The “lifestyle drift” of health promotion

caroline CostongsPublic Health organisations and health authorities are key in delivering health and wellbeing for people, which is reflected in several articles of this 11th edition of the EuroHealthNet magazine. National and regional public health authorities play a crucial role in tackling unhealthy diets, lack of physical activity, smoking, alcohol misuse, and stress, factors that determine most of the disease burden.

The curative potential of lifestyle interventions is also increasingly considered by the health care sector due to the reversibility of diabetes type 2, which is encouraging. Such services like stress management and exercise prescriptions should be covered by health insurance packages. Lifestyle interventions are cheaper and more effective than others in addressing illnesses like diabetes, asthma, or anxiety.

In order to support these preventative approaches, the European Commission’s Direcorate General SANTE has set up a ‘Steering Group on Promotion and Prevention’ consisting of representatives of Member State health ministries. Its purpose is “to facilitate the implementation of evidence-based best practices by EU countries, to ensure that the most up-to-date findings and knowledge are being put into practice”. Consequently, this group is getting an increasingly important role in EU funding allocations. Digital health, and in particular m-health, are also considered promising approaches to change lifestyles and achieve healthy ageing.

On the one hand we should applaud these efforts as it demonstrates an increased recognition of the potential of health promotion and disease prevention. “Promotion and prevention” is considered more important than ever and has led to the rise in new concepts, and new actors in the field. On the other hand, we should be careful with this “lifestyle drift”1 of health promotion, without real appreciation of the underlying causes of ill health and disease, the social determinants.

There is an abundance of evidence that show that sedentary and unhealthy lifestyles of people are heavily influenced by their social, economic, and environmental circumstances and cultural contexts. Unfortunately, these factors seem to get less attention nowadays and are not adequately taken on board. Why is that?

Firstly, these underlying factors do not easily translate into “evidence based interventions” and require multi-facetted, cross-sectoral, and systemic policy change. The above-mentioned EC Steering Group therefore prefers to take a more pragmatic approach, but in their efforts clearly risks investing in ‘downstream’, low-scale practices, with no real impacts or health equity outcomes.

A second reason is the lack of interest from the private sector or economic operators to develop such comprehensive approaches. There are no patents possible in interventions that address poverty or unemployment. No profits can be made from tackling stigma, discrimination, or inequalities in education. Solutions are not ‘marketable’, accept for digital approaches, hence its success in current health policy debates.

Championing comprehensive health promotion and disease prevention, in line with the EuroHealthNet REJUVENATE! Framework, has become more complex. We need to be active on many stages and in many fields at the same time. This is also reflected in the variety of subjects in this edition of the magazine. It showcases how EuroHealthNet member agencies are structuring health promotion services and supporting knowledge exchange and comprehensive good practices in their countries and beyond. For example, BZgA has been working on an improved and comprehensive approach to sexuality education in Europe as part of their WHO Collaborating Centre on the subject. Public Health Wales also hosts a WHO Collaborating Centre,  the first of its kind in the world, on investing in health and wellbeing as a driver and enabler of social, economic, and environmental sustainability and prosperity for all. The City of Riga is leading the way in using European Social Funds to invest in health promotion with a focus on vulnerable communities.

Organisations from the UK, Belgium, the Netherlands, and France are working together in the design and testing of innovative lifestyle interventions as part of health and care systems and to supporting people with type 2 diabetes. We should keep an eye on the outcomes of this work, considering the discussion above. Regions in Italy are being supported by a new organisation, ProMIS, which is helping them collaborate, share best practices, and access European funding. Municipalities in Norway are receiving support from the Directorate of Health and information about which measures are most effective in mental health and drug prevention. From Finland we learn about the significance of art and culture in promoting health and well-being. From Sweden, Västra Götaland region, we explore links between health and education in efforts to reduce school failures.

No single intervention or practice will make the difference, it’s the comprehensive, multifaceted and systemic approach that will lead to improved health for all.

Last, but not least, I would like to conclude with expressing my congratulations on the 100th anniversary of the National Institute of Public Health – National Institute of Hygiene in Poland. We interviewed the current and former directors of the institute on the progress made and to the challenges ahead.

I hope you enjoy the magazine and welcome comments and feedback which will help us transforming this magazine into a new format for the future.

Injustice is killing people on a large scale—but what is to be done about it? Jennie Popay, Margaret Whitehead, David J. Hunter Journal of Public Health, Volume 32, Issue 2, 1 June 2010, Pages 148–149

Caroline Costongs
Director at EuroHealthNet | + posts

Caroline Costongs is Director of EuroHealthNet.

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