Health Promotion Settings: Principles and Practice


Edited by: Angela Scriven & Margaret Hodgins

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    We wish to dedicate this book to all those health promoters globally who have worked and/or are working to promote health in settings.

    List of Figures and Tables

    • Figure 1.1 Connections between different health promotion settings 4
    • Figure 2.1 Putting health into settings 19
    • Figure 2.2 A model for conceptualizing and operationalizing the health promoting settings approach 25
    • Figure 6.1 Map of health determinants 94
    • Figure 6.2 How local government can make a difference to community health 98
    • Figure 6.3 Theory of maturing partnerships for health improvement 104
    • Figure 10.1 Settings as systems – the example of a university 158
    • Figure 10.2 Healthy universities: a model for conceptualizing and applying the healthy settings approach to higher education 160
    • Figure 10.3 Healthy universities: an operational process 162
    • Figure 11.1 The Ottawa Charter as a framework for action within the health promoting prison 173
    • Figure 12.1 Healthy workplace model 198
    • Figure 13.1 The integrated health management system at Volkswagen 211
    • Figure 13.2 Modules in the health management system 213
    • Figure 13.3 Volkswagen check-up facility 215
    • Table 2.1 Five types of settings-based health promotion Terms used in partnership working within and 22
    • Table 4.1 across settings 54
    • Table 4.2 Examples of the benefits of working in partnerships across a setting 57
    • Table 4.3 Process and outcome measures and indicators to use for measuring the success of health promotion partnerships 64
    • Table 5.1 Stages of the planning process 70
    • Table 5.2 An analytical framework for settings 72
    • Table 5.3 Examples of healthy eating criteria for Healthy Schools 79
    • Table 7.1 Summary of actions on health equity taken in Healthy Cities projects 118

    About the Editors

    Angela Scriven is Reader in Health Promotion at Brunel University in London, UK. She has been teaching and researching in the field of health promotion for over 25 years and has published widely, including authoring, editing or co-editing the following books: Health Promotion Alliances: Theory and Practice (1998), Health Promotion: Professional Perspectives (1996; 2001 2nd edn), Promoting Health: Global Perspectives (2005), Health Promoting Practice: The Contribution of Nurses and Allied Health Professionals (2005), Public Health: Social Context and Action (2007), Promoting Health: A Practical Guide (2010), Health Promotion for Health Practitioners (2010). Her research is centred on the relationship between health promotion policy and practice within specific contexts. She is a member of the International Union of Health Promotion and Education (IUHPE), is President Elect for the Institute of Health Promotion and Education (IHPE) and is a Fellow of the Royal Society for Public Health (RSPH).

    Margaret Hodgins is a lecturer in Health Promotion at the National University of Ireland (NUI), Galway. She is the Programme Director for the MA in Health Promotion and the Postgraduate Diploma in Health Promotion. The programme is recognized by the Institute of Health Promotion and Education. She has extensive teaching experience and is an active researcher within the Health Promotion Research Centre at NUI Galway, a WHO collaborating centre for Health Promotion research. Her research interests include workplace health promotion and healthy ageing, and she has been principal investigator on 13 projects, leading to 21 peer-reviewed papers. She is a member of the International Union of Health Promotion and Education (IUHPE), a registered psychologist with the Psychological Society of Ireland, and is currently Chairperson of the Association for Health Promotion, Ireland.

    About the Contributors

    Susan Biddle is joint Head of Programme for Healthy Communities at Local Government Improvement and Development (LGID), UK. She leads the programme on behalf of LGID, providing strategic vision and direction and managing the interface with key public health stakeholders. Susan has worked with LGID for over 11 years, joining the newly formed IDeA in 1999 as Head of Workforce Development. Her work at LGID has included providing the professional lead on workforce development and designing a local government e-learning service. Susan's professional background is in organizational development and her expertise is in large programme design and delivery, and change management. She has an MA in Management Learning, a Diploma in Executive Coaching and a first degree in Art History. Susan has worked in local government for more than 25 years, in a variety of roles, is a parent and active in her local community as a parent governor and PTA chair.

    Steven Boorman is Director of Health and Safety to Royal Mail Group, an experienced consultant occupational health physician with 20 years’ experience working in one of the UK's largest employers. He also led the 2009 review of health and wellbeing of the NHS workforce, commissioned by the Secretary of State for Health. His career has involved developing practical and cost-effective workplace-based programmes to maintain and improve employee health. He holds appointments as Chief Examiner to the Faculty of Occupational Medicine's Diploma examination, Honorary Senior Clinical Lecturer, University of Birmingham, and is a past president of the Royal Society of Medicine's Occupational Medicine section.

