Showing papers in "Health Promotion International in 1998"

Health promotion glossary (1998)

Abstract: The views expressed in this document by named authors are solely the responsibility of these authors. This document is not issued to the general public and all rights are reserved by the World Health Organization (WHO). The document may not be reviewed, abstracted, quoted, reproduced, translated, in part or in whole, without the prior written permission of WHO. No part of this document may be stored in a retrieval system or transmitted in any form or by any means – electronic, mechanical or other – without the prior written permission of WHO. Acknowledgements Special thanks are due to Ursel Broesskamp-Stone for her support, advice, technical contributions and perseverance, and to Desmond O'Byrne for his input and advice in the preparation of the glossary, both of the Health Education and Health Promotion Unit, WHO, Geneva; to Ilona Kickbusch for her expert opinion and guidance throughout the process of preparation and revision of the glossary, Division of Health Promotion, Education and Communication, WHO, Geneva; and to the Regional Advisors for Health Promotion/Health Education of the WHO Regional Offices for coordination of the review of the early drafts and helpful suggestions. Health 1 Health promotion 1 Health for All 2 Public health 3 Primary health care 3 Disease prevention 4 Health education 4 Advocacy for health 5 Alliance 5 Community 5 Community action for health 6 Determinants of health 6 Empowerment for health 6 Enabling 7 Epidemiology 7 Equity in health 7 Health behaviour 8 Health communication 8 Health development 8 Health expectancy 9 Health gain 9 Health goal 9 Health indicator 9 Health literacy 10 Health outcomes 10 Health policy 10 Health promoting hospitals 11 Health promoting schools 11 Health promotion evaluation 12 Health promotion outcomes 12 Health sector 12 Health status 12 Health target 13 Healthy cities 13 Healthy islands 13 Healthy public policy 13 Infrastructure for health promotion 14 Intermediate health outcomes 14 Intersectoral collaboration 14 Investment for health 15 Jakarta Declaration on Leading Health Promotion into the 21st Century 15 Life skills 15 Lifestyle (lifestyles conducive to health) 16 Living conditions 16 Mediation 16 Network 16 Ottawa Charter for Health Promotion 17 Partnership for health promotion 17 Personal skills 17 Quality of life 17 Reorienting health services 18 Risk behaviour 18 Risk factor 18 Self help 19 Settings for health 19 Social capital 19 Social networks 19 Social responsibility for health 20 Social support 20 Supportive environments for health …

Evaluating Health Promotion—Progress, Problems and solutions

Abstract: This article addresses various aspects of health promotion evaluation that are under debate. The paper opens by noting the recent growth in research directed toward health promotion and its evaluation. Next the definition of "success" in health promotion is discussed in terms of 1) valued outcomes and valued processes 2) health outcomes 3) health outcomes and health promotion outcomes and 4) measurement of outcomes. The next section describes how best to evaluate "success" by presenting a hierarchy of evaluation stages (problem definition solution generation testing innovations intervention demonstration intervention dissemination and program management). Analysis of ways to assess cause and effect in evaluating outcome considers experimental designs to attribute cause and effect alternatives to experimental designs strategic issues in evaluating community/population interventions community interventions and social movements and building evidence using multiple methods and multiple sources of data. Examination of the evaluation of the process looks at program reach program acceptability and program integrity. The article concludes that the four key challenges to the evaluation of health promotion are 1) using research evidence more systematically while planning activities 2) improving the definition and measurement of outcome 3) adopting an appropriate evaluation intensity and 4) adopting an appropriate evaluation design.

Photovoice as a Participatory Health Promotion Strategy

Abstract: Photovoice is a participatory action research strategy by which people create and discuss photographs as a means of catalyzing personal and community change. The use of photovoice as an effective tool for carrying out participatory needs assessment, conducting participatory evaluation and reaching policy-makers has been discussed elsewhere. Here the authors examine the claims made for the effectiveness of photovoice as a participatory method. To do so, they describe one large-scale case study and then consider where it succeeded or failed in fulfilling its participatory aims. Differences among participants in political power, class, education and control over one's life illustrate certain advantages and potential costs of participation, and suggest considerations for minimizing the risk of unintended consequences.

