research work on health promotion

Global Handbook of Health Promotion Research, Vol. 3 pp 11–19 Cite as

Doing Health Promotion Research: Approaches, Paradigms, Designs and Methods to Produce Knowledge

• Didier Jourdan 3 &
• Louise Potvin 4 , 5  
• First Online: 01 March 2023

472 Accesses

2 Altmetric

Our aim in this volume is to present solutions used by researchers to advance the knowledge base and solve epistemological difficulties linked to the practice of health promotion research. In the introduction to this volume, we first describe the characteristics of the knowledge base in health promotion research. Although the database is gradually constructed through the production of new knowledge, it is not primarily built on a cumulative basis. Research weaves networks of knowledge resulting from diversified research approaches. These networks of questions, concepts, methods and results are what structures research in health promotion beyond their diversity. Then we present the two main ways of advancing knowledge in our field. The first of these ways is through the development of research approaches rooted in various conceptual frameworks (new starting points) that shed new light on practice and thus advance knowledge. We propose seven examples of such approaches based on various paradigms (critical theories, political science, economics, etc.) which are all relevant frameworks for understanding the mechanisms at work in health promotion practices. The second way is by increasingly advanced innovations in the implementation of research. We thus propose 16 examples of heuristic research designs and methods likely to complete the toolbox of health promotion researchers.

• Health promotion
• Epistemology
• Research field

Reprinted by permission from Springer Nature: Springer. Conclusion: Characterising the Field of Health Promotion Research by D. Jourdan and L. Potvin. Fig. 53.2. In: Potvin, L., Jourdan, D. (eds), Global Handbook of Health Promotion Research, Vol. 1: Mapping Health Promotion Research . Copyright © 2022.

This is a preview of subscription content, log in via an institution .

Buying options

• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Purchases are for personal use only

Jourdan, D., & Potvin, L. (2022). Conclusion: Characterising the field of health promotion research. In L. Potvin & D. Jourdan (Eds.), Global handbook of health promotion research, Vol. 1: Mapping health promotion research . Springer. https://doi.org/10.1007/978-3-030-97212-7_53

Chapter   Google Scholar  

Potvin, L., & Jourdan, D. (2022). Markers of an epistemological framework in health promotion research. In L. Potvin & D. Jourdan (Eds.), Global handbook of health promotion research, Vol 1: Mapping health promotion research (pp. 801–812). Springer. https://doi.org/10.1007/978-3-030-97212-7_52

Download references

Author information

Authors and affiliations.

UNESCO Chair and WHO Collaborating Centre in Global Health & Education, University of Clermont Auvergne, Clermont-Ferrand, France

Didier Jourdan

School of Public Health, University of Montreal, Montreal, QC, Canada

Louise Potvin

Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Didier Jourdan .

Editor information

Editors and affiliations.

UNESCO Chair and WHO Collaborating Centre Global Health and Education, National Institute of Teaching and EducationUniversity of Clermont Auvergne, Clermont-Ferrand, France

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Cite this chapter.

Jourdan, D., Potvin, L. (2023). Doing Health Promotion Research: Approaches, Paradigms, Designs and Methods to Produce Knowledge. In: Jourdan, D., Potvin, L. (eds) Global Handbook of Health Promotion Research, Vol. 3. Springer, Cham. https://doi.org/10.1007/978-3-031-20401-2_2

Download citation

DOI : https://doi.org/10.1007/978-3-031-20401-2_2

Published : 01 March 2023

Publisher Name : Springer, Cham

Print ISBN : 978-3-031-20400-5

Online ISBN : 978-3-031-20401-2

eBook Packages : Medicine Medicine (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

The Twenty Five Most Important Studies in Workplace Health Promotion

Affiliation.

• 1 Editor in Chief, American Journal of Health Promotion and Senior Fellow, The Health Enhancement Research Organization (HERO).
• PMID: 35961021
• DOI: 10.1177/08901171221120719

In what direction has workplace wellness research been evolving over the past 20 years? What proportion of occupational health researchers have been focusing on how health impacts work compared to researchers who ask how work affects health? This editorial poses an audacious, albeit largely subjective, question. That is, what have been the most important research studies about workplace wellness? Readers are invited to respond with their opinions about seminal studies we missed. Readers are also challenged with a thought experiment and exercise designed to organize the past decades of workplace wellness studies into a table that identifies trends in this research domain. Based on trends, I posit that researchers are waning in their interest in how health affects work productivity and healthcare costs and waxing in their considerations of how work affects well-being.

