northern territory health promotion...health promotion framework 5 framework health promotion...
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www.nt.gov.au/health
Northern Territory
FrameworkHealth Promotion
Community Action
Health Information
Social Marketing
Health Education
Skills Developmen
t
Setti
ngs
& Su
ppor
tive
Envi
ronm
ent
Risk Assessment, Immunisation
Screening, Individual
NTHealth Promotion FrameworkDeterminants of Health
Preventing diseasePromoting wellbeing EMPOWERMENT Intersectoral Collaboration
CQI
Continuum Of Health Promotion Practice Equity
PartnershipHealth Promoting Schools
Cultural Knowledge
Scre
enin
g
SCREENINGImmunisationenablingSocial Marketing
Mediation Health Promoting HospitalsPrimaryHealthCare
Healthy Weight
AdvocateSustainability
Tobacco Control
Health in All Policies
CQI
CapacityBuildingHealth Promoting Health Services
SKILLS DEVELOPMENT
Com
mun
ity A
ctio
n
Continuum Of Health Promotion PracticeEmpowermentIndividual Risk AssessmentHealth Literacy
IMMUNISATIONequity
Supportivehealth education
heal
th e
duc
atio
n
IMMUNISATION
Settings
Social Justice
Settings
immunisation
imm
unis
atio
n
Health Literacy
Primary Health Care
Social Marketing
Health Information
Health InformationHealth Literacy
Health Literacy
SettingsEq
uity
Eq
uity
AdvocateHealth
Health
Sustainability
Sustainability
health information
Supportive Environments
SUPPORTIVE ENVIRONMENTSAdvocate
Health in All PoliciesCQI
EquityRe orient health services
CQIAdvocate Health in All Policies
health promoting hospitalsSkills
Community EngagementIntersectoral Collaboration
Intersectoral CollaborationPromoting wellbeing
Skills Development
preventing diseaseEMPOWERMENT
social determinants of health
Tobacco Control
Sustainabilitysupportive environments
Healthy Public Policy
PARTNERSHIPIMMUNISATION
enabling
health education
Individual Risk Assessment
enabling
Mediation
equity
Health
policy
Acknowledgement The NT Health Promotion Framework has benefited from consultation across the Northern Territory. The Department of Health gratefully acknowledges all stakeholders that contributed and provided feedback in the development of this document.
Disclaimer
Please note that throughout this document the term Aboriginal should be taken to include Torres Strait Islander people.
© Department of Health, 2013.
This publication is copyright. The information in this report may be freely copied and distributed for non-profit purposes such as study, research, health service management and public information subject to the inclusion of an acknowledgement of the source. Reproduction for other purposes requires the written approval of the Chief Executive of the Department of Health, Northern Territory.
Suggested citation:
Northern Territory Health Promotion Framework. Department of Health Darwin, 2013.
An electronic version is available on the Health Promotion Strategy Unit website http://www.health.nt.gov.au/Health_Promotion/Resources_for_Good_Practice
General enquires about this publication should be directed to
Program Leader, Health PromotionDepartment of HealthPO Box 40596, Casuarina, NT 0811
Phone: 08 8985 8019
Health Promotion FRAMEWORK
FrameworkHealth PromotionNorthern Territory
Table of Contents
Foreword 2
Background 3
Improving Health and Wellbeing 3
Health Promotion Context 5
NT Health Promotion Framework 6
Framework Objectives 6
Who can use the framework? 7
Utilising the Health Promotion Framework 7
Determinants of Health 8
Continuum of Health Promotion Practice 11
Implementation 18
Examples of utilising the Framework 18
Benefits of implementing the Framework 18
Possible measures to track implementation of the Framework 19
Glossary of Terms 20
Health Promotion Tools 26
References 27
Health Promotion FRAMEWORK32
D E PA R T M E N T O F H E A LT H
Minister for Health
Robyn Lambley MLA
Many of the diseases and injuries that lead to the high rates of morbidity and mortality in the
Northern Territory (NT) are preventable. In order to reduce preventable disease and avoidable
injuries, the promotion and protection of health and wellbeing has to be incorporated in health
service planning and delivery. A focus on health promotion and preventive health is an integral
part of the current National Health Reform agenda and is reflected in core national documents
such as the National Primary Health Care Strategic Framework and the Aboriginal and Torres
Strait Islander Health Performance Framework. Locally documents such as the Northern Territory
Chronic Conditions Prevention and Management Strategy 2010-2020 (CCPMS) and the Northern
Territory Aboriginal Health Forum Core Functions of Primary Health Care: A framework for the
Northern Territory also reflect this focus. Health Promotion is an integral part of these strategic
plans, strategies and frameworks, therefore the Northern Territory requires an overarching Health
Promotion framework that guides Health Promotion planning, programs and service development
across the Northern Territory.
The NT Health Promotion Framework provides guidance on incorporating quality health promotion
actions, interventions and programs into service delivery. It provides a consistent language and
processes for planning, implementing and evaluating actions across the continuum of Health
Promotion, which ranges from working to create health promoting environments, engaging
communities and consumers, providing effective targeted health information and health education,
to the provision of screening and immunisation. Well planned, quality health promotion activities
have an important role to play in maintaining and improving the health and well being for all
Territorians.
The Health Promotion Framework is consistent with other national and regional Primary Health
Care strategies and frameworks and forms an essential building block within the matrix of strategic
plans and documents utilised in the Northern Territory to guide health service planning and delivery.
The framework can be utilised by service providers and communities in the further development of
client centred, evidence based and cost-effective health services.
I thank all those who have given their time and attention to the development of this important
framework. It is with great pleasure that I commend to you the Northern Territory Health Promotion
Framework.
Honourable Robyn Lambley MLA
Minister for Health
Foreword
3Health Promotion FRAMEWORK
FrameworkHealth PromotionNorthern Territory
Background
Health Promotion is an integral part of health service delivery, and health promotion has long been seen as “everybody’s business” within the health and community services sectors. This Framework provides a structure for describing the broad range of health promotion actions that are utilised across the Northern Territory (NT). It enables a shared understanding of the actions that can be taken to improve health and wellbeing, and provides guidance about embedding a health promotion approach into planning processes, programs and service development across the NT.
This Framework summarises well established Health Promotion principles and practices and key concepts such as the Social Determinants of Health, and positions them within an NT context.
Health Promotion as an approach recommends collaborative practice across sectors. Therefore whilst this framework is primarily intended to be used within the health sector, sectors and agencies outside the health domain are encouraged to utilise this Framework to inform their service delivery.
This Framework builds on and is consistent with other health promotion resources used in the NT, such as the Public Health Bush Books, the Northern Territory Chronic Conditions Prevention and Management Strategy 2010-2020, the Quality Improvement Program Planning System (QIPPS) and the One21Seventy Health Promotion Continuous Quality Improvement Tools. The framework can be used in conjunction with these health promotion resources as well as other strategic documents relevant to program areas.
Improving Health and Wellbeing
The World Health Organisation (WHO) acknowledges the growing evidence that health promotion and preventive health approaches are effective in improving overall health and wellbeing, reducing the burden of chronic disease and injury, addressing health inequities, facilitating the better use of resources and enhancing economic productivity (1,2,3,4).
Striking a balance between investments in a health promoting approach that addresses the escalating burden to the healthcare system of preventable chronic conditions and investments that increase the level of expenditure in treatment services is a major component of health system reform. It is particularly important to utilise key performance indicators and benchmarks that relate to improving health outcomes across the lifespan.
A large proportion of the disease burden in Australia and the NT is attributed to lifestyle-related behaviours such as tobacco use, overweight and obesity, physical inactivity and alcohol misuse (5,6). Within the NT, the largest contributor to the disease burden is low socioeconomic status (7).
Health Promotion FRAMEWORK4
The other health challenges we are facing today in the Northern Territory, Australia and across the world are (8, 9,10):
• The gap between Aboriginal and non-Aboriginal health status and outcomes• Increasing levels of chronic conditions, disability, injury and mental illness• The ageing of the population • Growing inequities in health and other social factors between different population groups
between and within countries• Increasing environmental degradation and climate change with severe health consequences
Investing in health promotion is an important strategy to contain the projected increase in health expenditure (11, 12). Health promotion is essential for implementing the national health reform agenda. This is highlighted by the establishment of the Australian National Preventive Health Agency (13).
