Assessing public health intervention practices in a Danish municipality: applying criteria based on the European Community Health Promotion Indicator Development (EUHPID) model.

AIM: To develop a set of assessment criteria and assess public health interventions at municipal level in Denmark using the European Community Health Promotion Indicator Development (EUHPID) model to support more effective planning and funding allocation in public health. METHODS: Based on knowledge synthesis, a set of assessment criteria were developed to classify interventions into the four types of public health provided by the EUHPID model: health promotion, health protection, disease prevention, and health care. Information was then collected on all current public health interventions in Varde Municipality within a 3-month period in spring 2009. Finally, the interventions were categorised using the developed assessment criteria. RESULTS: The knowledge synthesis process resulted in the development of a set of assessment criteria and the 154 reported public health interventions were divided into relevant types using these criteria. 57% of the interventions were based on a salutogenic health promotion approach, 33% on a pathogenic disease prevention approach, 10% on the pathogenic health protection approach, and 0% on the pathogenic health care approach. CONCLUSIONS: The assessment criteria based on the EUHPID model can be useful and have wider global significance for planning public health interventions, allocating appropriate funding to support public health interventions, and thereby encouraging and supporting more effective intersectoral working practices.

The gradient in health inequalities among families and children: a review of evaluation frameworks.

Public health policies and interventions that seek to tackle the social gradient in health need to be more adequately evaluated. The GRADIENT Project sets out to recommend public health policy options which effectively tackle health inequalities and address the gradient in health determinants among families and children in Europe. This work is underpinned by the development of a dedicated evaluation framework-a scheme that elaborates steps in a process of assessment which can act as a useful guide for decision makers. This paper presents the results from a narrative review, based on realist review principles, of 34 evaluation frameworks. It uses a set of analytical criteria, drawn from the EUHPID health development model, the Ottawa Charter for Health Promotion, and the wider literature on health inequalities, to analyse these frameworks. The findings reveal that no one suitable evaluation framework exists to evaluate whether policies and/or interventions targeting children and families reduce the health gradient. It is suggested that this work will be useful in assessing the complex nature of public health interventions and their evaluation. It will be used to develop an evaluation framework to guide decision makers to begin to understand the key drivers at each stage of the policy development and implementation cycle.

Health in the urban environment: a qualitative review of the Brighton and Hove WHO Healthy City Program.

Phase IV of the WHO European Region's Healthy Cities Program ended in December 2008. This article presents the findings from a recently completed review of Brighton and Hove's Healthy City Program which aimed to scope whether added value had accrued from the city's role as a WHO Healthy City during phase IV. In contrast to most other evaluations of healthy cities, this review adopted a qualitative approach representing an appraisal of the Brighton and Hove Healthy City Program from the internal viewpoint of its local stakeholders. In addition to documentary analysis and a facilitated workshop, a series of in-depth interviews (N = 27) were conducted with stakeholders from the Brighton and Hove Healthy City Partnership representing each of the sectors reflected in the Local Strategic Partnership (public, statutory, elected, community and voluntary, neighborhood and communities, business). The key findings of the review are presented in a way which reflects the three key areas of the review including (1) the healthy cities approach, (2) participation in phase IV of the WHO Healthy Cities Program, and (3) the Brighton and Hove Healthy City Partnership. These findings are discussed, and recommendations for action at local, national, and European levels are proposed. In particular, we argue that there is an urgent need to develop a suitable monitoring and evaluation system for the WHO Healthy Cities Program with appropriate indicators that are meaningful and relevant to local stakeholders. Moreover, it would be important for any such system to capitalize on the benefits that qualitative methodologies can offer alongside more traditional quantitative indicators.

Health promotion policies in the Republic of Korea and Japan: a comparative study.

Health promotion strategies have been developed and implemented in some Asian countries, particularly in the Republic of Korea (Korea) and Japan. It would help to understand features of health promotion in each country to compare health promotion strategies between them. In this study, using categories developed by HP-Source.net, we conducted a comparative analysis of health promotion strategies between Korea and Japan to understand features of health promotion in each country and contribute to the improvement of population health. One of the goals of Health Plan 2010 is to assess its achievements with numerical targets, which is also the case in Japan. One of the important discussion points involves a decision on the optimal number of targets for evaluation. There is a major difference in the funding of health promotion activities between Korea and Japan. They are financed through the general account in Japan, while in Korea a foundation for health promotion has been established and the income from tobacco tax is ring-fenced for this fund. The database and methodology of HP-Source needs adaptation for global use. We encountered some disadvantages in using its current framework for comparing and analysing information on health promotion in Korea and Japan. It has been recognised that HP-Source could influence the development and implementation of health promotion strategies in other parts of the world. Health promotion tools can help decision makers, planners and researchers to formulate and enhance comprehensive plans. In this study we learned many lessons in expanding policy tools outside of one region to aid the global development of effective health promotion policy and practice.

The EUHPID Health Development Model for the classification of public health indicators.

The European Community Health Promotion Indicator Development Model has been developed as the basis for establishing a European set of indicators for monitoring health promotion interventions. This paper offers the model more generally as a common frame of reference for broader public health practice and indicator development. The model builds around the physical, mental and social health of individuals and shows how health develops by interaction between individual and environmental health determinants. It demonstrates that health development can be analysed from a salutogenic and a pathogenic perspective and explains how the differing starting points of different intervention approaches such as health promotion and health care are related to these two perspectives. Finally, a classification system for pathogenic and salutogenic public health outcome indicators is derived from the model and has been applied to the current core list of the European Community Health Indicator system. The model and its application highlight the need for systematic salutogenic indicator development in the field of public health and for strengthening the health promotion perspective in the future.

Advancing a theoretical model for public health and health promotion indicator development: proposal from the EUHPID consortium.

This paper discusses the work of the EUHPID Project to develop a European Health Promotion Monitoring System based on a common set of health promotion indicators. The Project has established three working groups to progress this task--health promotion policy and practice-driven, data-driven and theory-driven. The work of the latter group is reviewed in particular. EUHPID has taken a systems theory approach in order to develop a model as a common frame of reference and a rational basis for the selection, organization and interpretation of health promotion indicators. After reviewing the strengths and weaknesses of those health promotion models currently proposed for indicator development, the paper proposes a general systems model of health development, and specific analytical, socio-ecological models related to public health and health promotion. These are described and discussed in detail. Taking the Ottawa Charter as the preferred framework for health promotion, the socio-ecological model for health promotion adopts its five action areas to form five types of systems. The structure and processes for each of these five systems are proposed to form the basis of a classification system for health promotion indicators. The paper goes on to illustrate such a system with reference to indicators in the workplace setting. The EUHPID Consortium suggest that their socio-ecological model could become a common reference point for the public health field generally, and offer an invitation to interested readers to contribute to this development.