Keywords: health outcomes; health promotion research; research methods; seminal studies.

Publication types

• Health Promotion*
• Occupational Health*

• Tools and Resources
• Customer Services
• Communication and Culture
• Communication and Social Change
• Communication and Technology
• Communication Theory
• Critical/Cultural Studies
• Gender (Gay, Lesbian, Bisexual and Transgender Studies)
• Health and Risk Communication
• Intergroup Communication
• International/Global Communication
• Interpersonal Communication
• Journalism Studies
• Language and Social Interaction
• Mass Communication
• Media and Communication Policy
• Organizational Communication
• Political Communication
• Rhetorical Theory
• Share This Facebook LinkedIn Twitter

Article contents

Ethical issues in health promotion and communication interventions.

• Nurit Guttman Nurit Guttman Department of Communication, Tel Aviv University
• https://doi.org/10.1093/acrefore/9780190228613.013.118
• Published online: 27 February 2017

Health promotion communication interventions invariably raise ethical issues because they aim to influence people’s views and lifestyles, and they are often initiated, funded, and influenced by government agencies or powerful public or private organizations. With the increasing use of commercial advertising tactics in health promotion communication interventions, ethical issues regarding advertising can be raised in health promotion communication when it applies techniques such as highly emotional appeals, exaggerations, omissions, provocative tactics, or the use of children. Key ethical concerns relate to infringing on people’s privacy, interfering with their right to freedom of choice and autonomy, and issues of equity (such as by widening social gaps, where mainly those who are better off benefit from the interventions). Interventions using digital media raise ethical issues regarding the digital divide and privacy. The interventions may have unintended adverse effects on the psychological well-being of individuals or groups (e.g., by inadvertently stigmatizing or labeling people portrayed as negative models). They can also have an effect on cultural aspects of society (e.g., by idealizing particular lifestyles or turning health into a value) and raise concerns regarding democratic processes and citizens’ consent to the interventions.

Interventions can have repercussions in multicultural settings since members of diverse populations may hold beliefs or engage in practices considered by health promoters as “unhealthy,” but which have important cultural significance. There are also ethical concerns regarding collaborations between health promoters and for-profit organizations. Identifying and considering ethical issues in the intervention is important for both moral and practical reasons. Several ethical conceptual frameworks are briefly presented that elucidate central ethical principles or concerns, followed by ethical issues associated with specific contexts or aspects of communication interventions.

• health promotion
• interventions

Introduction: Why Are Ethical Considerations a Pivotal Part of Communication for Health Promotion Interventions?

The process of health promotion communication involves various types of communication approaches and strategies to encourage people to adopt recommended health practices. This process often entails the articulation, development, testing, and dissemination of practical suggestions, claims, and persuasive messages within various communication formats and media channels (including social networks) for the purpose of promoting the health of individuals and the public as a whole. Clearly, because this process aims to influence people’s views, beliefs, preferences, relationships, social norms, and lifestyles, it raises a variety of ethical issues and dilemmas related to the persuasive and influence strategies used. Ethics and morals both concern precepts or principles for what governs or should govern people’s voluntary behavior, in terms of what is considered right or wrong, in particular when it could have an impact on others. Some scholars make a distinction between ethics and morals, with ethics referring to mainly to the guiding principles and morals to the more practical and social and cultural context (Johannesen, Valde, & Whedbee, 2008 ).

