Research since the 1970s has demonstrated the paramount role of social, economic and environmental factors in the maintenance of health and well-being (Evans et al. 1994; Evans and Stoddart 1990). The most significant determinants of health are social and economic factors, not those most strongly linked with healthcare services or personal choices and behaviours. For instance, individuals, families and communities with low incomes are more likely to have physical, social and mental health problems than those with higher incomes. They are also more likely to die earlier than other members of the population, regardless of which cause of death is considered (Smith et al. 1996; Wilkinson 1996; World Health Organization 1998).
The gradient nature of health status suggests that it is embedded in collective factors in society, not just in individual factors (Wilkinson 1996). Recognizing the fact that health is significantly affected by policy decisions in non-healthcare areas (including housing, transportation and food distribution), the World Health Organization (WHO) called for inter-sectoral collaboration efforts to improve the conditions required for an optimal level of health and well-being. The result was the Ottawa Charter for Health Promotion (World Health Organization 1986), a document that has radically re-shaped health education and health promotion in many countries around the world. The Charter emphasizes societal change rather than individual responsibility, and supports an active role for the public in setting priorities, making decisions, planning strategies and implementing them to achieve better community health (Terris 1992). It also extends the concept of health to mean a "resource for everyday life" embodying social, environmental and personal assets and physical capacities (World Health Organization 1986). Using this broad definition, enhancing health goes far beyond how much or what type of service is provided as part of traditional healthcare services.
Research since the 1970s has demonstrated the paramount role of social, economic and environmental factors in the maintenance of health and well-being (Evans et al. 1994; Evans and Stoddart 1990). The most significant determinants of health are social and economic factors, not those most strongly linked with healthcare services or personal choices and behaviours. For instance, individuals, families and communities with low incomes are more likely to have physical, social and mental health problems than those with higher incomes. They are also more likely to die earlier than other members of the population, regardless of which cause of death is considered (Smith et al. 1996; Wilkinson 1996; World Health Organization 1998).
The gradient nature of health status suggests that it is embedded in collective factors in society, not just in individual factors (Wilkinson 1996). Recognizing the fact that health is significantly affected by policy decisions in non-healthcare areas (including housing, transportation and food distribution), the World Health Organization (WHO) called for inter-sectoral collaboration efforts to improve the conditions required for an optimal level of health and well-being. The result was the Ottawa Charter for Health Promotion (World Health Organization 1986), a document that has radically re-shaped health education and health promotion in many countries around the world. The Charter emphasizes societal change rather than individual responsibility, and supports an active role for the public in setting priorities, making decisions, planning strategies and implementing them to achieve better community health (Terris 1992). It also extends the concept of health to mean a "resource for everyday life" embodying social, environmental and personal assets and physical capacities (World Health Organization 1986). Using this broad definition, enhancing health goes far beyond how much or what type of service is provided as part of traditional healthcare services.
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