Effectiveness of Alliances and Partnerships for Health Promotion

Abstract: SUMMARY This paper assesses the impact of alliances or partnerships for health promotion in northern and southern nations, as described in published papers and through contemporary accounts of best practice. The balance of evidence from published literature and case study accounts is clear. Alliance or partnership initiatives to promote health across sectors, across professional and lay boundaries and between public, private and nongovernment agencies, do work. They work in tackling the broader determinants of health and well-being in populations in a sustainable manner, as well as in promoting individual health-related behaviour change. The greater the level of local community involvement in setting agendas for action and in the practice of health promotion, the larger the impact. Volunteer activities, peer programmes and civic activities ensure the maximum benefit from community approaches. In addition, durable structures which facilitate planning and decisionmaking, such as local committees and councils, are key factors in successful alliances or partnerships for health promotion. Such mechanisms also support the sharing of power, responsibility and authority for change, the maintenance of order and of programmatic relevance, and allow local people one means of reflection and for dissent. At a national, regional, district, village and local community or neighbourhood level, this review found that the existence and implementation of policies for health promotion activities were also crucial to sustainability. The evidence from the review suggests the need for new ‘social’ indicators to measure the effects of health promotion. Indicators for success which focus only upon benefits for individuals cannot capture adequately the extent of the impact of the many and varied collective, collaborative health promotion initiatives, alliances or partnerships currently underway around the world. These have been shown to affect families, communities, institutions and aspects of the organisation of social and civic life. This paper posits the notion of social capital as one important new framework for organising our thinking about the broader determinants of health and how to influence them through communitybased approaches to reduce inequalities in health and well-being.

Working Invisibly: Health Workers Talk About Capacity-Building in Health Promotion

Abstract: SUMMARY A series of six focus groups was held with health promotion workers to explore the meaning and experience of ‘capacity-building’, a term which is used variously in the literature. The research is part of a participatory, practice-based project to develop outcome indicators in capacity-building. Capacity-building was defined as seeking to develop health promotion skills and resources, and also problem-solving capability, at five levels: the individual; within health care teams; within health organisations; across organisations; and within the community. While workers had little difficulty in identifying outcomes of capacity-building, indicators of quality or good process were more difficult to articulate. This was partly because capacity-building was described as an invisible, even secret process. Capacitybuilding is hidden from funders and administrators because it is not generally regarded as a legitimate project activity; that is, it is not directly linked to risk factor behaviours in priority areas such as cancer, heart disease and injury control. Capacity-building is also hidden from other workers in order to make it more effective. This is particularly the case with health promotion workers working within what they perceive to be hostile climates, such as health care settings experiencing funding cut backs. The invisibility of practitioners’ capacity-building work has implications for quality control, guiding theory, practice ethics, peer support, worker morale and funding mechanisms in health promotion.

Australian Teachers' Understandings of the Health Promoting School Concept and the Implications for the Development of School Health

Abstract: SUMMARY The health promoting school has emerged as a comprehensive framework to enhance the health status and health potential of school students. It requires teachers to be proactive in a number of areas beyond the formal curriculum. The success of health promoting schools will depend largely on what teachers know about its building blocks and the likelihood that they will be adopted. A number of teachers were interviewed and surveyed in a sequential study to ascertain their understanding of what constitutes a health promoting school. The findings indicate that teachers think mainly about school health in terms of the curriculum; have little understanding of how community partnerships might work; are very supportive of the concept; and have limited preservice and inservice training in health issues. It is argued that the growth of health promoting schools will be dependent on comprehensive professional development programmes; the production of resources which link teachers’ perceived core business—teaching the mandated curriculum—to the building blocks of the health promoting school; closer collaboration between the health and education sectors; and a recognition by the community that schools cannot easily address (and solve) society’s health concerns.