Ethical theories aim to identify and justify the moral norm that can serve to guide and evaluate the morality of the conduct or policy (Beauchamp & Childress, 2001 ). Ethical dilemmas emerge when a particular ethical principle (e.g., respecting people’s privacy) conflicts with another principle or moral obligation (e.g., protecting someone from harm) when planning a health promotion communication intervention (Guttman, 2000 ). Because various health issues have raised ethical issues concerning healthcare professionals’ decisions and practices since ancient times, philosophers and medical practitioners developed a body of literature and guiding principles, often referred to as medical ethics , that specifically pertain to health-related issues but draw on the more general principles in ethical theories (Beauchamp, 2009 ). Currently, with advances and developments in biomedicine that can affect individuals and society, the term bioethics has been introduced to refer to the study and practice of ethics in the wider healthcare context. Scholars note that it is also a more critical and reflective activity that is concerned not only with ethical precepts and codes, but also with understanding the issues and pointing to policy implications (Khuse & Singer, 2001 ).

Health communication interventions may also have unintended adverse effects on the psychological well-being of individuals or groups (e.g., by inadvertently stigmatizing or labeling people who are used to portray a negative model) (Cho & Salmon, 2007 ). Further, health promotion communication interventions could have an effect on cultural aspects of society (e.g., by idealizing particular lifestyles or turning health into a value) and raise concerns regarding democratic processes, citizens’ consent to the intervention (Ayo, 2012 ), and the role that they place in the appropriation of the political, social, and moral realms of the public consciousness and discourse.

Despite the obvious role played by ethics in health promotion communication interventions, communication researchers note that they are seldom discussed in daily health communication practice and are mainly raised only after critical questions are raised by others (Bouman & Brown, 2010 ). Therefore, practitioners and scholars concerned with ethical issues in health promotion note that it is imperative that ethical issues regarding the intervention should be identified and addressed already at the outset of the intervention, and that it could be assumed that additional ethical issues may emerge during the implementation (Brenkert, 2002 ).

Moral and Practical Reasons

Identifying and considering ethical issues in the health promotion intervention is important for both moral (adhering to ethical principles or cultural conceptions of what is right and wrong) and practical (producing the desired impact) reasons (Carter et al., 2011 ). From a moral perspective, one compelling argument is that since health promotion aims to promote a social good and since its goals are for a “noble” cause, the means to achieve them must be ethical as well (Holden & Cox, 2013 ; Kirby & Andreasen, 2001 ; Rothschild, 2001 ). Health promotion interventions are laden with moral concerns because the behaviors that they aim to influence typically relate to intimate aspects of people’s lives, their relationships, culture, and social values. For example, food is a symbolically and socially central aspect of human life. Therefore, interventions to change people’s food habits essentially intervene into their culture, habits, preferences, and personal and work relationships (Carter et al., 2011 ; Mayes & Thompson, 2014 ). Such interventions can have repercussions in multicultural settings since members of diverse populations may hold beliefs or engage in practices considered by health promoters as “unhealthy,” but which have important cultural significance to them. Thus, interventions might address sensitive topics or challenge people’s deeply held beliefs and moral judgments.

Another reason for considering ethical issues is that health promotion interventions increasingly rely on advertising campaigns and marketing strategies, which enhance their persuasive potential. Further, health promotion interventions increasingly use digital media, and this use also raises ethical issues regarding the digital divide and privacy. In addition, there are ethical concerns regarding current and potential collaborations between health promoters and for-profit organizations. Finally, with the increasing adoption of commercial advertising tactics in health promotion interventions, ethical issues that are raised regarding advertising can be raised in health promotion communication when it applies techniques such as highly emotional appeals, exaggerations, omissions, provocative tactics, or the use of children.

From a pragmatic perspective, if the intervention is to be perceived as doing things that are unethical, it would lose its credibility. Further, the consideration of ethical issues can help health promoters avoid using communication tactics that could be ineffective because they might be insensitive to the values of the intended population and cause people to respond negatively.

Types of Ethical Concerns Regarding Health Promotion Communication Interventions

Key ethical concerns in health promotion include issues related to infringing on people’s privacy, interfering with their right to freedom of choice and autonomy for the sake of promoting the health of individuals or society as a whole. Further, ethical issues in health promotion interventions raise concerns regarding unequal or unfair treatment or provision of services, referred to as equity , and distributive justice, which expands the term to include unequal distribution of risks or burdens or of fair opportunities to attain health goals (Daniels, 1985 ). For example, communication interventions might serve to widen social gaps when mainly those who are better off benefit from these interventions.

