Health promotion through the lens of population health: Toward a salutogenic setting

A healthy settings approach to addressing painogenic environments: New perspectives from health promotion

Structural approaches to promoting health focus on policies and practices affecting health at the community level and concentrate on systems and forces of society, including distribution of power, that foster disadvantage and diminish health and well-being. In this paper we advocate consideration of structural approaches to explore macro level influences on the burden of persistent pain on society. We argue that health promotion is an appropriate discipline to ameliorate painogenic environments and that a "settings approach" offers a crucial vehicle to do this. We encourage consideration of socio-ecological frameworks to explore factors affecting human development at individual, interpersonal, organizational, societal, and environmental levels because persistent pain is multifaceted and complex and unlikely to be understood from a single level of analysis. We acknowledge criticisms that the structural approach may appear unachievable due to its heavy reliance on inter-sectoral collaboration. We argue that a settings approach may offer solutions because it straddles "practical" and cross-sectorial forces impacting on the health of people. A healthy settings approach invests in social systems where health is not the primary remit and utilises synergistic action between settings to promote greater health gains. We offer the example of obesogenic environments being a useful concept to develop strategies to tackle childhood obesity in school-settings, community-settings, shops, and sports clubs; and that this settings approach has been more effective than one organisation tackling the issue in isolation. We argue that a settings approach should prove useful for understanding painogenic environments and tackling the burden of persistent pain.

Youth Perspectives on What Makes a Sports Club a Health-Promoting Setting-Viewed through a Salutogenic Settings-Based Lens

Sports participation has the potential to contribute to young people’s health. A prerequisite for young people to benefit from sports is that they stay in sports. Studies that consider both personal and contextual factors are needed to unpack the broader health-promoting potential of youth sports. The purpose of the study is to contribute to knowledge about the health-promoting potential of young people’s participation in organized sports by exploring youth perspectives on what makes a sports club health-promoting with a focus on health resources that young people consider important for sports club participation. For this cross-sectional study a brief survey was conducted with 15–16 year old students (n = 123) at two schools in Sweden, asking three open-ended questions about their participation in sports. The study used a salutogenic theory-driven analysis in combination with statistical analysis. Five health resources that young people consider important for sports club participation are revealed. On an individual, more ‘swimmer’-related level, these are personal well-being and social relations, including relationally meaningful activities, and on an organizational level, relating to the ‘river’, that sports clubs offer a supportive and well-functioning environment. For sports clubs to be health-promoting settings for young people and thus hopefully to reduce drop-out, we need a more sustainable approach emphasizing drop-in, drop-through, and drop-over as a continuous iterative process. We also need to consider the complexity of sports participation for young people, involving individual, organizational and environmental issues.

Rethinking passive transport: bus fare exemptions and young people's wellbeing

Much recent public health research has emphasised the health impacts for young people of 'active travel' modes, typically defined as walking and cycling. Less research has focused on public transport modes. Drawing on qualitative data, we examine the links between bus travel and wellbeing in London, where young people currently have free bus travel. Our findings indicate that bus travel can be both a physically and socially active experience for young people. We suggest a more nuanced understanding of 'active travel' is now needed, alongside greater attention to urban public transport networks as key sites that impact on important determinants of wellbeing such as independent mobility and social inclusion.

Integrating social theory into public health practice

The innovative practice that resulted from the Ottawa Charter challenges public health knowledge about programming and evaluation. Specifically, there is a need to formulate program theory that embraces social determinants of health and local actors' mobilization for social change. Likewise, it is imperative to develop a theory of evaluation that fosters reflexive understanding of public health programs engaged in social change. We believe advances in contemporary social theory that are founded on a critique of modernity and that articulate a coherent theory of practice should be considered when addressing these critical challenges.

Comprehensive Health Promotion Interventions at the Workplace: Experiences With Health Circles in Germany

Health circles, the central element of a comprehensive health promotion approach that has been developed in Germany in recent years, emphasize organizational and psychosocial factors while actively involving employees in the process. Through an extensive review the authors identified 11 studies, presenting the results of 81 health circles. The scientific quality of the data is limited: only 3 studies used (nonrandomized) control groups, whereas the remaining studies are based on retrospective before-and-after comparison. Nonetheless, the available data suggest that health circles are an effective tool for the improvement of physical and psychosocial working conditions and have a favorable effect on workers' health, well-being, and sickness absence. More rigorous studies are needed to confirm these results.

A theoretical and empirical analysis of context: neighbourhoods, smoking and youth

Numerous studies are currently addressing the issue of contextual effects on health and disease outcomes. The majority of these studies fall short of providing a theoretical basis with which to explain what context is and how it affects individual disease outcomes. We propose a theoretical model, entitled collective lifestyles, which brings together three concepts from practice theory: social structure, social practices and agency. We do so in an attempt to move away from both behavioural and structural-functionalist explanations of the differential distribution of disease outcomes among areas by including a contextualisation of health behaviours that considers their meaning. We test the framework using the empirical example of smoking and pre-adolescents in 32 communities across Québec, Canada. Social structure is operationalised as characteristics and resources; characteristics are the socio-economic aggregate characteristics of individuals culled from the 1996 Canadian Census, and resources are what regulates and transforms smoking practices. Information about social practices was collected in focus groups with pre-adolescents from four of the participating communities. Using zero-order and partial correlations we find that a portrait of communities emerges. Where there is a high proportion of more socio-economically advantaged people, resources tend to be more smoking discouraging, with the opposite being true for disadvantaged communities. Upon analysis of the focus group material, however, we find that the social practices in communities do not necessarily reflect the "objectified" measures of social structure. We suggest that a different conceptualisation of accessibility and lifestyle in contextual studies may enable us to improve our grasp on how differential rates of disease come about in local areas.

Collective lifestyles as the target for health promotion

The last five years have witnessed intense debate among health researchers in Canada regarding the overlap of the health promotion and population health discourses. Meanwhile, strong currents within health promotion have attempted to move the field beyond a focus on individual behaviour towards the influence of social environments on health, although the tendency is often to fall back on individual behaviour modification as the primary lever for change. The Population Health research agenda bypasses behavioural determinants of health and explores instead social determinants. This body of knowledge provides useful insight for addressing some of the tensions in the health promotion discourse. This paper explores two of these tensions: whether individuals at risk or general populations should be targeted for change; and whether lifestyle is an individual or a collective attribute. We propose the notion of collective lifestyles as a heuristic for understanding the interaction between social conditions and behaviour in shaping health.