboriginal and Torres Strait Islander peoples, with the steepest falls following structural rather than educational measures [1]. The strongest answers close by recommending disaggregated evaluation, which is the practical consequence of the measurement point.
Control, not information. Health promotion is the process of enabling people to increase control over, and to improve, their health. That definition is the reason the whole field moved: a campaign raises information, and information was rarely the thing in short supply.
Three approaches, still all present. Biomedical asks what is wrong with this body. Behavioural asks what this person is doing wrong. Socio-ecological asks what conditions are producing this pattern. They are nested rather than sequential — Australia did not stop treating illness when it started changing environments.
Each shift was forced by evidence. Biomedical to behavioural, because chronic disease replaced infectious disease as the main burden and could not be treated after the fact. Behavioural to socio-ecological, because education improved the average while widening the gap. That second finding is the most transferable idea in this module, and you have now met it four times.
Four statements, each adding what the last one lacked. Alma-Ata 1978 gave primary health care and the principle that health is made across sectors. Ottawa 1986 gave the five action areas. Jakarta 1997 gave partnerships. Bangkok 2005 gave globalisation.
And the dot point itself: the nature of health promotion in Australia is a multi-level, multi-sector, prevention-oriented and equity-targeted system. If you can say that sentence and then justify each of its four adjectives with an example, you can answer this dot point in any form it is asked.
Lesson 16 takes the framework that does most of the practical work — the Ottawa Charter's five action areas and three strategies — and the partnerships with communities that make them function.
Mark lesson as complete
Tick when you've finished the practice and review.