    Uwe Brandenburg is Head of Work Science/Strategies and Projects at Volkswagen AG, Central Health Division, Wolfsburg, Germany, and also Honorary Professor at the Technical University, Braunschweig. He has a degree in Business Studies and in Social Sciences. He has written more than 70 publications in the field of health prevention and health promotion on health management, workplace design, work organization, absenteeism, demographic change. His current research is centred on the relationship between leadership and health. He is President of the German Network Enterprise for Health and advises several private and public institutions.

    Jennie Cawood is Coordinator of the UK Healthy Cities Network and the English Healthy Universities Network based in the Healthy Settings Development Unit at the University of Central Lancashire. Previously, Jennie has worked in public health at a regional level, as Director of the Yorkshire and Humber Teaching Public Health Network and in various roles with the Yorkshire and Humber Regional Public Health Group. She has extensive experience of leading and developing public health networks and managing public health programmes.

    Sharon Doherty is based in the Healthy Settings Development Unit, at the University of Central Lancashire in Preston. Her post combines the coordination of the University of Central Lancashire's Healthy University initiative with a wider development role, supporting the unit's generic work across settings and contributing to research, lecturing, evaluation, training and consultancy. She has experience of working in public health/health promotion for over 20 years. Previous posts include, Sexual Health Lead, Healthy School Coordinator and Health Promotion Specialist for Young People and Sexual Health. Her public health work has focused on sexual health, drugs issues, young people within the education setting. Sharon has previously worked as a further education lecturer in Communication and Media Studies and as an Arts Administrator/Project Manager with a community-based theatre company specializing in health work.

    Mark Dooris is Director of the Healthy Settings Development Unit and Reader in Health and Sustainable Development at the University of Central Lancashire. Mark is engaged in research, evaluation, teaching, training and programme delivery and is currently project manager for the UK Healthy Cities Network and the English Network of Healthy Universities. Mark studied at Oxford University and Southbank Polytechnic, has completed the National Public Health Leadership Programme, undertook his Doctorate at Deakin University and is a Fellow of the Royal Society for Public Health and Visiting Professor in Wellbeing at London South Bank University. He has a background in health promotion, public health, community development and environmental policy and has worked in a range of local government, health service and voluntary sector roles, as well as being a consultant to WHO. Mark was co-chair of the UK Health for All Network from 1992 to 1994 and currently chairs the International Union of Health Promotion and Education's Global Working Group on Healthy Settings.

    Katrin Engelhardt was a Technical Officer in the Health Promotion Unit, WHO Regional Office for the Western Pacific Region (WPRO), working on issues related to urbanization and health. Between 2003 and 2006 she was Adviser to the Seoul Metropolitan Government, Republic of Korea, working to help strengthen health promotion and establish a Healthy City programme within the city government and its districts; and as visiting research fellow at the Korean Institute for Health and Social Affairs (KIHASA). Prior to her employment in Korea she was project coordinator for a Healthy City Pilot Project in Vienna, Austria. Katrin also worked as study coordinator at the University of Munich where she coordinated the establishment of Masters Programmes in Public Health and Epidemiology at the School of Public Health. She lectures on health promotion, community nutrition, evaluation and global public health as a parttime lecturer at various universities, including the Seoul National University and the University of Munich.

    Sally Fawkes is currently Senior Lecturer in Health Promotion and Leadership at La Trobe University in Melbourne, Australia, and has worked as a practitioner, manager, educator and researcher in health promotion. In relation to healthy cities/urban health, she has worked at WHO (EURO) Healthy Cities Unit and for WHO (Western Pacific) on strengthening a regional healthy cities network across Asia and the Pacific. Recent research has focused on leadership for health, building foresight capacity in public health and healthcare, and reform of health services and systems. She is co-author (with Lin and Smith) of Public Health Practice in Australia: The Organized Effort (2007). Sally is an elected member of the Governance Board of the International Network of Health Promoting Hospitals and Health Services, Convenor of the Regional Coordinating Institution (Victoria-Australia) for the International HPH Network and Council Member of Women's Health Victoria. She is a member of the International Union of Health Promotion and Education (IUHPE) and an Associate Fellow of the Australian College of Health Service Executives.

