Settings-based Approaches to Health Promotion

The World Health Organization defines settings-based approaches to health promotion as those that  “involve a holistic and multi-disciplinary method which integrates action across risk factors. The goal is to maximize disease prevention via a "whole system" approach. The settings approach has roots in the WHO Health for All strategy and, more specifically, the Ottawa Charter for Health Promotion. Healthy Settings key principles include community participation, partnership, empowerment and equity. The Healthy Settings movement came out of the WHO strategy of Health for All in 1980. The approach was more clearly laid out in the 1986 Ottawa Charter for Health Promotion. These documents were important steps towards establishing the holistic and multifaceted approach embodied by Healthy Settings programmes, as well as towards the integration of health promotion and sustainable development. Building on the Ottawa Charter, the Sundsvall Statement of 1992 called for the creation of supportive environments with a focus on settings for health. In 1997, the Jakarta Declaration emphasized the value of settings for implementing comprehensive strategies and providing an infrastructure for health promotion. Today, various settings are used to facilitate the improvement of public health throughout the world.


According to the WHO Health Promotion Glossary, a Setting for Health is a place or social context in which people engage in daily activities in which environmental, organizational, and personal factors interact to affect their health and wellbeing. These settings are often called places where people live, learn, work or play. Settings can normally be identified as having physical boundaries, a range of people with defined roles, and an organizational structure. Examples of settings include schools, work sites, hospitals, villages and cities as well as “hybrid settings (community gardens) or virtual settings (socially oriented web sites or services) . Action to promote health through different settings can take many forms but should include a focus on multiple, coordinated intervention ns that modify the physical, social, economic, instructional, recreational or other aspects of that setting . 


Actions in settings-based health promotion often involve some level of organizational development, including changes to the physical or social environment or to the organizational structure, administration and management. Settings can also be used to promote health as they are vehicles to reach individuals, to gain access to services, and to synergistically bring together the interactions throughout the wider community. Dooris (2006) has pointed out that basic difference in goals (invidudual or setting) this has caused confusion between the concepts of doing health promoting programs aimed at modifying individual behaviours within a setting as opposed to multiple interventions aimed at modifying the conditions of the setting or even the factors or conditions underlying the setting. Poland et al (2009) have addressed this by providing a framework for planning and delivering multiple interventions in settings that are aimed at the whole setting or underlying conditions.