Shifting discourses on health in Canada: from health promotion to population health

Abstract: SUMMARY This paper argues that discourses on health are products of the particular social, economic and political context within which they are produced. In the early 1980s, the discourse on health in Canada shifted from a postLalonde Report lifestyle behaviour discourse to one shaped by the discourse on the ‘social determinants of health’. In Canada, we are currently witnessing the emergence of another discourse on health—‘population health’—as a guiding framework for health policy and practice. Grounded in a critical social science perspective on health and health promotion, this paper critiques the population health discourse in terms of its underlying epistemological assumptions and the theoretical and political implications which follow. Does it matter whether we talk about ‘heterogeneities in health’ or ‘inequities in health’? This paper argues that it does, and concludes that population health is becoming a prevailing discourse on health at this particular historical time in Canada because it provides powerful rhetoric for the retreat of the welfare state. This paper argues further that it is health promotion’s alignment with the moral economy of the welfare state that makes it a countervailing discourse on health and its determinants.

Fruit and Vegetables as Adolescent Food Choices in New Zealand

Abstract: The consumption of fruit and vegetables has been shown by nutritionists to have preventative effects with regard to cardiovascular disease and cancer, and recent health promotions in New Zealand have emphasised the need to eat `5+' a day. This paper examines interaction between 20 New Zealand teenagers and the parent responsible for food purchasing to identify factors affecting teenagers' consumption of and attitudes towards fruit and vegetables, both at home and as snacks away from home. Although the teenagers believed fruit and vegetables were `good for you', consumption was affected by the teenagers' perceptions of the desirability of different foods, and the degree of independence or parental control in different eating situations. Possible health promotion and marketing strategies are suggested.

Making Dissemination a Two-Way Process

Abstract: Despite repeated expressions of concern, both academic researchers and programme delivery practitioners have neglected the dissemination of new knowledge about health promotion programmes This has meant that effective programmes are often not implemented as widely as they could be and that health promotion programmes are not achieving their full potential This paper analyses what has been written in the published literature about dissemination and discusses the problems from the point of view of practitioners who are involved in programme delivery Factors influencing dissemination have been well described; yet the dominant notion in the literature is of dissemination as a one-way process, a downstream transfer from a group who produce knowledge to a group who implement programmes At the same time, there is considerable theoretical and practical evidence that linkage systems between researcher and implementer groups can foster more effective transfer of programmes From the perspective of those involved in programme delivery, it appears that dissemination is most likely to be influential if it is based on a two-way process of exchanging knowledge between researcher and implementer groups While linkage systems offer the kind of structure or process to support two-way exchange, they need to overcome significant barriers if they are to become a feature of the health promotion system we work in Linkage systems must span different organisations, and these organisations do not necessarily have compatible purposes A two-way construction of dissemination also has implications for how research on dissemination is tackled, and makes apparent how such research could benefit from collaboration with programme delivery practitioners The irony of dissemination researchÐ that the existing publications and ideas do not have wide currencyÐitself indicates that a new approach that genuinely tackles dissemination as a two-way exchange is essential, if we are to achieve the full benefits of our knowledge in health promotion

Cost-Effectiveness of the Primary Prevention of Non-Insulin Dependent Diabetes Mellitus