    Paul Fleming is Pro Vice-Chancellor (Science) at the University of Canterbury in New Zealand where he is also a professor in health promotion and population health. He has been involved in health promotion for over 30 years, mainly in the UK, as a health promotion specialist, lecturer and researcher. He established the Masters programme in health promotion at the University of Ulster and has particular research interests in workplace health, cancer education and men's health. In health promotion practice he has developed theory related to reflection in health promotion. His publications include a co-authored book Impacting Health at Work, several book chapters and a number of research papers and reports. He is a Fellow of the Royal Society for Public Health, a Member of the Institute of Health Promotion and Education, a Fellow of the Higher Education Academy and a member of the International Union of Health Promotion and Education.

    Colin Fudge is Pro Vice-Chancellor and Vice-President of RMIT, Australia. He has worked in the University of Bristol (UK), the University of Cardiff (UK), Chalmers University and Royal Institute of Technology, Stockholm, and, in government, in the UK, European Commission, Sweden and Australia. Among his previous appointments are: Chair, European Union Expert Group on the Urban Environment; Founding Director of the WHO Collaborative Research Centre for Healthy Cities and Urban Policy; Chair, European Sustainable Cities and Towns Campaign; Chair, OECD International Urban Indicators Panel and member of the Commission for Architecture and the Built Environment (CABE) in England. Professor Fudge has contributed through interdisciplinary and transdisciplinary research on public policy formulation and implementation; cities, sustainable development and adaptation to climate change; public health; demographic change and urban design. This has been recognized through the awarding of the Royal Professorship of Environmental Science by the Swedish Academy of Sciences in 2002 and the award of an Honorary Fellowship of the Royal Institute of British Architects (RIBA). He was awarded an Honorary Doctorate in Bristol in 2009 for his work on public policy. Professor Fudge has written eight books, over 80 articles and reports, numerous book chapters and presented more than 120 conference papers.

    John Griffiths has 24 years’ experience in the development and implementation of health promotion programmes, and has worked for the Welsh Heart Programme (Heartbeat Wales), Health Promotion Wales and the Welsh Assembly Government. He led the development and implementation of the workplace health accreditation scheme, ‘Health at Work: the Corporate Standard’ and more recently the development of the Small Business Health Award. He was the principal author of the trainer's pack on alcohol and substance misuse in the workplace and is currently leading a Leonardo Life Long Learning Programme to equip line managers and supervisors in SMEs to deal with problematic use of alcohol and drugs among their staff. John has been closely involved in the development of the European Network for Workplace Health Promotion and is a technical adviser to the European Enterprise for Health Network. He is the external evaluator of two European mental health promotion programmes and is a Fellow of the Royal Society for Public Health (RSPH).

    Trevor Hancock is a public health physician and population and public health consultant in Victoria, British Columbia, Canada. He has worked in public health and health promotion for more than 30 years, first for the City of Toronto and then as an independent consultant. He presented the ‘Supportive Environments’ theme paper at the Ottawa Charter conference in 1986 and was one of the pioneers of the Healthy Cities and Communities movement from its inception, also in 1986. He was a co-founder of the Canadian Association of Physicians for the Environment and the Canadian Coalition for Green Healthcare, and from 1998 to 2002 was a co-Principal of Planetree Canada (but has had no financial or other interest in Planetree since then). He has many publications to his credit and his honours include Life Membership in the Canadian Public Health Association (1990) and a Regent's Lectureship at UC Berkeley (2000).

    Colin Noble is a senior adviser for behaviour and attendance within the National Strategies school improvement programme in England. He was previously a teacher, local education authority adviser and national coordinator of the National Healthy School Programme from 2004 to 2007. His published books include Getting it Right for Boysand Girls (1999), The PSHECoordinator's Handbook (2002) and How to Raise Boys' Achievement (2001) as well as a large number of articles and chapters in edited books. He is on the Editorial Advisory Committee of the journal Health Education.

    Sue Powell is Head of the Academy for Health and Wellbeing, Manchester Metropolitan University, UK. She is engaged in research, workforce development and training in public health. She is the Chief Operating Officer for the Greater Manchester Health Innovation and Education Cluster and leads research projects in health at work, healthy universities, preventing gambling-related harm in higher education and promoting healthy weight in adults and children. Until March 2010, Sue was the Coordinator of the North West Teaching Public Health Network which focused on public health curriculum development and she regularly delivers workforce development programmes for the health service and voluntary sectors. Sue started her career as an environmental health officer in local government. She maintains her links with environmental health and chairs the Qualifications Board for the Chartered Institute of Environmental Health.

