Cover Image
close this bookFact sheet No 172: Health Promotion - Encouraging healthy systems - Reviewed June 1998 (WHO, 1998, 3 p.)
close this folderHealth Promotion: Encouraging healthy systems
View the document(introduction...)
View the documentCASE STUDY 1 - Using a tobacco tax to finance health promotion
View the documentCASE STUDY 2 - Health-promoting hospitals
View the documentCASE STUDY 3 - A healthy city in Malaysia


The World Health Organization (WHO) advocates the “Settings for Health” approach to promote health. Settings for Health builds on the premise that there is a health development potential in practically every organization and/or community which can be fostered through a series of defined strategies and applied across a range of settings. While Fact Sheet No 171 explains the “Settings for Health” approach in detail, four practical examples of innovative health promotion in different settings are outlined below.

CASE STUDY 1 - Using a tobacco tax to finance health promotion

In the Australian State of Victoria, a portion of the tax imposed on tobacco products is used to promote good health.

The Victorian Health Promotion Foundation (VicHealth) is funded by a dedicated levy of 5% on sales of tobacco products, which now brings in Aus$22million per year. Of these funds, 20% go to research, 20%-30% to sports and arts, 40% to community, health and schools activities, and 10% to administration. Surplus funds are used for consulting, development and evaluation.

The new tax raises the price of cigarettes and thus provides a disincentive for smokers. A percentage of the tobacco tax is then used to fund health promotion throughout Australia in areas much wider than tobacco control - non-communicable disease prevention, mental illness prevention and environmental health promotion.

VicHealth, through its work with government, health agencies and community groups, has been able to lower smoking, drinking and injury rates in the state.

VicHealth has found that using a dedicated levy for health promotion includes the following advantages:

* Funding for the Health Promotion Foundation does not come from the general health budget, and thus does not have to compete with other claims from health services;

* Longer-term investment in health promotion initiatives is possible because there is security of funding;

* All sectoral interests (including the economic and education sectors, housing, transport, sports and arts, local governments and community organizations) are catered for through their representation on Foundation boards and committees;

* Community interest becomes part of the decision-making process.

VicHealth has sponsored sports and cultural events, which the tobacco industry has traditionally found attractive, to promote the benefits of not smoking and of adopting a healthy lifestyle, including healthy food and exercise, safe drinking, avoiding sunburn, cervical smear tests, mental health, safety promotion and safe sex.

CASE STUDY 2 - Health-promoting hospitals

In 1988, the European Region of the World Health Organization (EURO) recommended that the hospital, as the centre of the modern medical and health care system, focus on promoting health. That same year, a pilot project began in Vienna, Austria, at the Rudolfstiftung Hospital.

Through 1996, 12 projects to create better health for patients, hospital staff and the population in the community were carried out. Health of patients was promoted by reducing hospital infections, an education programme was included in the standard treatment of diabetics, the quality of nursing services was enhanced, staff satisfaction increased through organizational and personnel development projects, while the overall organization of the hospital was also improved.

Based on this experience, 19 European hospitals in 11 countries initiated similar pilot projects starting in 1993. By April 1997, 150 sub-projects, planned according to local needs and available resources, had been undertaken. The majority were aimed at improving the health of patients, but almost half included activities aimed at improving the health of staff and of the population in the community, and at helping the hospital as a whole develop into a “healthy organization”.

Most of these sub-projects were carried out within the normal hospital budget, relying to a large extent on voluntary work contributed by staff. Only 13 of these projects have had to be cancelled and most of the others are now part of normal hospital routine.

In a further development, a European Project of National and Regional Networks of Health-Promoting Hospitals (HPH) was initiated in 1995. By 1997 HPH networks had been set up in 15 European countries, as well as Australia and Canada.

An HPH promotes patients’ health through the reduction of risks associated with hospital stays by continuously improving services. An HPH also uses acute episodes of illness or injury to promote health - by providing or organizing rehabilitation, empowering patients to successfully prevent disease and cope with chronic illness, and furthering continuity of care by cooperating with primary health care organizations. An HPH should allocate its resources according to the health gain the services are capable of providing.

An HPH pays attention to the health of its staff. Awareness of the creation of biological, chemical, psychosocial and other risks at hospital workplaces is followed by policies and measures to reduce these risks.

An HPH modifies its services to reduce risks for the community stemming from dangerous waste. It builds alliances for continuous care, early risk detection and population-based prevention and health promotion. An HPH is an agent for the development of health in the community.

In Europe, the HPH network is being coordinated by WHO-EURO and the Ludwig-Boltzmann Institute for the Sociology of Health and Medicine in Vienna, Austria (and is sponsored by the Austrian Federal Ministry of Health).

CASE STUDY 3 - A healthy city in Malaysia

An ever-greater number and percentage of the world’s people are living in cities. They live, work and grow up there and thus urban settings have a crucial role to play in determining health: the prerequisites for a healthy city are considered to be peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity.

Healthy Cities are a centrepiece of WHO’s Settings for Health approach to health promotion. In Malaysia, the Healthy City Kuching project sought to enhance the quality of life in that city by involving all government agencies, private sector and community organizations, whose activities are related to health, in the attainment of better health. Their activities covered the economic, social and physical dimensions of city life.

The project began with a situation analysis of the city’s resources and problems and from this a profile of the city was developed. A Healthy City Kuching Plan was then prepared. Two years later implementation of the Plan was reviewed. Parts of the Plan were modified as needed. The Plan included inputs from various government agencies concerned with the production and promotion of health, the Chief Minister of the State, other government officials, as well as from the public who were surveyed on what they liked most and least about the city and on what they most wanted to change.

Apart form the Healthy City Plan, the project also led to the establishment of a steering committee headed by the State Planning Unit, with technical committees and a secretariat. There are regular meetings and dialogue between the agencies involved and public awareness has been raised through the holding of Healthy City-Kuching week every year.

No additional budget costs were incurred as a result of the project; support came from the existing budgets of the agencies involved.

The healthy cities project has the support of the top politicians in the region and because of the success of the project in Kuching, the Malaysian Government has decided to extend the project to cover the whole of the country and has set up a Healthy Urban Malaysia Programme.

Moreover, 30 agencies now discuss together how to enhance the quality of life in the city: they now understand that they all have roles to play; the health of the city is not the responsibility of the Health Department and the local authorities alone.