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Health promotion and health promotion programs are rooted in the World Health Organization’s (1947) definition of health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” While most of us can identify when we are sick or have some infirmity, identifying the characteristics of complete physical, mental, and social well-being is often a bit more difficult. What does complete physical, mental, and social well-being look like? How will we know when or if we arrive at that state?

In 1986, the first International Conference of Health Promotion, held in Ottawa, Canada, issued the Ottawa Charter for Health Promotion, which defined health in a broader perspective: “health has been considered less as an abstract state and more as a means to an end which can be expressed in functional terms as a resource which permits people to lead an individually, socially, and economically productive life” (World Health Organization, 1986). Accordingly, health in this view is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities.

Arnold and Breen (2006) identified the characteristics of health not only as well-being but also as a balanced state, growth, functionality, wholeness, transcendence, and empowerment and as a resource. Perhaps the view of health as a balanced state between the individual (host), agents (such as bacteria, viruses, and toxins), and the environment is one of the most familiar. Most individuals can readily understand that occasionally the host-agent interaction becomes unbalanced and the host (the individual) no longer is able to ward off the agent (for example, when bacteria overcome a person’s natural defenses, making the individual sick).

An ecological perspective on health emphasizes the interaction between and interdependence of factors within and across levels of a health problem. The ecological perspective highlights people’s interaction with their physical and sociocultural environments. McLeroy et al. (1988) identified three levels of influence for health-related behaviors and conditions: (1) the intrapersonal level (or individual level), (2) the interpersonal level, and (3) the population level. The population level encompasses three types of factors: institutional or organizational factors, social capital factors, and public policy factors (Table 1.1).

Table 1.1 Ecological Health Perspective: Levels of Influence

Concept	Definition
Intrapersonal level	Individual characteristics that influence behavior, such as knowledge, attitudes, beliefs, and personality traits
Interpersonal level	Interpersonal processes and primary groups, including family, friends, and peers, that provide social identity, support, and role definition
Population level Institutional factors Social capital factors Public policy factors	Rules, regulations, policies, and informal structures that may constrain or promote recommended behaviors Social networks and norms or standards that may be formal or informal among individuals, groups, or organizations Local, state, and federal policies and laws that regulate or support healthy actions and practices for prevention, early detection, control, and management of disease
Source: Adapted from McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15, 351–377.

Health promotion programs provide planned, organized, and structured activities and events over time that focus on helping individuals make informed decisions about their health. Health promotion programs promote policy, environmental, regulatory, organizational, and legislative changes at various levels of government and organizations. These two complementary types of interventions by design achieve specific objectives to improve the health of individuals as well as, potentially, all individuals at a site. Health promotion programs take advantage of the pivotal position of their setting within schools, colleges and universities, workplaces, healthcare organizations, and communities to reach children, adults, and families by combining interventions in an integrated, systemic manner.

Health promotion programs are designed to work with a priority population (in the past called a target population)—a defined group of individuals who share some common characteristics related to the health concern being addressed. Programs are planned, implemented, and evaluated to influence the health of a priority population. The foundation of any successful program lies in gathering information about a priority population’s health concerns, needs, knowledge, attitudes, skills, and desires related to the disease focus. At the planning stage, it is also important to engage schools, workplaces, healthcare organizations, and communities where the priority population lives and interacts to seek their cooperation and collaboration,

Finally, health promotion programs are concerned with prevention of the root causes of poor health and lack of well-being resulting from discrimination, racism, or environmental assaults—in other words, the social determinants of health. Addressing root causes of health problems is often linked to the concept of social justice. Social justice and health equity are the belief that every individual and group is entitled to fair and equal rights and equal participation in social, educational, and economic opportunities. Health promotion programs have a role in increasing understanding of oppression and inequality and taking action to improve the quality of life for everyone.