Another particularly contentious issue concerns the emphasis on personal responsibility in health promotion interventions. It raises ethical concerns regarding whether interventions that aim to promote healthier lifestyle choices might invariably result in putting the burden of being healthy on the individual. Other types of ethical issues are related to tactics and strategies. For example, strategic decisions regarding which population should be the target of the intervention, and which will not, or what kind of persuasive arguments and visual appeals should be used. Overall, the range of ethical issues in health promotion interventions is as broad as the types of issues addressed and the types of tactics used. Ethical issues can be found in each component of the intervention, from the conception of its goals, from the way it considers (or not) the issue of informed consent or participation of the intended population in the design of the intervention, to the assessment of its outcomes (Guttman & Salmon, 2004 ). These issues are further elaborated in the sections that follow.

In some cases, the ethical issues that emerge in health promotion activities are explicit and elicit a debate, while in other cases, pertinent ethical issues may be more difficult to recognize in the wide range of health promotion activities. Therefore, it is important to identify and elucidate them. For this purpose, the following sections will briefly outline several ethical conceptual frameworks that elucidate central ethical principles or concerns, followed by ethical issues associated with specific contexts or aspects of communication interventions.

How to Identify and Consider Ethical Issues: Drawing on Ethical Frameworks and Precepts

Because health communication interventions are intended to serve health-promotion goals, the discussion of ethical issues can be informed by the medical or bioethics (Beauchamp, 1996 ) and health promotion ethics literature (Buchanan, 2000 ; Buchanan, 2008 ; Callahan & Jennings, 2002 ; Cribb & Duncan, 2002 ; Dawson & Grill, 2012 ; Mittelmark, 2008 ; Seedhouse, 2001 ), from the communication and social marketing literature (Andreasen, 2001 ; Truss & White, 2010 ; Guttman, 2000 ), as well as from critical and cultural theories that point to ethical issues related to broad moral issues related to culture and democracy (Foucault, 1984 ; Lupton, 1993 ). Current discussions on ethics in health promotion emphasize two broad questions that they propose should be asked regarding the ethical base for the health promotion issue: first, does it indeed promote people’s health (e.g., is it based on reliable evidence); and second, whom does it actually benefit (e.g., is the benefit distributed fairly, and does it contribute to equity) (Carter et al., 2011 ; Holden & Cox, 2013 ). These two questions encompass some of the major ethical concerns in health promotion that directly or indirectly refer to the obligations of doing no harm, doing good, justice and equity, and effectiveness. These are among the central ethical principles specified in formal ethical frameworks, briefly noted next.

“Doing No Harm”

A series of precepts or moral obligations of healthcare practitioners that draws on this literature (Beauchamp & Childress, 1994 ) is briefly summarized in this section. One important obligation is that when one aims to better people’s health one needs to avoid doing them harm ( nonmaleficence ) (Beauchamp, 1996 ). This moral obligation is considered by some ethicists as the foremost ethical maxim for healthcare providers since the days of Hippocrates. The obligation to “do no harm” causes ethical concerns when an intervention of any kind, including a communicative activity, might directly or indirectly harm individuals or communities, whether on a physiological, psychological, social, or cultural level. For example, as a result of health promotion interventions, some individuals might become particularly anxious because of certain risk messages, or communication interventions might inadvertently stigmatize certain populations by using a derogatory depiction of their medical condition.

One example of potential harm elicited in health promotion communication interventions concerns initiatives that focus on body weight and obesity prevention. Health promotion interventions aimed at body weight are associated with ethical concerns because people’s identities are influenced by their body image, and thus messages about their bodies essentially concern their self-image and personal worth. People might also be affected by such interventions by viewing themselves more negatively, by having others see them in a more negative way, such as by being blamed for their presumed lack of willpower or character, regardless of economic, social, genetic, or psychological factors that affect their body weight and food consumption (Carter et al., 2011 ). This can serve as an example of situations in which people find it difficult to change their health conditions because of not having appropriate opportunities, support systems, or supportive environments, and might not succeed in their attempts to change, which could create or reinforce a cycle of self-blame and helplessness.

