SUNDSVALL - 1991

The Sundsvall Conference in 1991 highlighted the essential link between health and the physical environment. Environments are not just the visible structures and services surrounding us but have spiritual, social, cultural, economic, political and ideological dimensions as well. Building on the fact that health promotion addresses broad determinants of health - to create better health, the Conference focused on the six areas of education, food and nutrition, home and neighbourhood, work, transport, and social support and care. Delegates recognized that everyone has a role in making the world more supportive of health. They grouped strategies for environmental change in support of health into seven headings:

* policy development;
* regulation;
* reorientation of organizations;
* advocacy;
* building alliances/creating awareness;
* enabling;
* mobilizing/empowering.

For example, if a community’s drinking water is polluted, the necessary action of cleaning up the water or getting people to stop drinking it could be tackled from several directions, using different strategies. One could develop a “clean water” policy (policy development), take legal action (regulation), transform a wildlife protection society to include human health issues (reorienting organizations), call for change via the authorities, politicians or the media (advocacy), persuade appropriate ministries to cooperate (building alliances), help supply safe drinking water (enabling), or organize residents to fence off the area, educate the people, or facilitate these and other possible measures (mobilizing/empowering).

Sundsvall introduced three models for analysing, describing, understanding and addressing environmental problems and how to influence them to improve health. The first of these was the Health Promotion Strategy Analysis Model (HELPSAM), the second the “Sundsvall Pyramid of Supportive Environments”, and the third was the “Supportive Environments Action” model (SESAME), which illustrates a logical sequence of actions that takes place in many areas of human activity.