A health promotion approach to addressing health equity

I’d like to thank the organizers of the first Asia-Pacific Conference on health promotion and education for the excellent organization and delivery of this most important IUHPE conference. Japan has set a high standard and we all should work hard to see that the tradition continues in another part of our region for the second Asia-Pacific Conference. I also am grateful to be invited to speak on health equity. It is pleasing to note that this subject has both begun and ended the formal morning keynotes of this conference like a pair of bookends. The title of my address is ‘A Health Promotion Approach to Addressing Health Equity’ and I’d like to begin with some clarity about what I mean by the terms health promotion and health equity. Even though this is a health promotion conference, I am aware that there are many different understandings of what we mean when we say health promotion. To me, health promotion is a social process informed bymedical, social and political sciences that is used to improve life. Notice that I didn’t just say improve health – I said improve life. The reason I say this, is that I believe that health and well-being are so intrinsically linked to all other aspects of our life that it is not logical or practical to separate health-related aspects from all the other aspects of life when discussing health promotion. Health promotion, as I define it, is holistic in nature. It is not a narrow set of activities but a way of thinking and a way of working toward change that is inclusive and adaptable. Health promotion is a broad social process that is applicable to any life endeavour where improvement is the objective. Health promotion often utilizes a specific entry point such as a disease, a risk factor or even something as broad as community development, but we need not let the entry point restrict our thinking about what health promotion can be. Health promotion may begin with a focus on a specific aspect related to improving health or wellbeing but it also needs to work on the underlying inhibitors to living a healthy and happy life. Health promotion should take a holistic view, no matter what the focus is. If we are working with individuals – we must look at the context of their whole life – not just what we want to change – but all the factors in the life of that individual that might be related to what we want to change. Likewise with communities or with populations, we must look holistically at the determinants of their health to ensure that we are getting to what Marmot calls the causes of the causes. If, for example, we are working on diabetes in a population, it is not sufficient to only treat the disease – or even just to identify risk factors in the community and to try to change behaviours. We must also look at the associated conditions in that population that lead to diabetes. We must look at the social conditions that lead to the behavioural risks such as the availability of healthy foods, social attitudes toward healthy weight, the existence of infrastructure for physical activity, the social meaning of tobacco and alcohol use, and even the social capacity to comply with drug regimes or behaviour change. We may not be able to alter all of the social conditions associated with diabetes in a community, but understanding what those conditions are and how they impact on the lives of those we are trying to change should be critical to the actions we take. And can I just quickly say this – it is not reasonable to expect any one person in any one job to address ALL of the social determinants of health of a population or even of an individual. We must strive to better understand the