Abstract: Non-insulin dependent diabetes mellitus (NIDDM) is a chronic disease, with increasing prevalence widely reported. NIDDM is associated with high rates of morbidity and premature mortality and is the cause of high health service use. There is clinical, epidemiological and scientific evidence that NIDDM is potentially preventable through weight loss, enhanced fitness and nutrition modification. The research question addressed in this article is whether the prevention of NIDDM is costeffective compared with other possible uses of our health care resources and whether some approaches to NIDDM prevention are more cost-effective than others. Program types analysed are surgery, group behavioural program, media campaign, general practitioner (family physician) lifestyle advice, and intensive diet and behavioural programs. Target groups include seriously obese persons, women with previous gestational diabetes, overweight men and all adults. Expected diabetes years and life years were modelled for hypothetical intervention and control cohorts and used, with information on program cost, to derive estimates of cost-effectiveness, expressed as cost per diabetes year avoided and cost per life year gained. Markov modelling was used to track states of normal glucose tolerance, impaired glucose tolerance (IGT) and NIDDM for intervention and control cohorts. Expected life years were calculated through application of age and gender specific mortality vectors, adjusted for diabetic state and weight loss. Expected savings in health care costs from NIDDM prevention were based on estimated annual cost of NIDDM management and were used to derive net cost-effectiveness ratios. The group program for overweight men and media programs were identified as extremely worthwhile, generating estimated net savings in health care resources, while reducing diabetes incidence and extending life expectancy. The behavioural/diet programs for high risk groups were found to be highly cost-effective relative to other health care programs, at an estimated net cost per life year saved of between A$1000 (US$720) and A$2600 (US$1900). Surgery performed poorest, but still well at A$4600 (US$3300) net cost per life year saved, if targeted at persons with IGT. We conclude that the primary prevention of NIDDM can be highly cost-effective. The development and funding of pilot programs for NIDDM prevention is recommended to test these findings and address the increasing incidence of NIDDM.

Impacts of a National Mass Media Campaign on Walking in Scotland

Abstract: The promotion of walking as a form of exercise holds considerable potential, both in terms of health benefits and its wide appeal to inactive groups. This paper presents the results of the evaluation of a national mass media walking campaign in Scotland which involved a 40 s television advertisement and a telephone helpline. The target population consisted of people aged 30±55 who are not regular exercisers. The campaign impact was assessed in terms of awareness of the campaign and preand post-campaign changes in knowledge and beliefs about walking as a good form of exercise, in motivations and intentions regarding walking/exercise and in walking/exercise behaviour. The evaluation involved two population surveys and baseline and follow-up surveys of the helpline callers. Awareness levels for the television advertisement peaked at 70% of the adult population during the first 4-week burst of advertising, falling to 54% during the non-broadcast period. The evaluation findings show that, at a population level, the campaign had a notable positive impact on knowledge about walking as a form of exercise but no impact on walking behaviour. Among the helpline callers the campaign had a substantial impact at the level of intentions and behaviour: 48% of the callers followed up at 1 year claimed to be more physically active and there was an overall shift from the `contemplation' stage of change at baseline towards the `action' stage at the 10-week and 1year follow-ups. The proportion of adults aware of the telephone helpline rose from 5% at the start of the campaign to 16% 4 months later, but only 5% of these respondents used the service. This level of use represents 0.1% coverage at the start of the campaign rising to 1% 4 months later.

Healthy Public Policy and the World Trade Organization: A Proposal for an International Health Presence in Future World Trade/Investment Talks

Abstract: Poverty, other forms of social inequality and human impacts on the environment are increasingly recognized as important, perhaps fundamental, health determinants. These determinants, in turn, are largely conditioned and constrained by economic practices, and by government legislation that regulates such practices or seeks to mitigate inequalities that arise from them. Over the past two decades the ability of national governments to intervene in economic practices has been reduced by two interrelated phenomena: the dominance of a neoliberal economic orthodoxy, which emphasizes free (unregulated) markets and a `minimal' welfare state, and the growth in regional and global free trade and investment agreements. There is mounting evidence that policies based on neoliberal economic theory, including free trade/investment agreements, may seriously undermine public health by increasing social inequalities, depleting natural resources and increasing environmental pollution. This evidence has sparked a call among many public interest non-governmental organizations (NGOs) and policy `think tanks' for appending strong `social clauses' to global trade and investment agreements to ensure that such agreements are socially just and environmentally sustainable. This paper proposes creation of a strong public health lobby, both nationally and internationally, to join with other public interest NGOs in the social clause campaign. It begins by defining and critiquing some of the basic tenets of neoliberal economic orthodoxy which underpin the push towards global free trade and investment agreements. It then describes the current status of these agreements, and provides examples of how such agreements might imperil public health. The paper then discusses the social clause initiative, and concludes by advancing a proposal for a public health lobby presence at those fora where trade and investment agreements are negotiated and monitored.

