BMC Public Health 2004, 4 http://www.biomedcentral.com/1471-2458/4/11 There is also evidence that large HP programmes are effec- tive in reducing morbidity, mortality and improving qual- ity of life. In Canada, HP programmes began in the 1970s. There has been an increase in life expectancy at birth and reduction of infant mortality rates in Canada between the 1970s and 1990s. Nearly 10 million Canadians have reported improvement in their personal health practices such as reduced alcohol consumption, improved eating habits, increased physical activity and 67% of them attrib- uted this to increased awareness of health risks. The valid- ity of this self-reported behaviour is further supported by the fact that there has been a corresponding decline in car- diovascular mortality attributed to these healthier lifestyle and improved medical care [2]. Potential Successful implementation of the proposed programme may lead to the empowerment of individuals and com- munities. The potential public health benefits of the pro- posed programme are mentioned below. HP through SC and CP A participatory way of generating and disseminating SC information is likely to empower lay persons and result in healthy behaviour, which may lead to their HP. Conven- tional health education is often didactic. A vast majority of the people from the developing world still do not have access to the basic information for HP. The proposed pro- gramme may address these two drawbacks as communi- ties and professionals design SC information jointly and this information is put at the disposal of each individual from a very young age. Reduction of health care cost Cost of health care is constantly on the rise. Successful implementation of this programme has the potential to reduce cost of health care in a variety of ways as shown in different studies already mentioned. Facilitation of health planning, management and research If SCMHR were used as a tool in the programme, in com- bination with traditional sources, it may improve the health information system, which may facilitate health planning and management. Those epidemiological stud- ies which depend on health records like case control stud- ies and retrospective cohort studies may be greatly facilitated in the long run. Pitfall Confidentiality about the health and disease related information of an individual If SCMHR were used as a tool for recording important events of one's life, confidentiality of this information would have to be protected. This can be addressed at the time of designing the SCMHR, by deciding what informa- tion to include in the manual, to whom all these informa- tion be made accessible. Summary HP, SC and CP are emerging and dominant themes in health mostly in developed countries. There is a great win- dow of opportunity for initiating a HP programme fol- lowing principles of SC and CP in the developing countries. Elements of such a HP programme and broad outline for implementation are discussed. Demonstration programmes need to be initiated at the district level to assess appropriateness, feasibility, effectiveness of such a programme before any attempt of large-scale implementation. Abbreviations (CHW) community health worker (CIH) community involvement in health development (CP) community participation (CG) core group (EC) executive committee (HP) health promotion (NGOs) non-governmental organizations (PHC) primary health care (SC) self-care (SCMHR) self-care manual and health record (UK) United Kingdom (US) United States of America (WHO) World Health Organization Competing interests None declared. Acknowledgement The author is deeply indebted to Prof. SB Rifkin, who reviewed the paper and inspired me with many suggestions, based on which much of the paper was rewritten. I am grateful to the reviewers, whose critical comments have greatly improved the paper. I am also grateful to my friends and col- leagues, who reviewed the draft and gave many useful suggestions. References 1. Lalonde M: A new perspective on the health of Canadians. Ottawa: Health and Welfare Canada 1974. 2. Hancock T, Labonte R: Lessons from Canada. In: The Evidence of Health Promotion Effectiveness: Shaping public health in a New Europe, Page 10 of 12 (page number not for citation purposes)