Transnational factors also have a significant impact on health. These include the integration of the global economy, financial markets and trade, access to media and communication technology, as well as environmental degradation due to the irresponsible use of resources. These changes shape values, lifestyles throughout the lifespan, and living conditions across the world. Some have great potential for health, such as the development of communications technology, others such as international trade in tobacco, have a major negative impact. Health promotion strategies can develop and change lifestyles, and the social, economic and environmental conditions which determine health.
Health promotion is a practical approach to achieving greater equity in health.
Those which use combinations of the five strategies are more effective than single track approaches settings offer practical opportunities for the implementation of comprehensive strategies. These include mega-cities, islands, cities, municipalities, and local communities, their markets, schools, workplace, and health care facilities participation is essential to sustain efforts. People have to be at the centre of health promotion action and decision-making processes for it to be effective health learning fosters participation. Access to education and information is essential to achieving effective participation and the empowerment of people and communities. These strategies are core elements of health promotion and are relevant for all countries.