Across Australia, a “Health in All Policies” approach is increasingly being used by Governments. It involves the consideration of the impacts on health from policy and program development processes across all sectors. It inevitably involves systems and organisational change (14).
It will be essential to have ongoing monitoring of the cost effectiveness of health promotion interventions to increase the evidence base for policy-makers (15).
With increasing investment in health promotion in the NT, the development of a framework that can be used to guide practitioners, researchers and policy-makers to undertake evidence-based health promotion work is necessary.
5Health Promotion FRAMEWORK
FrameworkHealth PromotionNorthern Territory
1
Health Promotion Context
The Ottawa Charter is a global framework aimed at guiding health promotion action. It outlines five areas for health promotion action:
• Build healthy public policy• Create supportive environments• Strengthen community action• Develop personal skills• Reorient health services
In essence, health promotion is about:
• Preventing disease and promoting wellbeing by encouraging and enabling people to adopt healthy lifestyles• Empowering individuals and populations to have control over, and make informed decisions
about, their health• Providing supportive social, economic and physical environments through diverse but
complementary strategies• Working in collaboration with a wide range of sectors• Enabling individuals to take control over the determinants of health• Equipping systems and sectors to address the social determinants of health
Contemporary Health Promotion Objectives
✔ To Promote Equity✔ To Ensure Social Justice✔ To use a Strengths Based Approach✔ To Advocate for improved population health outcomes ✔ To Work in Partnership✔ To Ensure Intersectoral Collaboration✔ To Promote Community Engagement✔ To Support Empowerment✔ To Promote Sustainability✔ To Embrace Evidence based Practice✔ To Value Contextual Knowledge✔ To Celebrate and value Cultural Knowledge✔ To improve health literacy through system level changes✔ To commit to the use of Continuous Quality Improvement (CQI) in order to improve health promotion practice
Health Promotion FRAMEWORK6
NT Health Promotion Framework
Framework Objectives
• To support a consistent approach to the description and implementation of health promoting services and programs across the NT
• To provide guidance as to how health promotion can be reflected in business planning and service development processes within health services
• To raise awareness of the range of strategies that sit across the health promotion continuum• To facilitate a common understanding and language about health promotion strategies and
actions• To stimulate discussion that promotes a common understanding of the role and contribution of
health promotion strategies and actions• To support collaboration between government agencies, non-government organisations,
private sector, industry and communities• To support the health and wellbeing workforce to provide health promoting health services and
programs
Who can use the framework?
The framework is intended to be used by a diverse audience both within and external to the health sector, such as:
• The health workforce (including health professionals , community workers and administrative staff)• Directors, managers and senior policy makers in health and community services• Other NT Government Departments• Other private and non-government workforces that work in different settings:
✔ Non-Government Organisations (NGO)✔ Private businesses and industry✔ People working in other sectors such as education, planning and housing
• Communities and the general public
7Health Promotion FRAMEWORK
FrameworkHealth PromotionNorthern Territory
1
The Northern Territory Health Promotion framework not only celebrates and values cultural knowledge but also supports the need for all health promotion to be responsive and respectful to the cultural context in which we are working.
The Northern Territory Department of Health (DoH) is committed to working in a culturally safe and secure manner. The DoH is in particular committed to building community and Aboriginal health promotion workforce capacity to ensure health promotion activities are entirely appropriate and highly effective.
Utilising the Health Promotion Framework
Over the last few decades, there have been significant developments in evidence supporting the importance of a health promotion focus aimed at reducing the burden of diseases, particularly in vulnerable communities and populations. The evidence suggests that single strategies aimed at providing health information to support behaviour change and lifestyle modification are least effective and that multiple and complementary actions that occur in tandem are shown to be the most effective.
There has also been a parallel process of building an evidence-base about the specific value and outcomes associated with the use of particular health promotion strategies. Part of this effort has involved standardising the use of terminology to describe such strategies. This has clarified which strategies are the most appropriate and effective, and under what circumstances.
In order to make good use of the NT Health Promotion Framework, it is important to understand what is meant by the terms:
• Determinants of health; and• Continuum of health promotion practice
The following sections define what is meant by these terms and what this means in relation to health promotion practice.
A glossary of common health promotion terms has been compiled to assist staff to use the Health Promotion Framework effectively.
Health Promotion FRAMEWORK8
Determinants of Health A determinant of health is defined as a factor or characteristic that contributes to health status. These determinants consist of a range of individual, behavioural, social, economic, cultural, physical and environmental factors that interact to influence health.
Current evidence suggests that action is required to adequately improve existing health inequities. (Health Inequity relates to unequal population health outcomes that are avoidable) (16). Turrell et al suggest that actions or interventions to improve health inequities occur at three discrete yet closely interrelated levels; Upstream, Midstream and Downstream (17).
Upstream determinants are those that occur at a macro level such as global forces and government policies. Factors at this level include education, employment, income, living and working conditions.
Midstream determinants can be defined as intermediate factors such as health behaviours and psychosocial factors.
Downstream determinants occur at a micro level and include physiological and biological factors such as genetic makeup and gender.
Changes in the social, economic, physical, cultural and environmental factors have the potential to yield the biggest health gains. The Department of Health is committed to work in collaboration with stakeholders across sectors to influence these factors in order to reduce their negative impact on health of the NT Population.
Age , sex andConstitutional
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socio
economic, cultural and environmental issues
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production
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olat
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iet a
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drug
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sexu
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ge
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thni
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ose
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ardi
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rtens
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h lip
ids)
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uscu
lar-s
kele
tal s
yste
ms
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oste
opor
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Upst
ream
Facto
rs
11
22
Dire
ct im
pact
thro
ugh
fact
ors
rela
ting
to s
afet
y (a
ccid
ents
, inj
ury
and
viole
nce)
Indi
rect
impa
ct b
y in
fluen
cing
hea
lth
beha
viou
rs a
nd p
sych
osoc
ial f
acto
rs
Socia
lly d
isadv
anta
ged
peop
le a
re m
ore
likel
y to
hav
e po
orer
heal
th o
utco
mes
and
hig
her r
isk fa
ctor
pro
files.
L
ow s
ocio
-eco
nom
ic st
atus
is a
maj
or c
ontri
butin
g fa
ctor
in re
latio
n
to A
borig
inal
hea
lth.
Thes
e fa
ctor
s ca
n be
com
poun
ded
by is
sues
suc
h as
rem
oten
ess
and/
or s
ocia
l isol
atio
n a
nd la
ngua
ge b
arrie
rs. T
hese
are
impo
rtant
fact
ors
to b
e co
nsid
ered
in th
e NT
con
text
.
Thes
e fa
ctor
s ca
n be
cha
lleng
ing
to a
ddre
ss, b
ut h
ave
the
pote
ntia
l to
yield
the
bigg
est h
ealth
gai
ns.
Chan
ge in
pol
icies
and
legi
slatio
n on
a re
gion
al, n
atio
nal a
nd in
tern
atio
nal le
vel is
nee
ded
to
a
ddre
ss th
ese
fact
ors.
Hea
lth in
all P
olici
es is
one
mec
hani
sm th
at c
an b
e ut
ilised
to a
ddre
ss
ups
tream
fact
ors.
Mid
stre
am
Facto
rs
Dow
nst
ream
Facto
rs
Actio
ns d
esig
ned
to c
hang
e m
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erm
inan
ts in
clude
indi
vidua
l life
style
pro
gram
s an
d th
e cr
eatio
n of
sup
porti
ve e
nviro
nmen
ts to
mak
e he
alth
y ch
oice
s ea
sier.
Ther
e is
an e
lem
ent o
f ind
ividu
al c
hoice
. How
ever
cho
ices
norm
ally
oper
ate
with
in th
e co
ntex
t of u
pstre
am fa
ctor
s. In
oth
er w
ords
Indi
vidua
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ccur
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uum
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are
influ
ence
d by
fact
ors
such
as
educ
atio
n,
inco
me
leve
l, em
ploy
men
t, liv
ing
and
work
ing
cond
itions
.
Chan
ges
to p
hysio
logi
cal s
yste
ms
and
biol
ogica
l fun
ctio
ning
are
bro
ught
abo
ut b
y su
stai
ned
and
long
er te
rm e
ffect
s of
psy
chos
ocia
l and
beh
avio
ural
fact
ors.