“Doing Good”

A second obligation that could be seen as the flip side of doing no harm is the obligation to “do good” ( beneficence ), which is considered a basic tenet of the helping professions. This obligation is supposed to be carried out by actively pursuing means to help individuals and communities to reach a positive state of health or by preventing them from being endangered by risks and potential harm. The obligation could involve the protection and promotion of people’s health on the individual level, as well as the family, community, and societal levels (Beauchamp, 1996 ). Numerous dilemmas emerge when interventions aim to “do good,” but other factors might be involved that raise concerns regarding the means applied in the intervention. For example, to reach male youth who are typically uninterested in health information, health promoters might seek to employ computer video games. However, in order for these games to be attractive to the youth, they might consider using images that are violent or sexist. Other concerns and examples are presented in the sections that follow.

Respecting People’s Privacy and Their Autonomy to Make Free Choices and Not to Be Manipulated

Two central obligations rooted in liberal Western philosophy and democratic theory, which are related to each other, are to respect people’s right to autonomy and the obligation to protect their privacy. These are based on the premise that individuals have an intrinsic right to make their own decisions on matters that affect them, so long as such decisions do not bring harm to others. This precept places high importance on individual choice regarding both political life and personal development. It underlies democratic forms of government and self-determination of individuals, communities, and nations, and it has been the foundation for the development of important medical care codes such as patients’ rights, informed consent, and confidentiality. Ethical issues associated with respect for autonomy and privacy typically concern the use of persuasive arguments that might be considered manipulative, or the use of graphic material such as mutilated bodies or human suffering that might offend people or expose them to issues or sights to which they do not want to be exposed (Hastings, Stead, & Webb, 2004 ).

One of the main criticisms of ethical frameworks that prioritize the importance of autonomy is that it represents mainly a Western approach to the conception of moral issues, draws too much on assumptions of individualism and universalism, and does not reflect diversity in moral reasoning (Makau & Arnett, 1997 ). Another criticism, which has particular relevance to health promotion ethics, is that an emphasis on persuasion and manipulation as threats to people’s autonomy presents a narrow conception of autonomy that does not take into consideration the social and relational context of human choices and behavior (Bouman & Brown, 2010 ; Owens & Cribb, 2013 ). For example, people’s health-related behaviors are done in the context of their family relations, and it might be very important to them to adjust their behavior so that it would fit the cultural traditions of their close relatives.

Another criticism addresses the actual potential to realize one’s autonomy, whether on the personal or collective level. It adds a stipulation to autonomy in health promotion that people should have the capacity not only to choose, but be able to act upon their choice (e.g., have the opportunity to eat healthier food at work, or walk to work instead of drive). The stipulation to ensure that people have the capacity to act upon a healthier choice can be articulated as an important condition to meet both ethical considerations of autonomy and equity or justice, which are referred to in the sections on justice and equity (Lee, Rogers, & Braunack-Mayer, 2008 ). This stipulation corresponds to one of the central guiding principles in social marketing: namely, the main goal of an intervention is to identify and reduce barriers—whether social, physical or psychological—in order to facilitate people’s ability to engage in the promoted health-related practice (Lefebvre, 2013 ; Hastings, 2007 ). However, these stipulations should not be used by decision makers as a justification to avoid communicating about issues when the intended population does not have the means to act. In such cases, for example, the discourse can focus on what is needed and how to create the necessary means, or on what kind of actions could be adopted even partially to address the health challenges.