Eliciting the Views of Children About Health in Schools Through the Use of the Draw and Write Technique

Abstract: SUMMARY A draw and write scenario was devised in order to elicit the views of primary school pupils (ages 8‐12) regarding the qualities they would expect to see in a school which promotes health, and the qualities their own schools need to develop to become more health promoting. The draw and write investigation was conducted in a sample of six primary schools in Lothian, Scotland. These schools are located in both urban and rural environments, and cater for communities of different socioeconomic status. Categorisation of the children’s responses revealed that the majority of pupils from all the schools considered issues relating to healthy eating, the school environment and exercise as being vital elements of a healthy school. There was inter-school variation in the richness of data produced and range of responses given. The scenario was also capable of detecting intra-school similarities and differences in response. We conclude that this draw and write investigation could be utilised to ascertain pupils’ opinions on the qualities schools need to possess and develop to promote health. These views, in turn, could help to inform the development of the Health Promoting School concept.

Caveat Partner: Reflections on Partnership with the Private Sector

Abstract: First, let me begin by stating that I see nothing inherently evil in the private sector, nor anything inherently wrong about partnership with the private sector. After all, the private sector grows my food, builds my house, creates employment and in a myriad of ways meets our basic and no-so-basic needs. However, I do believe that there are some very difficult challenges to face in developing partnerships for health promotion with the private sector, as detailed below.

The Politics of Health Promotion: Insights from Political Theory

Abstract: Health promotion is inherently political. Not only is it largely funded by government, but the very nature of the enterprise requires shifts in power. Political theory has much to contribute to an understanding of the politics of health promotion. In this paper three key political theories are explained and their insights for health promotion explored. They are then applied to the development of a National Drug Policy in New Zealand. The theoriesÐpluralist interest group theory, the new institutionalism and neo-Marxist theoryÐare each at a different level of analysis. The significance of interests, institutional factors and class as political influences on health promotion are discussed. It is concluded that to ensure good practice health promotion practitioners need to be aware of these influences on their work. They need to strategise to ensure support from key interests, build capacity for health promotion into their institutions and recognise the macro-political context within which they work in order to influence it.

Community Participation in Health Promotion: Evaluation of the California Wellness Guide

Abstract: SUMMARY With the rapid rise in health care costs, it has become imperative that departments of health services find effective and affordable ways to prevent disease and promote health. During the past 20 years, most of the major educational interventions in the US designed to prevent disease by changing behavior have not been as successful as expected. At the same time, there is increasing evidence that community participation, a central feature of the ‘new public health’, is a powerful component of the programs that have been successful. In this paper, we describe and evaluate an intervention that heavily involves the community. The Wellness Guide is a comprehensive health promotion guide developed with community participation to improve the wellness knowledge, attitudes and behaviors of recipients. 100 000 copies of The Guide in English