Thes
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ts d
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ate
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curre
nt h
ealth
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e sy
stem
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y ge
nera
lly re
late
to ill
ness
and
dise
ase.
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le w
e ar
e lim
ited
to w
hat c
an b
e do
ne to
cha
nge
non-
mod
ifiabl
e ris
k fa
ctor
s, th
ey c
an b
e us
ed to
id
entif
y gr
oups
at i
ncre
ased
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MID
ST
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te le
vel
Socia
l, E
conom
ic, P
hys
ical,
Cult
ura
l & E
nvir
onm
enta
l Facto
rs (18, 1
9)
✓ E
arly
Year
s✓
Edu
catio
n (in
cludi
ng lit
erac
y)✓
Foo
d Se
curit
y✓
Em
ploy
men
t and
wor
king
cond
itions
✓ In
com
e✓
Rac
ism
Psy
choso
cia
l Facto
rs
Behav
ioura
l Facto
rs
Non-M
odifia
ble
Indiv
idual
Facto
rs
Phys
iolo
gic
al S
yste
ms
✓ H
ousin
g✓
Tra
nspo
rt ✓
The
soc
ial g
radi
ent
✓ S
ocia
l inclu
sion
✓ G
ende
r✓
Bel
iefs
and
val
ues
syst
ems
✓ H
ealth
Lite
racy
✓ W
elfa
re S
uppo
rt Sy
stem
s✓
Hea
lth C
are
Syst
ems,
inclu
ding
acce
ss to
hea
lth s
ervic
es
✓ C
ontro
l of o
ne’s
life
✓ S
ocia
l sup
ports
✓ Is
olat
ion
and
m
argi
nalis
atio
n
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elf E
stee
m
✓ D
epre
ssio
n
✓ S
tress
✓ A
ggre
ssio
n
✓ D
iet a
nd n
utrit
ion
✓ S
mok
ing
✓ A
lcoho
l
✓ P
hysic
al A
ctivi
ty
✓ S
ubst
ance
use
(eg
drug
s, p
etro
l sni
ffing
)
✓ S
elf-H
arm
✓ G
ambl
ing
✓ S
afe
sexu
al b
ehav
iour
s
✓ E
ngag
emen
t in
prev
entiv
e
heal
th c
are
prac
tices
✓ H
ygie
ne P
ract
ices
✓ A
ge
✓ S
ex
✓ E
thni
city
✓ G
enet
ics
✓ E
ndoc
rine
(eg
gluc
ose
Into
lera
nce)
✓ Im
mun
e sy
stem
s (eg
redu
ced
imm
unity
)
✓ C
ardi
ovas
cula
r sys
tem
(eg
hype
rtens
ion,
hig
h lip
ids)
✓ M
uscu
lar-s
kele
tal s
yste
ms
(eg
oste
opor
osis)
Upst
ream
Facto
rs
11
22
Dire
ct im
pact
thro
ugh
fact
ors
rela
ting
to s
afet
y (a
ccid
ents
, inj
ury
and
viole
nce)
Indi
rect
impa
ct b
y in
fluen
cing
hea
lth
beha
viou
rs a
nd p
sych
osoc
ial f
acto
rs
Socia
lly d
isadv
anta
ged
peop
le a
re m
ore
likel
y to
hav
e po
orer
heal
th o
utco
mes
and
hig
her r
isk fa
ctor
pro
files.
L
ow s
ocio
-eco
nom
ic st
atus
is a
maj
or c
ontri
butin
g fa
ctor
in re
latio
n
to A
borig
inal
hea
lth.
Thes
e fa
ctor
s ca
n be
com
poun
ded
by is
sues
suc
h as
rem
oten
ess
and/
or s
ocia
l isol
atio
n a
nd la
ngua
ge b
arrie
rs. T
hese
are
impo
rtant
fact
ors
to b
e co
nsid
ered
in th
e NT
con
text
.
Thes
e fa
ctor
s ca
n be
cha
lleng
ing
to a
ddre
ss, b
ut h
ave
the
pote
ntia
l to
yield
the
bigg
est h
ealth
gai
ns.
Chan
ge in
pol
icies
and
legi
slatio
n on
a re
gion
al, n
atio
nal a
nd in
tern
atio
nal le
vel is
nee
ded
to
a
ddre
ss th
ese
fact
ors.
Hea
lth in
all P
olici
es is
one
mec
hani
sm th
at c
an b
e ut
ilised
to a
ddre
ss
ups
tream
fact
ors.
Mid
stre
am
Facto
rs
Dow
nst
ream
Facto
rs
Actio
ns d
esig
ned
to c
hang
e m
idst
ream
det
erm
inan
ts in
clude
indi
vidua
l life
style
pro
gram
s an
d th
e cr
eatio
n of
sup
porti
ve e
nviro
nmen
ts to
mak
e he
alth
y ch
oice
s ea
sier.
Ther
e is
an e
lem
ent o
f ind
ividu
al c
hoice
. How
ever
cho
ices
norm
ally
oper
ate
with
in th
e co
ntex
t of u
pstre
am fa
ctor
s. In
oth
er w
ords
Indi
vidua
l cho
ices
do
not o
ccur
in a
vac
uum
, and
are
influ
ence
d by
fact
ors
such
as
educ
atio
n,
inco
me
leve
l, em
ploy
men
t, liv
ing
and
work
ing
cond
itions
.
Chan
ges
to p
hysio
logi
cal s
yste
ms
and
biol
ogica
l fun
ctio
ning
are
bro
ught
abo
ut b
y su
stai
ned
and
long
er te
rm e
ffect
s of
psy
chos
ocia
l and
beh
avio
ural
fact
ors.
Thes
e de
term
inan
ts d
omin
ate
the
curre
nt h
ealth
car
e sy
stem
. The
y ge
nera
lly re
late
to ill
ness
and
dise
ase.
Whi
le w
e ar
e lim
ited
to w
hat c
an b
e do
ne to
cha
nge
non-
mod
ifiabl
e ris
k fa
ctor
s, th
ey c
an b
e us
ed to
id
entif
y gr
oups
at i
ncre
ased
risk
of d
evel
opin
g di
seas
e to
ena
ble
targ
eted
inte
rven
tions
.
U
pstre
am fa
ctor
s ca
n im
pact
on
heal
th in
tw
o wa
ys
10H
ealth
Pro
mot
ion
FRA
ME
WO
RK
11Health Promotion FRAMEWORK
FrameworkHealth PromotionNorthern Territory
Continuum of Health Promotion PracticeThe continuum of health promotion practice generally contains a range of approaches within five areas for action, comprising both individual and population approaches. The five areas of action across the Continuum of Health Promotion Practice are:
Settings and Supportive Environments
Community Action
Health Information and Social Marketing
Health Education and Skills Development
Screening, Individual Risk Assessment and Immunisation
The areas of action are designed to complement one another as they target the determinants of health and different factors at various stages of health across the life course. Health promotion practice is most effective when a combination of approaches is implemented (20). The Public Health Bush Book is a useful guide for assisting health practitioners in the Northern Territory to implement actions in these areas.
The continuum of health promotion practice has been developed to be consistent with and reflective of the five action areas of health promotion in the Ottawa Charter. Consistency with and reflection of the Ottawa Charter, as the overarching global framework guiding health promotion, is important.
Table 2 provides a summary of the continuum of health promotion practice. The aims of the various parts that make up the continuum are described. It also provides a description of the activities that sit across the continuum. Examples of health promotion activities across the continuum are provided both for Issues and Settings based health promotion.
The settings-based examples provided relate specifically to health promoting hospitals, health promoting schools and health promoting workplaces. The issues-based examples chosen relate to tobacco control and healthy weight. As health promotion is not practiced exclusively using a settings or issues approach, generic examples of health promotion activities specific to the NT have also been listed.
