Health promotion is a core function of public health. It is a cross-cutting, cross-sectoral and cross-disciplinary action applicable across all public health conditions.
Health promotion enables people to increase control over the health risks and their determinants, and thereby improving their health outcomes. In that regard, health promotion is a public good and ultimately a justifiable social investment which produces desired health (well-being) and development outcomes across population groups.
However, health outcomes are produced by a complex mix of social, economic, environmental and political factors that often exist outside the domain of the health sector. The required interventions to promote health are built on sound strategic actions, policies, legislations, content and skills derived from disciplines such as education, marketing, social sciences and the arts among other fields.
Therefore, these interventions should adopt multisectoral and interdisciplinary approaches to effectively and comprehensively address potential causes of illness, disability and premature deaths across disease — specific issues or population groups.
Health promotion situation and challenges The landmark decision to adopt health promotion was taken at the 1st Global Conference on Health promotion organised by World Health Organisation in 1986. It was agreed that health promotion should involve other players (communities, civil society and private sector) to promote, support and protect health through policies and legislations, human and infrastructure capacity building, financial resources mobilizing and generating evidence.
The body of health promotion knowledge related to content, practice skills and evidence is widely embraced in the African countries as is the case in other regions. Primary health care is also widely considered the cornerstone of all health systems in Africa, however, there has been a slow shift from curative to preventative services. Concerted efforts to strengthen health promotion actions at the individual, family and community levels continue to be hampered by limited financial and technical resources.
To compound the problem, there is a lack of policies or legislative frameworks to remedy the resource-gap situation. Due to limited resources, we -continue to witness activities that predominantly focus on information giving / awareness creation and little efforts that seek to address enabling and reinforcing factors influencing behaviors and health outcomes of individuals and communities. These actions are evident across preventable conditions such as HIV/AIDS, malaria, tuberculosis, maternal and child health issues and injuries among others.
To date, there is no country in Africa with a sustainable mechanism for financing health promotion such as a Health Promotion Foundation. However, Thailand, Australia, Tonga, Singapore and Fiji are among the countries with successful Health Promotion Foundations funded using a tax levy on alcohol, tobacco or road use. There is ample evidence to demonstrate that health promotion works.
Ideally, the national health budget allocation should provide adequate financial resources to support health promotion. However, due to the numerous public health needs competing against limited financial resources, most of the national health budget goes for curative services and not health promotion. Given that most causes of disease and premature death are preventable through health promotion, it is prudent that other innovative financing options are explored.
Globally, examples and evidence exists regarding innovative financing health promotion options and their efficacy and effectiveness. South Africa stands on the verge of taking a lead in demonstrating that innovative financing of health promotion is feasible even under these difficult economic periods.
The Health Promotion Foundation’s role would be to:
(a) manage and coordinate funds;
(b) ensure -adequate and sustainable financing arrangements;
(c) increase awareness about health gains;
(d) produce country-specific evidence;
(e) create the demand for health promotion;
(f) ensure broad participation and commitment; and (g) providing effective stewardship.
A national social dialogue on establishing Health Promotion Foundation using tobacco and alcohol tax should be opened at all levels. This debate should take place at the political and decision-making levels, civil society and with parliamentarians focusing on legislative action, policy options and innovative financing respectively.
The views expressed here are solely those of the author. Professor Davison Munodawafa is the Co-ordinator of the Determinants and Risk Factors Unit in the Health Promotion Cluster at the World Health Organisation’s Regional Office for Africa
Countries considering innovative financing of health promotion should:
- Integrate health promotion in all policies and translate the health promotion financing policy options into action.
- Forge partnership, alliances and networks with parliamentarians, civil society, public and private sectors, academic/research institutions, development partners including WHO and communities in order to open a national social dialogue on financing health promotion policy options.
- Identify leadership and delineate roles and responsibilities for establishing a Health Promotion Foundation as well as setting up legislative and regulatory frameworks.
- Organise study tours to established health promotion foundations e. g. Thai Health Promotion Foundation, Thailand. Member States should seek technical support from UN agencies such as the World Health Organisation.
This article originally appeared in the Mail & Guardian newspaper as a sponsored feature