Canada's Active Living policy: a critical analysis

Abstract: SUMMARY The shift from a rigorous prescriptive exercise model to Canada’s moderate ‘Active Living’ is examined. In its articulation as a ‘new’ and ‘unique’ approach, Active Living is reaching a critical turning point in the evolution of fitness policy in Canada. Active Living claims to represent the emergence of a new way of thinking and practice, as well as a new domain of discourse and ideology. In particular, it represents an example of a ‘top-down’ versus ‘bottom-up’ strategy for influencing the health of populations. Like the health promotion field, the literature on Active Living is replete with jargon and rhetoric. To the extent that Active Living represents a government-driven concept, a political agenda is implicit in its mandate. This article begins with an overview of the social, political and economic context underlying the evolution of Active Living. This overview sets the stage for understanding how and why Active Living was created. Following is a critical analysis of the discourse of Active Living (for example, lifestyle, empowerment, community and collaboration). An attempt is made to unpack meaning and hidden political agendas. What is revealed are the ways in which discourse has: (i) functioned to conceal power imbalances between government officials, practitioners and the community; and (ii) been appropriated by government to justify the rapid retreat of the welfare state from social responsibility for fitness and health. A discussion of the future of Active Living is provided. Here I argue that, in so far as it represents a powerful ideological mechanism for a de-centralized federal role in fitness, the thrust toward Active Living will continue.

Behaviour Change Following a Workplace Health Check: How Much Change Occurs and Who Changes?

Abstract: An observational study, involving 1053 employees of a Glasgow factory, was conducted to determine the overall level of behaviour change and the characteristics of those who responded after attending a workplace health check. Eight hundred and sixty-eight individuals received one of four versions of a health check. Participants were deemed to have `responded' if they made one or more of the advised behaviour changes (stopped smoking, increased exercise, reduced alcohol consumption, improved diet). Twenty-six per cent of participants were not `at risk' on entry to the study. Those in the `not at risk' group were characterised by having higher socio-economic status and educational attainment than those `at risk' and were more likely to perceive themselves as being in good health and at low risk of coronary heart disease. Forty-seven per cent of those who received the health check and returned for follow-up reported one or more of the desired behaviour changes (responders). In comparison to those who made none of the desired changes (the non-responders), responders tended to perceive their own health to be poorer and their risk of coronary heart disease to be greater and they were more likely to have perceived the health check as threatening. In future, health check interventions should take account of these two important findings: that such a large proportion (almost half) responded positively by changing behaviour and that it was those who perceived themselves to be `at risk' who tended to comply with advised behaviour changes.

Challenges for Safer Sex Education and HIV Prevention in Services for People with Intellectual Disabilities in Britain

Abstract: This paper reviews progress and competence in HIV prevention work for people with intellectual disabilities in Britain. It identifies key challenges for specialist residential support and sex education services for people with intellectual disabilities as well as for mainstream health promotion services. The discussion is informed by research and practice evidence and explores ways to develop competence in safer sex education offering suggestions for HIV risk assessment and risk management. While the paper demonstrates that the politics of sexuality and HIV are difficult for services to manage the rights of people with intellectual disabilities to information and support for sexuality and sexual health should be put first. (authors)

A Review of the Health Promoting Status of Secondary

Abstract: Following a questionnaire survey of secondary schools in Wales and England it is apparent that only a few schools are perceived to be health promoting. On the whole the understanding of the health promoting school concept is disappointing. Finally there are indications that pupils and their families had barely any involvement in the schools decision-making procedures with regards to health matters. A set of recommendations is provided to assist schools to become health promoting. (authors)

Implementing the European network of health promoting schools in Bulgaria, the Czech Republic, Lithuania and Poland: vision and reality

Abstract: SUMMARY This article explores key developments in health promotion within the European Network for Health Promoting Schools project (ENHPS) in four formerly communist countries: Poland, the Czech Republic, Bulgaria and Lithuania. The concept of the Health Promoting School has been uniquely interpreted by these countries resulting in a variety of health promotion initiatives at school, community and national levels. These include: variations in the management of the project in the different countries; the direction and support for schools provided by the national project teams in each country; the effect of national governments on project outcomes; the communication between project participants and strategies for disseminating project outcomes; the training of teachers and health professionals; and the extent to which the local community and parents have been involved in school projects. The introduction of a holistic concept of health promotion into the education system and schools in these countries has inspired and equipped teachers to adopt ‘democratic’ approaches to health education teaching and move away from the more traditional, didactic approaches. The two researchers witnessed more relaxed relationships and more opportunities for pupils to engage and be active. This corresponded with changes in the political, social and economic conditions of these countries since the removal of communist regimes. The vestiges of past regimes, current economic circumstances and national histories inevitably play a part in the context in which a radical vision of ENHPS is embraced by entrepreneurial professionals in under-resourced communities and schools.