Community Action
Health Information
Social Marketing
Skills Developmen
t
Health Educatio
n
Setti
ngs
& Su
ppor
tive
Envi
ronm
ent
Risk Assessment, Immunisation
Screening, Individual
Hea
lth P
rom
otio
nFR
AM
EW
OR
K12
Setti
ngs
and
Supp
ortiv
e En
viro
nmen
tsC
omm
unity
act
ion
Hea
lth In
form
atio
n
& S
ocia
l Mar
ketin
gH
ealth
Edu
catio
n an
d S
kills
Dev
elop
men
tS
cree
ning
, Ind
ivid
ual
Ris
k A
sses
smen
t,Im
mun
isat
ion
AIM
To d
evel
op h
ealth
ier
phys
ical
, soc
ial a
nd c
ultu
ral
envi
ronm
ents
whe
re p
eopl
e liv
e, le
arn,
wor
k an
d pl
ay.
This
can
be
esta
blis
hed
thro
ugh:
• O
rgan
isat
iona
l dev
elop
men
t•
Eco
nom
ic a
nd re
gula
tory
ac
tiviti
es
To in
crea
se c
omm
unity
con
trol
over
the
dete
rmin
ants
of h
ealth
th
roug
h co
llect
ive
effo
rts, c
omm
unity
pa
rtici
patio
n, e
mpo
wer
men
t, ca
paci
ty b
uild
ing
and
incr
easi
ng
heal
thy
liter
acy
To in
fluen
ce in
divi
dual
be
havi
our c
hang
e th
roug
h th
e pr
ovis
ion
of
heal
th in
form
atio
n an
d de
velo
pmen
t of p
erso
nal
skill
s.
To a
dvoc
ate
for b
road
er
soci
al a
nd e
nviro
nmen
t ch
ange
age
ndas
.
To im
prov
e kn
owle
dge,
at
titud
es, c
onfid
ence
and
in
divi
dual
cap
acity
to c
hang
e ps
ycho
soci
al a
nd b
ehav
iour
al
risk
fact
ors.
To im
prov
e he
alth
lite
racy
of
indi
vidu
als,
com
mun
ities
and
or
gani
satio
ns.
To e
nabl
e ea
rly d
etec
tion
and
man
agem
ent o
f dis
ease
s to
im
prov
e ph
ysio
logi
cal r
isk
fact
ors.
AC
TIO
N
Org
anis
atio
nal d
evel
opm
ent
Inte
grat
ion
of h
ealth
pro
mot
ion
prin
cipl
es in
org
anis
atio
nal
polic
ies,
stru
ctur
es a
nd
syst
ems,
to c
reat
e a
supp
ortiv
e en
viro
nmen
t. •
Service
(Rew
ard
syst
ems,
in
form
atio
n sy
stem
s,
mon
itorin
g an
d ev
alua
tion,
qu
ality
impr
ovem
ents
, in
tegr
atio
n of
hea
lth li
tera
cy
focu
s)•
Managem
ent(
polic
ies,
st
ruct
ures
, sup
port
and
com
mitm
ent)
Econ
omic
, reg
ulat
ory
activ
ities
and
legi
slat
ion
Fina
ncia
l and
legi
slat
ive
ince
ntiv
es o
r dis
ince
ntiv
es
(sta
ndar
ds, p
ricin
g, p
rom
otio
n an
d re
stric
tion
of p
rodu
cts)
This
mus
t inv
olve
:•
Com
mun
ity e
ngag
emen
t in
prio
rity
setti
ng, d
ecis
ion
mak
ing,
pl
anni
ng, i
mpl
emen
tatio
n an
d ev
alua
tion
of s
trate
gies
It ca
n al
so in
volv
e:•
Adv
ocac
y w
ork
to g
ain
polit
ical
co
mm
itmen
t, st
ruct
ural
cha
nges
or
sys
tem
s su
ppor
t for
a
parti
cula
r iss
ue
Hea
lth In
form
atio
nP
rese
ntat
ion
of in
form
atio
n to
a g
ener
al o
r tar
gete
d au
dien
ce u
sing
a v
arie
ty o
f fo
rms
and
lang
uage
s, s
uch
as s
poke
n w
ord,
writ
ten
mat
eria
ls a
nd in
tern
et a
nd
web
-bas
ed in
form
atio
n.
Soci
al M
arke
ting
App
licat
ion
of c
omm
erci
al
mar
ketin
g te
chni
ques
to
the
anal
ysis
, pla
nnin
g,
exec
utio
n an
d ev
alua
tion
of p
rogr
ams
that
are
de
sign
ed to
influ
ence
be
havi
our.
Hea
lth E
duca
tion
Hea
lth e
duca
tion
is a
ny
com
bina
tion
of le
arni
ng
expe
rienc
es d
esig
ned
to
faci
litat
e vo
lunt
ary
actio
ns
cond
uciv
e to
hea
lth. I
t can
in
volv
e in
divi
dual
s an
d/or
gr
oups
.
Skill
s D
evel
opm
ent
Bui
ldin
g th
e sk
ills
requ
ired
to
empo
wer
indi
vidu
als
and/
or
com
mun
ities
to h
ave
grea
ter
cont
rol o
ver t
heir
lives
.
Scre
enin
g S
yste
mat
ic u
se o
f a te
stin
g to
ol to
det
ect i
ndiv
idua
ls a
t ris
k of
dev
elop
ing
a sp
ecifi
c di
seas
e.
Indi
vidu
al R
isk
Ass
essm
ent
Det
ectin
g th
e ov
eral
l ris
k of
dis
ease
(s) t
hrou
gh
iden
tifica
tion
of b
iolo
gica
l, ps
ycho
logi
cal a
nd b
ehav
iour
al
risk
fact
ors.
Imm
unis
atio
nIn
ocul
atio
n of
vac
cine
to
redu
ce th
e sp
read
of v
acci
ne-
prev
enta
ble
dise
ases
.
Table
2 -
Conti
nuum
of
Healt
h P
rom
oti
on P
racti
ce
(ada
pted
from
the
Inte
grat
ed H
ealth
Pro
mot
ion
Kit,
Vic
toria
) (21
)
Hea
lth P
rom
otio
nFR
AM
EW
OR
K13
Setti
ngs
and
Supp
ortiv
e En
viro
nmen
tsC
omm
unity
act
ion
Hea
lth In
form
atio
n
& S
ocia
l Mar
ketin
gH
ealth
Edu
catio
n an
d S
kills
Dev
elop
men
tS
cree
ning
, Ind
ivid
ual
Ris
k A
sses
smen
t,Im
mun
isat
ion
HEA
LTH
PR
OM
OTI
NG
HO
SPIT
ALS
and
HEA
LTH
PR
OM
OTI
NG
HEA
LTH
SER
VIC
ES
• A
hosp
ital/h
ealth
ser
vice
sp
ecifi
c he
alth
pro
mot
ion
polic
y•
Des
igna
ted
spac
es fo
r sta
ff to
eng
age
in p
hysi
cal a
ctiv
ity
free,
fee-
for-
serv
ice
or
subs
idis
ed•
Sm
oke
Free
hos
pita
l/hea
lth
serv
ice
cam
puse
s•
Cle
ar s
igna
ge to
ass
ist
patie
nts
to e
asily
loca
te
rele
vant
are
as w
ithin
the
hosp
ital/h
ealth
ser
vice
• P
rovi
sion
of h
ealth
y fo
ods
in
vend
ing
mac
hine
s an
d ca
fete
rias
acce
ssib
le to
pat
ient
s, v
isito
rs a
nd
staf
f•
Con
sum
er p
artic
ipat
ion
on
hosp
ital/h
ealth
ser
vice
boa
rds
and/
or c
omm
ittee
s
• Q
UIT
pos
ters
in
prom
inen
t loc
atio
ns
thro
ugho
ut th
e ho
spita
l/he
alth
ser
vice
(suc
h as
lifts
, st
airw
ells
, wai
ting
room
s an
d ba
thro
oms)
.•
Pat
ient
targ
eted
in
form
atio
n ab
out s
peci
fic
heal
th is
sues
(suc
h as
sm
okin
g).
