Health promotion and mental health

This chapter examines health promotion campaigns and policies designed to raise the profile of mental health, and more specifically to help those suffering from mental illness. It begins with an overview of mental illnesses such as schizophrenia, depression, anxiety, obsessive compulsive disorder, post-traumatic stress disorder, eating disorders, and personality disorders. It then considers the NHS policy on mental health; the mental health promotion strategies in the UK, including the Scottish Health Survey of 2016, the All Wales Mental Health Promotion Network, and the Mental Health Foundation report in Northern Ireland; the implications of the coexistence of physical and mental illness for policy makers and practitioners; and mental health charities such as Anxiety UK, Centre for Mental Health, Rethink Mental Illness, SANE and Time to Change. The chapter also discusses various mental health promotion strategies throughout the UK, locations for mental health promotion, and economic evaluations of mental health promotion.

Health economics and health promotion

This chapter examines the techniques used by health economists to evaluate the value for money of health promotion initiatives. It first provides an overview of concepts related to economics and health economics, including efficiency, equality, equity and accessibility. Efficiency can be evaluated in terms of cost-minimisation, cost-effectiveness, cost-benefit and cost-utility. The chapter then considers the various rationing strategies by which the NHS can try to reduce expenditure, the use of QALYs to compare the cost-effectiveness of health promotion projects, and conjoint analysis. It also explains how health economists calculate the cost to society of unhealthy lifestyles such as obesity and smoking, and goes on to tackle the question of prevention vs cure in health promotion, the expenditure on the NHS, and the limitations of health economics in evaluation of health promotion endeavours. The chapter concludes with an assessment of how to estimate the costs of health promotion.

Strategies for health promotion

This chapter focuses on various strategies for health promotion in the UK. It begins with a discussion of two opposing routes to better health, known as health promotion doctrines: Approach A is a health education approach that seeks to influence individual lifestyle, while Approach B argues that health inequalities can be reduced and public health can be improved only through social change and political action. The chapter then considers the different causes of ill health, with particular emphasis on the link between health and poverty. It also examines poverty in the UK, taking into account various definitions of poverty in the twentieth and twenty-first centuries, and health surveys that provide an annual update on current health behaviours and conditions in England, Scotland, Wales and Northern Ireland. Finally, it reviews health promotion strategies pursued in the four countries, such as tackling obesity, increasing physical activity and improving diet.

Main themes

This book examines the evidence on the effectiveness and cost-effectiveness of health promotion policies and projects, with particular emphasis on the UK. As an introduction, this chapter clarifies the key concepts in the health promotion literature such as ‘new public health’, civil society, poverty and empowerment. It first considers the potentially disputed assumption that ‘health’ is an unequivocal concept before discussing the social determinants of health, the emergence of a ‘new public health’ in the UK that consists of health promotion as a model of health policy, and the role of civil society in health promotion. It also explains what poverty is, the impact of public health and health promotion interventions, the purpose of health promotion, and motives for improving people's health (such as empowerment, charity, economics). Finally, it reflects on the future for health promotion.

The future for health promotion

This chapter reflects on the future for health promotion in the UK, first by highlighting the health promotion initiatives of civil society organisations and then discussing the issue of homelessness. More specifically, it considers the health promotion needs of homeless people and the challenges involved in addressing the problem. It also examines public health issues of the past that have either re-emerged in the twenty-first century or have never actually disappeared, such as widespread diseases and two of the more persistent causes of ill health: air pollution and river pollution. The chapter goes on to take a look at agencies and government departments that provide health protection services, including the Environment Agency in England and Natural Resources Wales. Finally, it reviews the claim that empowerment should be a central aim of health promotion, the controversy surrounding health promotion evaluation methodologies, and whether health promotion was effective and cost-effective.

Evidence base and methods for evaluation

This chapter focuses on the importance of the evidence base in evaluation methodologies for health promotion policies. It first considers the use of performance indicators for measuring the effectiveness of health promotion strategies, along with their limitations, before discussing two other methods designed to generate hard data on the effectiveness and cost-effectiveness of health promotion policies and projects: randomised controlled trials (RCTs) and interviews. It then explains what is meant by project, programme and policy in the context of Public Health England's policy to tackle child obesity and goes on to examine two extended health promotion projects in Wales: the National Exercise Referral Scheme (NERS) and the Caerphilly Cohort Study. The chapter concludes by looking at qualitative evaluation methods as alternatives to RCTs, including focus groups, and ‘empowerment’ as a key aim of health promotion.

The origins of health promotion

This chapter examines the origins of health promotion in the UK. It begins with a discussion of diseases in Britain before and during the nineteenth century that made public health a major concern of governments, followed by an analysis of the role of William Farr in establishing a system that recorded the cause of death, along with three important pieces of legislation: Poor Law Amendment Act 1834, Public Health Act 1848, and Public Health Act 1875. The chapter then considers disease monitoring and surveillance before describing Charles Booth's work on poverty in the late nineteenth century, Benjamin Seebohm Rowntree's poverty surveys, and the consequences of the Boer Wars for public health. Finally, it explores key legislation in the twentieth century prior to the establishment of the NHS, the emergence of a new public health, and the impact of health promotion on the social determinants of health.

International perspectives

This chapter considers international perspectives in the area of health promotion. It begins with an overview of health promotion as a global enterprise, citing major developments such as the founding of the World Health Organization (WHO), the Alma Ata Declaration, and the introduction of the notion of the social determinants of health by Thomas McKeown. It then examines the Ottawa Charter for Health Promotion (1986) and the five health promotion areas that it identified for achieving better health: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services. The chapter goes on to discuss other international health promotion initiatives, including the Bangkok Charter for Health Promotion in a Globalized World (2005) and the Helsinki Global Conference on Health Promotion (2013). Finally, it analyses the role of the WHO in health promotion, along with the issues of health inequalities and health inequities.