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Creating a Consistent Health Promotion Approach in a National Network

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I The Canadian Health Network: A National Health Promotion Website

A commitment to health promotion and the determinants of health is not
enough, on its own, to ensure consistency in application across all of
the services and actions of an organization.  The Canadian Health
Network (CHN) is a case in point.  Although it is likely the
largest and most comprehensive health promotion website in the world,
until recently it lacked a consistent approach to health promotion in
terms of the range of resources and kinds of messages included on the
website.

CHN, at http://www.canadian-health-network.ca, is a national,
non-profit, bilingual health information website supported by the
Public Health Agency of Canada.  Their mission is to help
Canadians to make informed choices about their health.  CHN
provides
* Access to credible information on how to stay healthy and prevent disease and injury, 
* Over 17,000 consumer-friendly health promotion resources, and
* Information on multiple health topics, population groups and preventable diseases.

A key asset of CHN is its exceptional collaboration, including
* An extensive network of health information providers;
* The Public Health Agency of Canada and Health Canada;
* National and provincial/territorial non-profit organizations;
* Universities, hospitals, libraries and community organizations; and
* A national network of 22 Affiliates (which are all non-government
organizations (NGOs)) who are the content experts for the CHN resource
collections.

The CHN Affiliates include a diverse range of health and social sector
organizations that employ their knowledge, skills and expertise to
ensure that CHN is Canadians' first choice for reliable health
information. CHN Affiliates
* Build and maintain the content of the CHN collection within their specific topic areas,
* Produce original content for the website, including homepage articles and answers to frequently asked questions,
* Respond to health information requests from consumers, and
* Carry out specific promotional and network building activities.

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II Strengthening the  Focus on Health Promotion

Because of its distinct focus on health promotion, CHN stands apart
from other Internet-based consumer health information services. CHN's
focus on health promotion also complements the Public Health Agency of
Canada's mission, which is to "promote and protect the health of
Canadians through leadership, partnership, innovation and action in
public health." For 2004-06, one of CHN's strategic directions is to
strengthen its focus on health promotion, including all of the
determinants of health.

Although the concept of the determinants of health is now widely
understood and accepted by many working in the broad field of health
promotion, public health, community health and social services,
translating health promotion and the determinants of health into
practice can still be a challenge.   Even in accepting the
World Health Organization definition of health promotion as "the
process of enabling people to increase control over and to improve
their health," this leaves tremendous scope for interpretation and for
a variety of models, approaches and strategies. 

A challenge for CHN has been to agree upon a health promotion framework
to guide the work of the network itself, recognizing that each
Affiliate may be working with a different model and definitions within
the scope of their host organization's primary mandate and
directions.  Differing mandates and approaches to health promotion
mean that
* Affiliates may emphasize some health promotion strategies or some determinants of health more than others, 
* Affiliates representing chronic diseases may stress individual risk factors for those diseases,
* Affiliates representing population groups may emphasize factors that
contribute to healthier groups, schools and communities, and 
* It is a challenge to achieve a consistent message and approach to health promotion that is understandable to a wide audience.

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III CHN's Health Promotion Affiliate

To meet this challenge, CHN established a Health Promotion (HP)
Affiliate, which became operational in the summer of 2004.  The HP
Affiliate
* Is a partnership of OPC and the Centre for Health Promotion at the
University of Toronto (CHP), with OPC taking the lead (OPC and CHP are
well prepared to take on this role due to their health promotion
expertise, established networks, and track records in translating the
determinants of health to multiple audiences);
* Has a similar mandate to other CHN Affiliates to build and maintain a health promotion collection and CHN's network; and
* Has a "specialized consulting role" to assist with building the health promotion capacity of CHN.

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IV Applying a Health Promotion Lens

In order to build the health promotion capacity of CHN, Affiliates must
be supported in applying a health promotion/determinants of health lens
to their collections, promotion and marketing approaches and other
activities.

One of the initial tasks was to expand the predominant focus on
lifestyles to the broader determinants of health.  Given the
diverse nature of Affiliate organizations, the HP Affiliate proposed
and carried out a series of HP workshops during the fall of 2005 for
all Affiliate staff to achieve a shared understanding of health
promotion across CHN:
* The first round of regional workshops focussed on the development of
a common understanding of health promotion, including the creation of a
working definition of health promotion to guide CHN's activities.
* The second round focused on the development and application of
guidelines in the form of a health promotion assessment tool (modeled
after the OHPE's subject search framework and the work of Larry
Hershfield of the The Health Communication Unit, Centre for Health
Promotion, University of Toronto). 
* A special workshop was held to define disease prevention within CHN's health promotion framework.
 
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V Results of the Regional HP Workshops

Dr. Suzanne Jackson, director of the Centre for Health Promotion,
University of Toronto, joined the HP Affiliate for the first round of
workshops in order to provide an overview of health promotion. 
Her presentation compared and contrasted concepts like health promotion
and disease prevention, which share similar strategies but have

different goals: 
* Disease prevention tends to focus on removing or reducing the effects
of particular risk factors known to contribute to the development of
various chronic diseases. 
* Health promotion is a broader concept founded on the notion that health is more than the absence of disease.

As a result of the workshops, the Affiliates agreed to adopt a broader view of health promotion that
* Embraces all of the determinants of health;
* Spans the continuum from biomedical information to information on the
social, economic and environmental pre-requisites for health;
* Focusses on a strength-based, positive, goal orientation to health; and,
* Empowers individuals, groups, communities and society, enabling them
to make informed decisions and to take action on issues affecting their
health.

All 22 Affiliates unanimously adopted a working definition of health
promotion and a tool for assessing HP content in order to ensure
collections, network and audience-building activities reflect health
promotion in its broadest sense, including
* Multiple determinants,
* Populations,
* Settings,
* Strategies, and
* Levels. 

The CHN health promotion definition (adapted from Health Promotion
Ontario (public health) at http://www.hpoph.org/about/index.html) also
acknowledges the importance of disease and injury prevention within CHN:
"Health promotion is the process of enabling people to increase control
over and improve their health. This process is based on the
understanding of the important influences that determinants of health
(such as income and social status, social support networks, education
and employment/working conditions) have on an individual's health.
Health promotion activities include the three levels of disease, injury
and disability prevention and move beyond health education and changes
in personal behaviours to address social change, institutional change
and community change."

The Health Promotion Assessment Tool/Checklist
* is based on OHPE's subject search framework, including health determinants, strategies, settings, levels and populations;
* provides access to definitions and examples of complex health
promotion and determinants of health concepts through multiple
hyperlinks, and
* is being pilot tested by all Affiliates during spring 2006.

The resource list related to this article provides links to a wide
variety of existing definitions of health promotion terms and concepts.
In addition to their value in developing the assessment tool, they were
particularly helpful in achieving a common understanding of health
promotion across the range of CHN Affiliates.

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VI Conclusion

By providing access to high quality health promotion information, CHN
builds the capacity of all Canadians to make healthy choices for
themselves and their communities.  CHN helps Canadians to
understand all the factors that determine health and provides
information about how to take action to improve health. 

Developing a common understanding of health promotion and a tool to
ensure consistency in how it gets applied ensures that CHN will become
the best source of health promotion information on the Net, for
consumers and health intermediaries alike.