• B
rief i
nter
vent
ion
train
ing
for
hosp
ital/h
ealth
ser
vice
sta
ff•
On-
war
d/du
ring
heal
th
serv
ice
hour
s Q
UIT
co
unse
lling
ser
vice
s de
liver
ed b
y ap
prop
riate
ly
qual
ified
sta
ff an
d/or
vo
lunt
eers
• Th
e es
tabl
ishm
ent o
f a
heal
th e
duca
tion
cale
ndar
th
at li
sts
upco
min
g se
min
ars,
m
eetin
gs a
nd/o
r for
ums
that
ar
e fa
cilit
ated
in th
e lo
cal
hosp
ital/h
ealth
ser
vice
are
a
• A
ccur
atel
y re
cord
ing
the
smok
ing
stat
us o
f all
patie
nts
• H
ealth
scr
eeni
ng d
ays
in
hosp
ital/h
ealth
ser
vice
foye
rs
Sett
ings
Base
d H
ealt
h P
rom
oti
on
Hea
lth P
rom
otio
nFR
AM
EW
OR
K14
Setti
ngs
and
Supp
ortiv
e En
viro
nmen
tsC
omm
unity
act
ion
Hea
lth In
form
atio
n&
Soc
ial M
arke
ting
Hea
lth E
duca
tion
and
Ski
lls D
evel
opm
ent
Scr
eeni
ng, I
ndiv
idua
l R
isk
Ass
essm
ent,
Imm
unis
atio
n
HEA
LTH
PR
OM
OTI
NG
SC
HO
OLS
and
‘Kid
sMat
ter’
• P
rovi
sion
of H
ealth
P
rom
otin
g S
choo
l Nur
ses
• C
ante
en, N
utrit
ion
and
Hea
lthy
Eat
ing
Pol
icy
to p
rom
ote
the
sale
and
co
nsum
ptio
n of
hea
lthy
food
s, in
clud
ing
fruits
and
ve
geta
bles
• D
epar
tmen
t of E
duca
tion
and
Trai
ning
(DE
T) P
hysi
cal
Act
ivity
Req
uire
men
ts fo
r S
choo
ls P
olic
y to
ens
ure
that
stu
dent
s pa
rtici
pate
in
a m
inim
um o
f 2 h
ours
per
w
eek
of p
hysi
cal a
ctiv
ity•
Sm
oke
Free
Pre
mis
es P
olic
y•
Chi
ld S
afet
y an
d W
ellb
eing
, S
tude
nt S
ervi
ces
Div
isio
n w
ithin
DE
T
• S
choo
l com
mun
ity g
arde
n•
Sch
ool C
ounc
ils e
stab
lishi
ng
fund
rais
ing
effo
rts th
at p
rom
ote
heal
thy
eatin
g an
d ph
ysic
al a
ctiv
ity
• C
omm
unity
con
sulta
tion
in p
olic
y re
view
and
dev
elop
men
t•
Wor
k w
ith th
e A
ustra
lian
Cou
ncil
for H
ealth
, Phy
sica
l Edu
catio
n an
d R
ecre
atio
n (A
CH
PE
R)
on a
dvoc
acy
and
com
mun
ity
enga
gem
ent
• E
ngag
emen
t with
gov
ernm
ent a
nd
non-
gove
rnm
ent o
rgan
isat
ions
on
stra
tegi
es to
impr
ove
heal
th
prom
otio
n in
sch
ools
• S
uppo
rt fo
r res
earc
h ap
plic
atio
ns
in th
e ar
ea o
f hea
lth
• In
clus
ion
of h
ealth
in
form
atio
n in
cur
ricul
um
reso
urce
s
• D
istri
butio
n of
hea
lth
info
rmat
ion
to s
choo
ls
and
com
mun
ity v
ia
web
site
s, n
ewsl
ette
rs
and
soci
al m
edia
• D
evel
opm
ent o
f hea
lth is
sue
spec
ific
less
ons
plan
s•
The
prov
isio
n of
info
rmat
ion
abou
t saf
e se
x an
d he
alth
y pe
rson
al re
latio
nshi
ps to
sc
hool
stu
dent
s•
Pro
visi
on o
f ant
i-bul
lyin
g pr
ogra
ms
in s
choo
ls•
Stre
ngth
s ba
sed
appr
oach
to
skill
s de
velo
pmen
t •
Org
anis
atio
n an
d de
liver
y of
sem
inar
s, fo
rum
s an
d co
nfer
ence
s to
sha
re, e
xplo
re
and
expa
nd o
n cu
rren
t pe
dago
gy a
nd re
sear
ch in
he
alth
•
Pro
visi
on o
f pro
fess
iona
l de
velo
pmen
t to
scho
ols
and
com
mun
ities
pro
vide
d by
DE
T, D
oH a
nd o
ther
st
akeh
olde
rs
• P
rovi
sion
of H
ealth
y S
choo
l A
ged
Kid
s sc
reen
ing
• P
rovi
sion
of s
choo
l im
mun
isat
ion
prog
ram
Sett
ings
Base
d H
ealt
h P
rom
oti
on
Hea
lth P
rom
otio
nFR
AM
EW
OR
K15
Setti
ngs
and
Supp
ortiv
e En
viro
nmen
tsC
omm
unity
act
ion
Hea
lth In
form
atio
n &
Soc
ial M
arke
ting
Hea
lth E
duca
tion
and
Ski
lls D
evel
opm
ent
Scr
eeni
ng, I
ndiv
idua
l R
isk
Ass
essm
ent,
Imm
unis
atio
n
HEA
LTH
PR
OM
OTI
NG
WO
RK
PLA
CE
• H
ealth
y op
tions
ava
ilabl
e in
can
teen
s an
d ve
ndin
g m
achi
nes
• N
utrit
ion
and
cate
ring
polic
y th
at m
eets
Hea
lthy
Eat
ing
Gui
delin
es•
Ade
quat
e E
nd o
f Trip
fa
cilit
ies
in w
orkp
lace
s to
en
cour
age
phys
ical
act
ivity
an
d ac
tive
trans
port
(i.e.
sh
ower
s an
d lo
cker
s)•
Sm
oke
Free
wor
kpla
ce
polic
y •
Alc
ohol
pol
icy
for e
vent
s an
d so
cial
func
tions
• W
ork
life
bala
nce
polic
ies
• A
cces
s to
opp
ortu
nitie
s fo
r phy
sica
l act
ivity
in
the
wor
kpla
ce (i
e on
-site
ex
erci
se c
lass
es)
• E
ngag
e st
aff i
n pr
ogra
m p
lann
ing
and
deve
lopm
ent
• S
uppo
rt st
aff a
nd p
rovi
de
reso
urce
s to
impl
emen
t stra
tegi
es
in th
eir w
ork
area
s
• S
ocia
l mar
ketin
g re
sour
ces
prov
ided
to
staf
f at i
nduc
tion
and
orie
ntat
ion
• D
ispl
ay a
nd d
istri
butio
n of
nat
iona
l soc
ial
mar
ketin
g ca
mpa
ign
reso
urce
s su
ch a
s S
wap
it,
‘G
o fo
r 2 &
5’,
anti-
smok
ing
cam
paig
ns
to p
rom
ote
heal
th
mes
sage
s
• H
ealth
y co
okin
g se
ssio
ns fo
r st
aff
• E
duca
tion
rega
rdin
g th
e he
alth
risk
s of
har
mfu
l/ ha
zard
ous
alco
hol
cons
umpt
ion
• S
taff
heal
th e
duca
tion
sess
ions
• Q
UIT
ses
sion
s fo
r sta
ff
• H
ealth
Ris
k A
sses
smen
ts fo
r st
aff (
scre
enin
g fo
r life
styl
e ris
k fa
ctor
s, i.