    Martin Seymour is a Principal Consultant with the Local Government Improvement and Development Healthy Communities Programme with lead responsibility for work-streams on the social determinants of health and the role of local government and population mental health and wellbeing. Martin has previously worked with NHS Norfolk and in joint PCT and local authority roles with a broad remit around health inequalities, partnership working and community development. Martin came into public health from a career in local authority leisure and community services. He has recently completed an MSc with distinction in public health and health promotion and has undertaken research into whether local strategic partnerships provide collaborative advantage for health improvement. Martin is a director of East Anglia Food Link, co-chair of the UK Public Health Association (UKPHA) Health and Sustainable Environments Special Interest Group and is a Fellow of the Royal Society for Public Health (RSPH).

    Jane South is a Reader in Health Promotion and Director of the Centre for Health Promotion Research, Leeds Metropolitan University. She has wide experience of research in community-based health promotion and has an interest in methodologies for evaluating health promotion. She is regularly involved in training practitioners around practical evaluation skills and is the author of Evaluation: Key concepts for public health practice. Her research interests are focused on community involvement in health and Jane was the lead investigator on the People in Public Health study, which looked at approaches to involve volunteers and lay health workers in delivering health improvement programmes. Her research has led to innovative tools for practice including evaluation and planning frameworks and a self assessment tool for community involvement.

    Marilyn Toft is the cross-phase programme director for behaviour and attendance within the National Strategies School Improvement Programme in England. Previously a secondary school teacher with management responsibility, Marilyn worked as a research associate for the DES on HIV and Aids education in the mid 1980s, evaluating resources produced for schools. Subsequently, she worked at a senior level in a local authority, leading schools’ professional development programmes, as well as the local Healthy Schools programme. In 1998, Marilyn was appointed to lead the development and implementation of a national scheme for schools that aligned education and health priorities. This resulted in the successful launch of the National Healthy School Programme the following year and the engagement of all local education and health authorities. During her career, Marilyn has contributed to several publications about health education including HIV and Aids, curriculum resources and advice documents for schools on improving behaviour and attendance.

    Rob Whiting began his working life in engineering before embarking on a 20-year career in computing. In the late 1980s he changed direction and went into Facilities Management. It was while working in the printing industry that the opportunity to train in Health and Safety management arose. He took this opportunity and gained his NEBOSH certificate. In 2002 he moved to Williams Medical Supplies as Facilities/H&S Manager and added environmental management to his role. In 2006 he was part of the team that won Health at Work (Gold) and in 2009 he led the team that achieved OHSAS 18001 and ISO 14001.

    James Woodall is a Lecturer in Health Promotion at Leeds Metropolitan University, UK. His PhD explored the health promoting prison and how values central to health promotion are applied to the context of imprisonment. James has published in a number of areas related to prison and offender health, including prisoners’ lay views on health, the mental health of prisoners and young offenders and the role of prison visitors’ centres in reducing health inequalities.


    We would like to thank all the contributors for their enthusiasm and cooperation in supporting this book and all those whose work has helped with the development of ideas in individual chapters. Particular thanks go to Alison Poyner and Emma Milman and the production team at Sage.

    Chapter 10 draws on research funded by the Higher Education Academy and the Department of Health (Dooris and Doherty, 2009, 2010a, 2010b) and on development work funded by the Higher Education Funding Council for England as part of the Developing Leadership and Governance for Healthy Universities Project.


    Since the development of principles and guidelines for health promoting settings in the mid-1980s there has been a great deal of progress and application in the field. Health Promotion Settings: principles and practice provides a twenty-first century perspective on the settings approach and its application to a broad range of contexts. Workplaces, schools, hospitals, universities, prisons, neighbourhoods and cities are discussed and useful real-life examples of work in these settings are provided. Further, the authors look critically and analytically at the settings approach and the social milieu in which it has developed. These considerations result in a work that successfully documents emerging thinking, frameworks and processes that are actively shaping contemporary health promotion.

    Health promotion activity is divisible into three main areas of focus: the regulatory or policy level; the population or community level; and the individual level. At a time when a great deal of attention is being paid to national policy level, changes to address determinants of health and to individual behaviour change to address non-communicable diseases, it is refreshing to read of ways to re-engage communities in settings. In this book, settings are seen as a useful way to engage community members, build partnerships for sustainable health promotion and address determinants. The chapters lead us through the background and principles of healthy settings and then show us how these can be effectively utilized to make a difference. A case is also made for the use of settings as a way of connecting the work that is done on determinants and that which is focused on behaviour change.

