Global challenges and opportunities in health promotion

Introduction Health promotion interventions at the community and population levels are among others, crucial for tackling non-communicable diseases (NCDs) and infectious diseases, enhancing mental health, and addressing the social determinants of health and health equity. As a key aspect of public health, it is not only aimed at developing individual skills and capabilities, but also to improvement of the political, social, environmental, and economic factors of importance for public and individual health. (1) To achieve long-term change, it is of great importance that health promotion is evidence-based, integrated, sustained, and adequately address the wide-ranging challenges. The Shanghai Declaration on Promoting Health in the 2030 Agenda for Sustainable Development emphasizes the need to address health determinants, ensure good governance, improve health literacy, create healthy cities and environments, and foster social mobilization and equity. (2) Addressing the structural determinants of health demands changes in social policies and systems to reduce poverty, improve living and working conditions, ensure equitable access to resources and services, and address societal norms and values to combat discrimination while promoting social justice. Past and Current state of Health Promotion The roles of public health, health education, and health promotion have evolved significantly over time. In the 19th century, improvements in nutrition, and hygiene contributed to better health. The introduction of vaccines in the late 19th and early 20th centuries and antibiotics in the 1930s enabled effective control of infectious diseases. Increasing awareness of the effects of risk factors on health underscored the importance of disease prevention in reducing noncommunicable diseases. The 1974 Lalonde Report (3) and the 1986 Ottawa Charter (4) marked the start of a significant era in health promotion, leading to a focus on population health. The health promotion paradigm also changed over time. The preventive paradigm is risk-focused, aiming at preventing health issues within populations and communities. It facilitates early diagnosis and access to reliable health information. On the other hand, the health-promotion paradigm emphasizes societal factors, health determinants, and the empowerment of individuals and communities, advocating for access to rights and equity. As stated in Minsk declaration, a life-course approach, focusing on health across different stages of life stress the importance of a healthy start and individuals' needs throughout their daily lives and during pivotal moments. By targeting the root causes of ill health rather than just the symptoms, it encourages early investments that can deliver significant advantages for both public health and economic outcomes. (5) The changes and challenges that the world is increasingly facing highlight the need for evidence-based health promotion utilizing the best available research, practice, and evaluation data to design, implement, and assess health promotion interventions, ensuring they are effective, efficient, and tailored to population needs. Challenges and Opportunities While advancements in science and living standards have improved longevity and reduced infectious disease rates, challenges such as pandemics, obesity, malnutrition, antimicrobial resistance, and NCDs remain significant. Such challenges remain, among other, due to of unhealthy lifestyles, growing pollution, and a focus on reactive rather than preventive medicine. Health-related behaviors, such as inadequate vaccination and low cancer screening rates, are often rooted in human behavior and impose a heavy burden on health systems and individual well-being. To effectively address them, the cultural contexts in which they occur, and the engagement of those affected are needed as well as application of models, and methods from behavioral and cultural sciences. Challenges also include the effects of global disruptions like climate change, armed conflicts, irresponsible business practices, corruption, and unsustainable production on health. These events highlight the critical importance of strong health systems and further strengthening of health promotion focus on promoting overall well-being, not just treating diseases. One of the opportunities for health promotions is people's increased awareness of their rights and responsibilities. Citizen participation in social mobilization can be a powerful tool to shape sustainable development policies and shall play an important role in health promotion. Social movements are gaining momentum worldwide. The World Health Organization (WHO) defines social participation as the empowerment of individuals, communities, and civil society by ensuring inclusive involvement in decision-making across all stages of policy development and at every level of the health system. Building upon previous intergovernmental agreements at the Seventy-seventh World Health Assembly, Member States endorsed a resolution aimed at establishment, enhancing, and sustaining meaningful social participation in health-related decision-making processes. Another, still persisting challenge is achieving effective intersectoral action for health, as it demands political will, coordinated efforts, and structures to support cross-sectoral policy development and implementation. A 'Health in All Policies' (HiAP) approach promotes intersectoral collaboration across government and society, advocating for new working models, including effective intersectoral structures, participatory processes, and partnerships. However, HiAP has been fully implemented in only a few countries, and many countries lack the necessary intersectoral policy systems and structures. Sustainable financing is essential for health promotion, as consistent funding is needed to maintain efforts over time. According to a study by the Organization for Economic Co-operation and Development (OECD), less than 3% of total healthcare expenditure is usually allocated to prevention and health promotion, with spending often decreasing significantly during economic recessions. (6) Future Directions in Health Promotion Global health concerns will change in the future, and health promotion will need to continuously adapt to the social and political changes such as globalization, emergencies, wars, economic crises, and periods of growth. Being strategically prepared for the future boosts the ability to navigate upcoming trends and uncertainties. To assess the megatrends, driving forces, and unpredictable factors that might profoundly impact people's well-being in future, in 2020, WHO team conducted strategic foresight that provides an analysis of health-promotion system capacity models and a horizon-scanning of global trends. The key findings on the future of health promotion suggest expanding the capacity of health-promotion and call for the paradigm shifts needed to progress the agenda on planetary health, One Health and well-being. Some practices are expected to endure, as they are vital for the sustainability of future systems, but current paradigms will evolve and shift significantly. Essentially, the future health model will blend elements of medical care, preventive measures, and health promotion, along with the planetary health paradigm. (7) To effectively implement comprehensive health promotion interventions, robust infrastructures are necessary to support delivery within the health system and across various sectors. This involves developing organizational capacity and structures with a clear mandate to support intersectoral health promotion at both national and local levels. In addition, mechanisms for cross-sectoral collaboration are essential and leadership and governance must broaden their thinking and adapt quickly to handle emergencies and uncertainties. Focus should be also on adopting a visionary approach, understanding people's willingness to act, and evaluating how much bureaucracy should be challenged. (8) Conclusion Despite achievements and developments, often there's a general lack of understanding about where health promotion fits within public health and the broader health system. The complexity of contemporary health threats, which disproportionately impact the most disadvantaged, underscores the need for immediate and transformative action to achieve measurable progress. Although understanding the past is crucial, relying on it alone is insufficient for effective decision-making in a in a rapidly changing world. Being strategically prepared for the future enhance the capability to manage emerging trends and uncertainties. It is crucial for governments to create responsive health policies and programs, ensuring broad stakeholder involvement and progress toward Universal Health Coverage (UHC) without leaving anyone behind.

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