e. d
iabe
tes,
bl
ood
pres
sure
etc
.)•
Sta
ff va
ccin
atio
n pr
ogra
m
Sett
ings
Base
d H
ealt
h P
rom
oti
on
Hea
lth P
rom
otio
nFR
AM
EW
OR
K16
Setti
ngs
and
Supp
ortiv
e En
viro
nmen
tsC
omm
unity
act
ion
Hea
lth In
form
atio
n &
Soc
ial M
arke
ting
Hea
lth E
duca
tion
and
Ski
lls D
evel
opm
ent
Scr
eeni
ng, I
ndiv
idua
l R
isk
Ass
essm
ent,
Imm
unis
atio
n
TOB
AC
CO
CO
NTR
OL
• Le
gisl
ativ
e ch
ange
s to
pr
ovid
e sm
oke
free
area
s an
d ta
xatio
n to
incr
ease
ci
gare
tte p
rices
•
Sm
oke
Free
Pol
icie
s; S
mok
e Fr
ee h
ospi
tals
and
hea
lth
serv
ices
• E
mbe
ddin
g m
onito
ring
and
eval
uatio
n ac
tiviti
es in
to
toba
cco
cont
rol p
rogr
ams
• D
ecla
ratio
n of
sm
oke
free
hom
es,
vehi
cles
, eve
nts
and
othe
r sm
oke
free
zoni
ng (u
nleg
isla
ted)
• C
omm
unity
QU
IT g
roup
s to
su
ppor
t sm
okin
g ce
ssat
ion
• C
omm
unity
repr
esen
tatio
n on
S
teer
ing
Com
mitt
ees
for t
obac
co
cont
rol p
rogr
ams
• Q
UIT
cam
paig
n in
form
atio
n an
d re
sour
ces
• Ta
lkin
g po
ster
s on
to
bacc
o-re
late
d ha
rms
• P
rodu
ctio
n of
sm
okin
g D
VD
s in
loca
l lan
guag
es
• Q
UIT
cou
nsel
ling
• E
duca
tion
sess
ions
in
scho
ols
and
hosp
itals
• P
rofe
ssio
nal d
evel
opm
ent
for h
ealth
pra
ctiti
oner
s th
at
supp
orts
sm
okin
g ce
ssat
ion
amon
g ke
y cl
ient
gro
ups
• A
sses
smen
t and
reco
rdin
g of
sm
okin
g st
atus
in h
ealth
re
cord
s•
Brie
f int
erve
ntio
n du
ring
clie
nt c
onsu
lts, i
n pa
rticu
lar
rela
ting
to s
mok
ing
cess
atio
n•
App
ropr
iate
refe
rral
pa
thw
ays
for t
obac
co
cess
atio
n pr
ogra
ms
and
coun
selli
ng
• P
rovi
sion
of N
icot
ine
Rep
lace
men
t The
rapy
Issu
es
Base
d H
ealt
h P
rom
oti
on
Hea
lth P
rom
otio
nFR
AM
EW
OR
K17
Setti
ngs
and
Supp
ortiv
e En
viro
nmen
tsC
omm
unity
act
ion
Hea
lth In
form
atio
n&
Soc
ial M
arke
ting
Hea
lth E
duca
tion
and
Ski
lls D
evel
opm
ent
Scr
eeni
ng, I
ndiv
idua
l R
isk
Ass
essm
ent,
Imm
unis
atio
n
HEA
LTH
Y W
EIG
HT
• E
nsur
ing
acce
ss to
hea
lthy
food
by
impr
ovin
g th
e av
aila
bilit
y an
d af
ford
abili
ty
of h
ealth
y fo
od in
loca
l sho
ps
• W
orki
ng w
ith h
ousi
ng
stak
ehol
ders
to im
prov
e co
nditi
ons
of h
ouse
s to
en
able
saf
e fo
od p
repa
ratio
n •
Wor
king
with
tow
n pl
anne
rs
to c
reat
e en
viro
nmen
ts th
at
are
cond
uciv
e to
phy
sica
l ac
tiviti
es
• C
omm
unity
wal
king
gro
ups
• C
ater
ing
to p
rovi
de h
ealth
y fo
od a
t co
mm
unity
eve
nts
• H
ealth
y ve
ndin
g m
achi
nes
in
wor
kpla
ces
and
publ
ic s
pace
s•
Loca
l act
ion
plan
s th
at p
rom
ote
and
supp
ort h
ealth
y ea
ting
and
phys
ical
act
ivity
in lo
cal
orga
nisa
tions
, inc
ludi
ng s
choo
ls,
loca
l gov
ernm
ent s
ervi
ces
and
hous
ing
• S
usta
inab
le c
omm
unity
gar
dens
• S
ocia
l Mar
ketin
g C
ampa
igns
(e.g
. Sw
ap It
, M
easu
re U
p, G
o fo
r 2
& 5
)
• H
ealth
y co
okin
g re
cipe
s
• E
vide
nce
base
d in
form
atio
n an
d Fa
ct
shee
ts a
vaila
ble
on
web
site
s
• D
iabe
tes
Nut
ritio
n G
roup
s•
Hea
lthy
cook
ing
sess
ions
us
ing
loca
lly a
vaila
ble
ingr
edie
nts
• N
utrit
ion
educ
atio
n
• S
cree
ning
for
wei
ght a
nd
wai
st c
ircum
fere
nce,
(e.g
. C
VD
risk
ass
essm
ent t
ools
)•
App
ropr
iate
refe
rral
pa
thw
ays
to li
fest
yle
prog
ram
s•
Brie
f Int
erve
ntio
n in
clie
nt
cons
ults
par
ticul
ar re
latin
g to
he
alth
y ea
ting
and
phys
ical
ac
tivity
Issu
es
Base
d H
ealt
h P
rom
oti
on
Setti
ngs
and
Supp
ortiv
e En
viro
nmen
tsC
omm
unity
act
ion
Hea
lth In
form
atio
n &
Soc
ial M
arke
ting
Hea
lth E
duca
tion
and
Ski
lls D
evel
opm
ent
Scr
eeni
ng, I
ndiv
idua
l R
isk
Ass
essm
ent,
Imm
unis
atio
n
Org
anis
atio
nal d
evel
opm
ent
Serv
ice:
•
Inte
grat
ing
cont
inuo
us q
ualit
y im
prov
emen
t int
o po
licy
or p
rogr
am d
evel
opm
ent
(QIP
PS
, Aud
it to
ols)
• S
uppo
rting
hea
lth in
form
atio
n sh
arin
g ne
twor
ks (C
hron
ic
Dis
ease
Net
wor
k, P
ublic
H
ealth
Net
wor
k)
• P
rovi
sion
of c
ultu
rally
ap
prop
riate
hea
lth s
ervi
ces
Polic
y an
d st
rate
gic
plan
s:•
App
lyin
g a
Hea
lth in
All
Pol
icie
s ap
proa
ch in
to p
olic
y de
velo
pmen
t•
Impl
emen
ting
heal
thy
wor
kpla
ce p
olic
ies
• C
apac
ity b
uild
ing
of s
taff
Man
agem
ent
• E
stab
lishi
ng ‘s
epar
ate’
or
‘gen
der s
ensi
tive’
ent
ranc
es
to h
ealth
clin
ics
• C
reat
ing
a yo
uth
frien
dly
spac
e or
clin
ic•
Sup
porte
d, e
ffect
ive
and
mea
ning
ful c
omm
unity
re
pres
enta
tion
on R
efer
ence
G
roup
s or
Wor
king
Gro
ups
Econ
omic
, reg
ulat
ory
activ
ities
and
legi
slat
ion
• Ta
xatio
n to
incr
ease
pric
es
of a
lcoh
olic
bev
erag
es,
ciga
rette
s•
Env
ironm
enta
l hea
lth a
nd
hous
ing
stan
dard
s •
Aus
tralia
n G
over
nmen
t lic
ensi
ng o
f com
mun
ity s
tore
s •
Intro
duct
ion
of le
gisl
atio
n fo
r man
dato
ry re
porti
ng o
f do
mes
tic a
nd fa
mily
vio
lenc
e
• In
volv
emen
t of c
omm
uniti
es in
de
cisi
on m
akin
g co
mm
ittee
s (e
.g.
Loca
l Im
plem
enta
tion
Pla
ns fo
r Te
rrito
ry G
row
th T
owns
, Loc
al
Com
mun
ity P
lans
in u
rban
se
tting
s)
• C
omm
unity
repr
esen
tatio
n on
S
teer
ing
Com
mitt
ees
and
Wor
king
G
roup
s•
Est
ablis
hing
com
mun
ity-b
ased
gr
oups
, sel
f-hel
p gr
oups
and
co
mm
unity
sup
port
grou
ps•
Wor
king
with
loca
l org
anis
atio
ns
and
com
mun
ity m
embe
rs in
pro
ject
pl
anni
ng a
nd im
plem
enta
tion
•
Sub
mis
sion
of p
aper
s or
lobb
ying
fo
r leg
isla
tive
or p
olic
y ch
ange
s.