A review of the health promoting status of secondary schools in Wales and England.

Abstract: Following a questionnaire survey of secondary schools in Wales and England it is apparent that only a few schools are perceived to be health promoting. On the whole the understanding of the health promoting school concept is disappointing. Finally there are indications that pupils and their families had barely any involvement in the schools decision-making procedures with regards to health matters. A set of recommendations is provided to assist schools to become health promoting. (authors)

The Social Context of Responses to Lead Contamination in an Australian Community: Implications for Health Promotion

Abstract: This paper illustrates how an understanding of the social context of responses to health hazards assists in the development of health promotion strategies. In early 1992, chronic environmental lead contamination became a public issue in Broken Hill, New South Wales, Australia. This paper is based on a study completed between May 1992 and December 1995, which set out to explore the nature of social responses to this environmental health hazard. Fieldwork conducted over 9 months during six visits to Broken Hill included the use of participant observation and in-depth interviews with residents and representatives of organisations. Residents' coping responses included thoughts and feelings about the significance and acceptability of the threat, and assignment of responsibility. Active responses included obtaining information about the hazard and exposure reduction, and using health interventions. Responses were found to be significantly affected by aspects of the social setting, including: stigma; individual and community economic factors; social support and undermining; social influence; and cultural assumptions, beliefs and values. I conclude that an understanding of social responses to health hazards, including factors underlying responses, provides an important basis for the development of appropriate and effective health promotion strategies.

Colorectal Cancer, Diet and Lifestyle Factors: Opportunities for Prevention

Abstract: A considerable amount of observational evidence from case-control and cohort studies demonstrates an association between various dietary and lifestyle factors and risk of colorectal cancer. This suggests the potential for colorectal cancer risk reduction by decreasing consumption of animal fats, red meat, alcohol and cigarettes, by increasing physical activity levels, and by increasing intake of fruits, vegetables and dietary fibre. Few intervention studies have been performed to corroborate this potential, although results of important trials will be available in the future. We argue, however, that the evidence is sufficient to support pilot implementation of lifestyle-modification programs in the context of targeted screening programs, and also the integration of prevention of colorectal cancer within a non-communicable disease strategy aimed at the general population. Evaluation of the costs and benefits of alternative strategies must be an integral part of program implementation, in order to advance the knowledge that we have of the impact of prevention strategies, so that resources are not wasted on ineffective interventions. Given the consistency of evidence relating lifestyle behaviours to colorectal cancer incidence and the negligible risk of undesirable consequences from promotion of a diet high in fruit, vegetables and fibre and low in red meat and animal fats, inaction can no longer be justified.

Reflections on the Role of Business in Health Promotion and the Challenge of Partnership

Abstract: Engaging private sector business in partnerships to promote health is one of the most important challenges for all who are concerned with improving health in the 21st century. The Jakarta Declaration is a major step toward realizing that goal. The Prince of Wales Business Leaders Forum is an international organization formed by 50 multinational companies from Europe America the Middle East and Asia to promote the active involvement of businesses in country and community development. Member companies include many of the leading investors in emerging markets employ approximately 25 million people directly and indirectly through their supply chains and operate in every country and territory in the world. The Forum works through national and international partnerships in more than 30 countries around the world and also brings together the major global hotel chains with 10% of the worlds hotel rooms in the International Hotels Environment Initiative global alliance. This paper discusses why concern should be had over private sector involvement why businesses want to be involved what business can bring to the partnership and the conditions for effective partnerships.