Ethical Issues in Choosing Issues and Obtaining Consent

In the medical care context, it has become an ethical and often a legal requirement to obtain people’s consent to perform a medical intervention on them or on their dependents and to inform them about the procedures and possible risks or adverse consequences (Olufowote, 2008 ). Because health promotion activities are often viewed as relatively unobtrusive or educational, and because they are mainly implemented in the context of populations or through the media, the question of whether informed consent is required is often not even considered. Further, because health promotion interventions are a result of the initiatives of government agencies or not-for-profit organizations that aim to promote the health of the public, it is taken for granted that the public approves of them. Yet, health promotion interventions, by definition, intervene in people’s lives, and their topics are often chosen by the government or influential public and commercial organizations (Eagle, 2009 ). This raises the question of what should and could be the standards or procedures to ensure that informed consent is obtained on behalf of diverse populations. On a national scale, health promotion may reflect policies formulated as a result of a political democratic process, but on the local or organizational level, the question might be raised as to who represents the community residents. The issue is of particular importance when programs serve as so-called social experiments, to prove the efficacy of one type of health intervention over another. There are various participatory methods to involve different stakeholders relevant to the intervention, and they could be considered part of the design of the intervention.

Obligation to Promote Health Effectively and Efficiently

Another ethical obligation concerns designing and implementing health promotion interventions so that they will benefit most people and will be conducted in the most efficient and effective way of using public resources. This approach draws on a teleological perspective in moral philosophy and focuses on consequences as the main criteria for determining moral worth. This is indicated by the word telos , which means “end.” This approach is associated with utilitarianism (though some refer to it as a separate approach) that assesses the worth of actions on what was or will be the most beneficial to most people or society as a whole, and by doing so with a consideration of effectiveness (Hiller, 1987 ).

One of the underlying premises for this type of justification is also that society has limited resources, which should be utilized to maximize their effectiveness. This obligation can influence decisions about how to choose the intended population for a health promotion intervention by drawing on a utilitarian basis rather than needs (Christians, 2007 ). However, it should be noted that utilitarian approaches that are employed in health promotion typically include considerations of equity and justice, which are embedded into the overall ethical framework. A teleological approach is often referred to in terms of “the ends justify the means,” and is used by practitioners to justify the use of particular persuasive strategies, which might offend, disturb, or even harm (e.g., stigmatize) certain members of the population. In such cases, arguments drawing on the importance of utility are presented in order to override concerns regarding privacy, autonomy, or causing harm to certain individuals or groups. These issues are further discussed in the section “ Using Provocative Appeals and Strong Negative Emotional Appeals ”.

Justice and Equity

An important guiding principle in democratic ethical frameworks refers to equity and justice. These are broad and contested issues that encompass obligations associated with distribution of resources, opportunities, benefits, and risks. Health promotion activities are typically committed to the moral obligation to promote equity in terms of health promotion opportunities across social groups. Overall, disparities in health have been linked to social and economic determinants and many health promotion interventions aim to address these disparities. However, paradoxically, health promotion activities that have achieved significant improvements in the adoption of healthier practices among large populations may inadvertently serve to reinforce, rather than reduce, existing social disparities.

It has been found that large-scale programs that aim to influence lifestyle behaviors, including the prevention of heart disease, smoking cessation, and increased physical activity or early cancer detection are more likely to have an impact on populations with greater economic resources (Viswanath & Ackerson, 2011 ). This has raised concerns regarding equity. Thus, several important ethical issues regarding justice and equity as they relate to public health communication interventions have been noted both conceptually and in empirical studies. These concern knowledge gaps, addressing barriers, digital media, targeting, and the issue of trust.

Equity and Knowledge Gaps

A recurring concern in the past two decades that concerns equity is that health promotion interventions may inadvertently widen health and social gaps by benefiting mainly those who are better off socially and economically. Communication scholars point to research findings that indicate that despite the promise that mass media campaigns could disseminate health promotion materials more equitably, such campaigns in fact were found to increase social gaps. A considerable social gap was found in the acquisition of, and the capacity of people to act upon, pertinent health information according to their socioeconomic backgrounds. This gap has been referred to as “the knowledge gap,” and its occurrence has been found regarding various health issues, including cancer, heart disease, and breastfeeding (Kulkla, 2006 ; Viswanath et al., 2006 ). Consequently, health promotion interventions may inadvertently serve to reinforce existing social disparities.

The emphasis on justice is particularly relevant because less economically well-off groups are typically more severely affected by chronic and infectious diseases than the well off because they are less economically equipped to prevent or control them. Thus, social inequalities in people’s health and welfare can be exacerbated (Lee et al., 2008 ). To address such knowledge gaps, the assumption is that what is needed is to ensure that all people should have ready access to accurate, up-to-date, and easily understood and relevant information about how to prevent or reduce risk and promote their health. Further, the communication should be tailored to overcome obstacles faced by members of disadvantaged groups in accessing such information.