Hea
lth In
form
atio
n
• M
edia
Rel
ease
in
resp
onse
to d
isea
se
outb
reak
s•
Onl
ine
reso
urce
s
• P
atie
nt In
form
atio
n B
roch
ures
• Ta
lkin
g po
ster
s an
d bo
oks
• R
adio
and
TV
an
noun
cem
ents
Soci
al M
arke
ting
• S
exua
l Hea
lth c
ampa
igns
• U
sing
prin
t or e
lect
roni
c m
edia
to c
reat
e st
orie
s th
roug
h ar
t/dra
ma
stor
y te
lling
• E
nviro
nmen
tal H
ealth
ca
mpa
igns
• Lo
cal a
dapt
atio
n of
W
hite
Rib
bon
cam
paig
n to
incr
ease
men
’s
parti
cipa
tion
in a
nti-
viol
ence
act
iviti
es•
NT-
wid
e D
omes
tic
and
Fam
ily V
iole
nce
man
dato
ry re
porti
ng
awar
enes
s ca
mpa
ign
Hea
lth E
duca
tion
and
Skill
s D
evel
opm
ent
• C
ultu
rally
app
ropr
iate
hea
lth
educ
atio
n se
ssio
ns, (
e.g.
us
ing
the
Chr
onic
Dis
ease
S
tory
Boa
rd c
once
pt)
• D
isea
se-s
peci
fic g
roup
s an
d ch
roni
c co
nditi
on s
elf
man
agem
ent g
roup
s, (e
.g.
cond
ition
spe
cific
sup
port
grou
ps a
nd M
ovin
g To
war
ds
Wel
lnes
s)•
Sus
tain
able
app
roac
h to
to
oth-
brus
hing
pro
gram
s in
sc
hool
s •
Bud
getin
g an
d ho
useh
old
man
agem
ent
• M
en’s
she
ds•
Girl
s ca
mps
• S
exua
l hea
lth a
war
enes
s pr
ogra
ms
Bui
ldin
g ca
paci
ty o
f loc
al
com
mun
ity s
taff
to c
ondu
ct
prog
ram
s
Scre
enin
g•
Can
cer s
cree
ning
(e.g
. Pap
sm
ears
, Mam
mog
raph
y)•
Scr
eeni
ng fo
r Sex
ually
Tr
ansm
itted
Dis
ease
s
• “O
ral H
ealth
- Li
ft th
e Li
p”
Indi
vidu
al R
isk
Ass
essm
ent
• A
sses
smen
t of r
isk
fact
ors,
(e
.g. A
dult
Hea
lth C
heck
s,
ante
nata
l scr
eeni
ng)
• H
ealth
y K
ids
Und
er F
ive
(HK
U5)
pro
gram
• H
ealth
y S
choo
l Age
Kid
s (H
SA
K) p
rogr
am
Ass
essm
ent o
f sus
cept
ibili
ty to
ris
k co
nditi
ons
(e.g
. ris
k of
falls
, ca
rdio
vasc
ular
risk
ass
essm
ent)
Imm
unis
atio
nIm
mun
isat
ion
agai
nst m
easl
es,
polio
, infl
uenz
a, H
uman
P
apill
oma
Viru
s (H
PV
) and
the
like
Generi
c E
xam
ple
s of
Healt
h P
rom
oti
on
18H
ealth
Pro
mot
ion
FRA
ME
WO
RK
19Health Promotion FRAMEWORK
FrameworkHealth PromotionNorthern Territory
Implementation
The way the Health Promotion Framework is utilised and implemented within an organisation will depend on organisational needs, priorities, focus and workforce makeup. This can range from using the Framework purely as a training and education resource for staff and stakeholders, which ensures a common language when discussing health promotion action and practice, to ensuring that Primary Health Care Programs include activities and actions across the Continuum of Health Promotion Practice.
Examples of utilising the Framework • Incorporating the Framework in workforce induction and professional development programs
and processes, to ensure a common understanding of Health Promotion principles and actions within the NT context.
• Utilise the Framework, particularly the Continuum of Health Promotion Practice, to facilitate the incorporation of Health Promotion into health service delivery as part of best practice.
• Utilise the Continuum of Health Promotion Practice to guide and track Health Promotion programs to ensure strategies reflect practice across the continuum and include actions at both an individual and population health level.
• Inform Health Promotion best practice and planning of service delivery through examples provided within the Continuum of Health Promotion Practice.
• Utilise the examples provided in the Framework to guide the planning, development or refinement of health promoting workplaces, schools or health services.
• Utilise the Continuum of Health Promotion Practice to map health promotion activities in order to identify gaps within service delivery and track progress over time.
• Utilise the Health Promotion Continuum to inform the planning of interventions and integrated program development and delivery.
Benefits and implementation
Health Promotion FRAMEWORK20
BenefitsofimplementingtheFrameworkThe benefits an organisation can expect from adopting this Framework will depend on the way and extent to which the organisation chooses to implement the Framework. In general terms, some of the benefits organisations could expect include:
• Ability to clearly identify health promotion activities delivered by an organisation in a recognised, integrated structure.
• Assistance in developing a health promoting workplace and/or health promoting health service.• Increased capacity of the workforce in health promotion practice. • Integration of health promotion actions into best practice service delivery.• A common language and understanding the organisation can utilise in conversations with
community and stakeholders.• Ability to trend spread of interventions and health promotion action across the continuum of
service delivery.• An increase in planned and evaluated health promotion action and a structured way of reporting.• Ability to include action on Social Determinants of Health in work practices.• A shift from individual to population health approach.• An increase in a systems approach to health promotion. • An increase in engagement of community and stakeholders.
Possible measures to track implementation of the Framework Whilst the evaluation measures and tracking of the Framework implementation will depend on how an organisation has chosen to implement it, the following is a list of possible evaluation and monitoring measures:
• The Framework is incorporated into organisational induction and professional development programs.
• An increase in actions occurring across the Continuum of Health Promotion Practice.• The Framework is utilised across professions in the organisation.• The Continuum of Health Promotion Practice is utilised in planning service delivery.• The Health Promotion Framework is referenced in organisational communication, strategic
plans and reports.• Uptake of health promoting setting approaches such as health promoting health services and
workplaces.
A-C
Glossary of Terms
These definitions are based on WHO’s glossary of terms and the Bush Book (22, 23, 24), unless otherwise stated.
Advocacy A combination of individual and social actions designed to gain political
commitment, policy support, social acceptance and systems support for a
particular health goal or program.
Capacity Building Development of knowledge, skills, commitment, structures, systems and
leadership to enable effective health promotion. It embraces building the
capacity of:
• Health workers, in terms of commitment and skills for working in a health
promoting way.
• Health organisations, in terms of their commitment, policy, systems and resources to promote health. This would include incorporating health
promotion principles and practices into primary health care and public
health systems.
• Communities and community members in terms of their skills, practices
and orientation to improving health and solving health problems.
Community action Collective efforts by communities to increase community control over the
determinants of health. It involves community engagement, empowerment,
capacity building and advocacy.
Community Development (25)
Community engagement (26)
Continuous Quality Improvement (CQI)
in terms of Health Promotion
The process of facilitating a community’s awareness of the factors and forces that affect their health and quality of life, and ultimately helping to empower them with the skills needed to take control over and improve these conditions
in their community. It often involves helping them to identify issues of concern and facilitating their efforts to bring about change in these areas.
Process that enables the participation by individuals and groups in the community in priority setting, decision making, planning, implementation, management and evaluation of health promotion activities.
CQI and its applicability to Health Promotion has been discussed widely since the late 1990’s. For a comprehensive discussion on CQI and its application
to health promotion see Barbara Kahan and Michael Goodstadt article
Continuous Quality Improvement and health promotion: can CQI lead to
better outcomes?, published in 1999 in Health Promotion International (27).
D-E
Determinants of
Health
The range of individual, behavioural, social, economic, physical and
environmental factors that determine the health status of individuals or
populations.
Empowerment
for health
The process by which people gain greater control over decisions and actions
affecting their health.
Enabling Taking action in partnership with individuals or groups to empower them,
through mobilisation of human and material resources, to promote and
protect health.
Equity Equity means fairness. Equity in health is about equality of health
opportunity, where everyone has an equal opportunity to develop and
maintain their health through fair and just access to resources required
for good health. Consequently this may result in different approaches for
different groups in the community dependent on their particular needs i.e.
gender, age, cultural background/language, education, and remoteness
(urban and rural) from services.
