Health promotion is the process of enabling people and communities to increase control over and improve their health. The modern concept was strongly articulated in the Ottawa Charter for Health Promotion in 1986, which defined health promotion in terms of enabling people to increase control over and improve their health. It emphasises that health is influenced by social, economic, environmental and political conditions as well as individual behaviour.
Health promotion can therefore include education and communication, but it is broader than simply providing information. It may involve creating supportive environments, developing community action, strengthening personal skills and influencing policies that make healthier choices more achievable. The approach recognises that people cannot always exercise meaningful control over health if they lack resources, safe environments, appropriate services or supportive social conditions.
Health promotion differs from disease treatment because its primary focus is improving health and wellbeing and preventing avoidable health problems rather than treating established disease. It overlaps with primary prevention, although the concepts are not identical. Primary prevention specifically aims to prevent a disease or injury before it occurs, whereas health promotion has a broader focus on enabling health and wellbeing, including factors that may not correspond to a single disease. For example, creating safe spaces for physical activity can promote physical and mental wellbeing while also contributing to prevention of cardiovascular disease. Health promotion can therefore address positive health, resilience, social participation and healthy environments rather than simply reducing disease incidence.
Health promotion can operate at several levels. Individual approaches may develop knowledge and skills relating to nutrition, physical activity, sexual health, medication use, sleep or stress management. Interpersonal approaches can involve families, peer groups and social networks. Community approaches may support local organisations, community-led projects and accessible recreational facilities. Organisational approaches can change conditions within schools, workplaces or healthcare services. Policy approaches can influence taxation, product regulation, transport, housing, food environments, tobacco control or other structural determinants. Effective health promotion often combines these levels because information alone may have limited effect when environmental or economic conditions make healthy behaviour difficult.
The Ottawa Charter identified five broad action areas: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and reorienting health services. Building healthy public policy means considering health effects when governments and organisations make decisions. Supportive environments involve physical and social settings that make healthy living safer and more feasible. Community action gives communities greater involvement and control over decisions affecting their health. Developing personal skills includes education and practical capabilities. Reorienting health services means moving beyond a narrow focus on treatment towards prevention, health education, participation and broader determinants. These principles remain influential in contemporary health-promotion practice.
Health education is an important component of health promotion but is not equivalent to it. Health education provides information and develops knowledge or skills, whereas health promotion includes changes to environments, policies, services and social conditions. Telling people to exercise more may provide useful information, but access to safe parks, affordable facilities, suitable transport and time for physical activity can strongly influence whether that advice is actionable. Similarly, telling people to eat a healthy diet has limited practical value if healthy foods are inaccessible or unaffordable. This distinction is important because health promotion seeks to address barriers and determinants rather than placing responsibility entirely on individuals.
Health promotion also has an important role in reducing health inequalities, although poorly designed interventions can sometimes widen them. If a programme relies heavily on digital technology, complex written information or substantial personal resources, people with fewer resources may benefit less. Universal interventions can therefore be combined with proportionate additional support for groups facing greater barriers. Culturally appropriate communication, accessibility, community involvement and attention to socioeconomic conditions can improve reach. Health-promotion interventions should be evaluated not only by whether the average population outcome changes but also by who participates, who benefits, who remains excluded and whether unintended consequences occur.
Behaviour-change theories can inform health promotion. Models such as the COM-B framework examine capability, opportunity and motivation as interacting influences on behaviour. Social-cognitive approaches consider factors such as self-efficacy, observational learning and environmental reinforcement. Behavioural interventions may use goal-setting, prompts, feedback, social support or changes to choice environments. No single theory works for every health behaviour, and interventions should be designed around the specific behaviour, population and context. Evidence-based health promotion therefore involves identifying determinants, selecting appropriate intervention mechanisms, implementing them effectively and evaluating outcomes rather than assuming that persuasive messaging alone will change behaviour.
Health promotion is ultimately a broad approach to creating conditions in which people and communities can achieve better health. It includes communication and education but also community participation, supportive environments, public policy, accessible services and action on social determinants. It can address physical health, mental wellbeing, injury prevention, healthy ageing, sexual health, substance use, nutrition, physical activity and many other areas.
Its defining principle is enabling rather than simply instructing people: individuals retain agency, while institutions and societies also have responsibilities for the conditions in which choices are made. Effective health promotion therefore combines evidence about behaviour with attention to inequality, environment, policy, culture, accessibility and the practical circumstances of people's lives.