    Effective twenty-first century health promotion requires practitioners to be well informed, evidence based, analytical and up to date. The authors and editors have a wealth and breadth of experience in healthy settings that ensure the chapters are both academically rigorous and relevant to practitioners. This book is a welcomed and useful reference for those engaged in health promotion settings as well as those who are learning about them. Just as the settings profiled in this volume are broad-ranging, so too should be the readership. This text will appeal to workers in the health, health promotion and community development sectors but should also resonate with workers in fields as diverse as education, youth work, workplaces and local authorities.

    MichaelSparks President, IUHPE

    Online Further Reading

    The companion website for this book allows you to extend your reading with a range of relevant SAGE journal articles selected by the editors and authors of this book.

    Visit for free access to the following articles:

    Dooris, M. (2009) ‘Holistic and sustainable health improvement: the contribution of the settings-based approach to health promotion’, Perspectives in Public Health, 129 (1): 29–36.
    Dooris, M. (2006) ‘Editorial – Healthy settings: future directions’, Promotion and Education, XIII (1): 4–6.
    Dooris, M. (2009) ‘Holistic and sustainable health improvement: the contribution of the settings-based approach to health promotion’, Perspectives in Public Health, 129: 29–36.
    Naaldenberg, J., Vaandrager, L., Koelen, M., Wagemakers, A., Saan, H and de Hoog, K. (2009) ‘Elaborating on systems thinking in health promotion practice’, Global Health Promotion, 16 (39): 39–47.
    Halliday, G., Asthana, S.N.M. and Richardson, S. (2004) ‘Evaluating partnership: the role of formal assessment tools’, Evaluation, 10 (3): 285–303.
    Poland, B., Krupa, G. and McCall, D. (2009) ‘Settings for health promotion: an analytic framework to guide intervention design and implementation’, Health Promotion Practice, 10: 505–16.
    Douglas, J. (2007) ‘Promoting the public health: continuity and change over two centuries’, in J.Douglas, S.Earle, S.Handsley, C.E.Lloyd and S.Spur, A Reader in Promoting Public Health, Challenge and Controversy. London: Sage.
    Semenza, J. and Krishnasamy, V. (2007) ‘Design of a Health-promoting Neighbourhood Intervention’, Health Promotion Practice, 8: 243–56.
    Kjellstrom, T. and Mercado, S. (2008) ‘Towards action on social determinants for health equity in urban settings’, Environment and Urbanization, 20: 551–75.
    Delobelle, P., Onya, H., Langa, C., Mashamba, J. and Depoorter, A. (2010) ‘Advances in health promotion in Africa: promoting health through hospitals’, Global Health Promotion, 17: 33–6.
    Barnekow Rasmussen, V. (2005) ‘The European Network of Health-promoting Schools – from Iceland to Kyrgyzstan’, Promotion and Education, 12: 169–72.
    Dooris, M. and Doherty, S. (2010) ‘Healthy Universities: current activity and future directions – findings and reflections from a national-level qualitative research study’, Global Health Promotion, 17 (3): 6–16.
    Condon, L., Hek, G. and Harris, F. (2008) ‘Choosing health in prison: prisoners’ views on making healthy choices in English prisons’, Health Education Journal, 67: 155–66.
    Woodall, J. (2007) ‘Barriers to positive mental health in a Young Offenders Institution: a qualitative study’, Health Education Journal, 66, 132–40.
    Moore, A.B., Parahoo, K. and Fleming, P. (2011) ‘Managers’ understanding of workplace health promotion within small and medium-sized enterprises: A phenomenological study’, Health Education Journal, 70: 92–101.
    Hunt, M.K., Lederman, R., Stoddard, A.M., LaMontagne, A.D., McLellan, D., Combe, C., Barbeau, E. and Sorensen, G. (2005) ‘Process evaluation of an integrated health promotion/occupational health model in WellWorks-2’, Health Education and Behaviour, 32: 10–26.
    Lomas, L. and McLuskey, J. (2005) ‘Pumping up the pressure: a qualitative evaluation of a workplace health promotion initiative for male employees’, Health Education Journal, 64: 88–95.
    Hodgins, M., Battel-Kirk, B. and Asgeirsdottir, A. (2010) ‘Building capacity in workplace health promotion: the case of the Healthy Together e-learning project’, Global Health Promotion, 17 (1): 60–8.

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