Equity in health is not about achieving the same health outcomes for
everyone, which is not possible due to differences in genetics and personal
conditions. However, when differences in opportunity are unfair and unjust
resulting in unequal health outcomes that are avoidable, this is what we term
a health inequity.
These terms relate very closely to the social determinants of health and the
concept of social justice and fairness.
Evidence based
health promotion
The use of information derived from formal research and systematic investigation to identify causes and contributing factors to health needs and the most effective actions to address these in given contexts and populations.
F-I
Health A state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity.
Health education Opportunities for learning, involving some form of communication designed
to improve health literacy, including improving knowledge and developing life
skills that are conducive to health.
Health Impact
Assessment
A combination of procedures, methods and tools by which a policy, program,
product or service may be judged concerning its effects on the health of the
population.
Health in All
Policies (28)
A horizontal health policy strategy that incorporates health as a shared goal
across all parts of Government and addresses complex health challenges
through an integrated policy response across portfolio boundaries.
Health Literacy Is the knowledge along with the cognitive and social skills that determine the
motivation and ability of individuals to gain access to, understand and use
information in ways that promote and maintain good health.
Health Promotion
Settings Approach
A settings approach locates Health Promotion action in the social, cultural
and physical places in which individuals live, work, learn and play. Settings
can be both within organisational or geographical structures. Examples of
settings-based health promotion includes health promoting hospitals, health
promoting schools, health promoting work places and health promoting
cities.
Healthy public
policy
This is characterised by an explicit concern for health and equity in all areas
of policy, and includes accountability for health impact. Its aim is to create a
supportive environment for healthy choices for everyone.
Health Promotion
Sustainability
Sustainable health promotion actions or programs are those that can
maintain their benefits for communities and populations beyond their initial
stage of implementation. Sustainable actions can continue to be delivered
within the resources or capabilities of stakeholders with consideration to
finances, expertise, infrastructure, natural resources and human resources
Intersectoral
collaboration
Recognised relationship between different sectors of society or
organisations which has been formed to take action on an issue to achieve
health outcomes in a way that is more effective, efficient and/or sustainable
than might be achieved by the health sector acting alone.
M-P
Mediation A process through which the different interests (personal, social, economic)
of individuals and communities, and different sectors (public and private) are
reconciled in ways that promote and protect health.
Partnerships Agreement between two or more partners to work cooperatively towards a
set of shared health outcomes. In health promotion practice, this involves
a wide range of partners, from individuals to families, communities,
organisations, businesses and governments.
Primary Health
Care
There are a number of definitions of Primary Health Care (PHC) currently in
use. It remains a contested concept and individuals may have different
interpretations of what they perceive PHC to be. For a start, PHC is distinct
from Primary Care, which is but one aspect of PHC that focus on clinical
services provided predominantly by general practitioners and nurses.
Comprehensive PHC, as envisioned at Alma Ata in 1978 (29), recognises
the multiple determinants of health and seeks to maximise wellness and
address poor health of individuals and populations by undertaking a
combination of health promotion, disease prevention, illness treatment and
rehabilitation approaches. It forms an integral part of the health system
and is usually the first contact of individuals to the health system. It is
underpinned by the core principles of equity, community participation and
control, intersectoral collaboration, integration, sustainability and evidence-
based practice.
Selective PHC (30) takes on a clinical focus and seeks to improve health by
using cost-effective medical interventions to fight a selected group disease
that would maximise improvements of health in a population. However the
important component is that health professionals form partnerships and
develop trusting relationships with the recipients of their services to ensure
more effective outcomes for interventions.
Comprehensive PHC Selective PHC
View of Health Positive Wellbeing Absence of Disease Focus of control over health Communities and individuals Health professionals Major focus Health through equity and
community empowerment Medical solutions for disease eradication
Health Care Providers Multi-disciplinary teams Medical doctors, Health Practitioners
Strategies for health Multi-sectoral collaboration Medical interventions
Sourced from UNSW (31)
The Northern Territory Aboriginal Health Forum published the Core functions of primary health
care: a framework for the Northern Territory in August 2011. The framework details five domains
that should be considered in primary health care in the NT. Health promotion is domain two.
R-Z
Re-orienting
health services
Health system changes in structure, funding and organisation that aim to
more effectively meet the needs of individuals and the wider population by
achieving an optimal balance between investments in health promotion,
illness prevention, diagnosis, treatment, care and rehabilitation services.
Social capital The degree of social cohesion which exists in communities. It refers to the
processes between people to establish networks, norms and social trust,
and facilitate co-ordination and co-operation for mutual benefit.
Social
Determinants
of Health (32)
Social inclusion
(33)
The social determinants of health are the circumstances in which people are
born, grow, live, work and age, including the health system that determines
the health status of individuals or populations. These circumstances are in
turn shaped by a wider set of forces: economics, social policies and politics
at global, national and local levels.
A socially inclusive society is defined as one in which everyone feels
valued and has the opportunity to participate fully in their lives by having
the resources, opportunities and capability to learn, work, engage in the
community and have a voice.
Social Justice (34) A social justice orientation for health is one that addresses the rights of
individuals and communities, social inequities, community empowerment
and self-determination and shared decision making.
A basic principle of social justice is to ensure equitable distribution and
access to essential resources for a healthy and satisfying life.
Social Marketing Application of commercial marketing technologies to the analysis, planning,
execution and evaluation of programs designed to influence the behaviour of
target audiences in order to improve the health and wellbeing of individuals
and society.
Supportive
environments for
health
These include the physical and social environments where people live,
work and play. A supportive environment offers people access to resources,
opportunities for empowerment and protection from threats to health. It
enables them to expand their capabilities and develop self-reliance in the
management of their health and well-being.
25
26Health Promotion FRAMEWORK
FrameworkHealth PromotionNorthern Territory
Framework Glossary
Health Promotion Tools
There are a range of national and international health promotion tools available, Below are links to those referred to in this document.
Public Health Bush BookThe Public Health Bush Book is a resource for those working in community settings in the Northern Territory. The Public Health Bush Book is published by the Department of Health in two volumes. Both are available to download from the Health Promotion Strategy Unit website http://www.health.nt.gov.au/Health_Promotion/Resources_for_Good_Practice
Quality Improvement Program Planning System (QIPPS)QIPPS is an innovative and unique tool designed for the planning and evaluation of a variety of projects including health promotion, community development and secondary prevention. QIPPS is a web-based system focusing on Continuous Quality Improvement (CQI) and planning and evaluation, with a web-based storage function and the ability for multiple users to access and contribute to a project. In the NT a variety of organisation are using QIPPS. The Department of Health and the Department of Education are using a joint subscription to QIPPS for planning and evaluating health promotion projects and programs. For more information visit www.qipps.infoxchange.net.au/
Health Promotion Continuous Quality Improvement (CQI)One21seventy is the National Centre for Quality Improvement in Indigenous Primary Health Care. One21seventy provides a health promotion Continuous Quality Improvement (CQI) system that is designed to benefit Aboriginal and Torres Strait Islander communities and can be used by a range of service providers. The One21seventy health promotion tools were developed using the best available research evidence and have been rigorously tested in Aboriginal and Torres Strait Islander settings to ensure they are practical and user friendly. For more information visit www.one21seventy.org.au
Health Promotion FRAMEWORK27
Tools
References1. The Evidence of Health Promotion Effectiveness. Shaping Public Health in a New Europe. A Report for the
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33. Social Inclusion, Australian Government 2010, Canberra. <http://www.socialinclusion.gov.au/Pages/default.aspx>
34. Ife JW. Community Development: Community-based alternatives in an age of globalisation. Pearson Education, 2002. NSW
© Department of Health, 2013.
This publication is copyright. The information in this report may be freely copied and distributed for non-profit purposes such as study, research, health service management and public information subject to the inclusion of an acknowledgement of the source. Reproduction for other purposes requires the written approval of the Chief Executive of the Department of Health, Northern Territory.
Suggested citation:Northern Territory Health Promotion Framework. Department of Health, Darwin 2013
An electronic version is available on the Health Promotion Strategy Unit website http://www.health.nt.gov.au/Health_Promotion/Resources_for_Good_Practice
General enquires about this publication should be directed to:
Program Leader, Health PromotionDepartment of HealthPO Box 40596, Casuarina, NT 0811
Phone: 08 8985 8019