Equity and Addressing Barriers

In the discussion of autonomy earlier in this article, it was noted that critics maintain that in order for people to make autonomous decisions regarding health practices, they must also have the capacity to recognize these choices. A similar stipulation could be made regarding equity is ensuring that there are equitable solutions to barriers that people may face when they want to adopt health promoting practices. Providing solutions to barriers is a central guiding principle in social marketing and highly relevant to considerations of equity (Lefebvre, 2013 ).

Communication interventions that do not provide relevant solutions for the specific problems or barriers that prevent people from adopting the recommended health practices raise a central ethical concern regarding the communication intervention as a whole (Brenkert, 2002 ). If people at whom the communication is aimed to promote their health are not provided with solutions to barriers that they must overcome to adopt the recommended action, they will be reluctant to adopt it and benefit from it or protect themselves. For example, people who work long hours and do not have affordable fresh fruit and vegetables in the vicinity or time to prepare meals need solutions for these problems. Another example comes in the context of public health emergencies, in which people are asked to evacuate their home or business immediately. People might ignore directives to evacuate their property if no assurances are given that their property will be protected (Lee et al., 2008 ). Another example concerns the promotion of smoking cessation treatments. Critics maintain that clinical smoking cessation programs have been presented by healthcare professionals as the most effective means for smoking cessation compared to unassisted smoking cessation. They argue, however, that this communication could be both ineffective and harmful when promoted in nations with mainly economically disadvantaged populations because the medical products are inaccessible to them and it could discourage personal efforts (Chapman & Mackenzie, 2012 ).

Another example that demonstrates issues of equity as they relate to the ability to realize health information concerns menu labeling. Researchers argue that menu labeling may preferentially influence the welfare of those who are healthier and wealthier and have the opportunity to make choices. An additional ethical concern is that focusing the responsibility on people to make choices might shift the focus away from the institutional changes needed for people to be able to make the healthier choices, such as ensuring that healthier foods are available to the public at a reasonable cost (Carter, 2015 ).

Digital Gaps

Digital media offer opportunities to widely disseminate health promotion information in various formats and have become the main source of health information for many people. However, their use also raises ethical concerns regarding equity and the so-called digital divide (Hargittai, 2002 ). People with limited digital literacy or who lack physical access to computing facilities, as well as relevant skills and competencies, are less able to access or use health information distributed online (Viswanath & Kreuter, 2007 ). One example is the information gap that occurs in public health emergencies that use digital media channels to reach the public. In such situations, some of the most vulnerable groups in society, including the aged, the homeless, recent immigrants, rural residents, and the poor, are more likely to be at risk if digital media serve as the main route for information provision (Lee et al., 2008 ). To meet the obligation of equity, various health promotion programs seek to develop ways to increase access and enhance digital literacy among populations for whom the use of digital media for the purpose of health promotion is less accessible (Ginossar & Nelson, 2010 ; Kreps, 2005 ).

Equity and Strategic Segmentation and “Targeting”

Designing health promotion programs to focus on particular segments of the population is accepted as both a practical and ethical strategic approach in health promotion. It is considered a more ethical and effective approach because it requires the provision of equivalent but culturally appropriate messages to populations with different sociocultural backgrounds and levels of literacy (Hornik & Ramirez, 2006 ). It is also considered efficient because interventions that are developed according to the social norms and values of the particular population, and which draw on metaphors and symbols that they are familiar with or prefer, will likely be more effective in reaching its health promotion goals.

Ethical issues that concern justice and equity are also related to these strategic decisions regarding which populations should be the “target” of the intervention and which will not. However, the mere decision to “segment” a population according to certain parameters and to allocate limited resources to adapt particular health promotion activities to certain populations raises ethical issues regarding equity as well as utility. Decisions regarding “targeting” are often made on the basis of utilitarian or efficiency considerations. For example, it might be recommended by social marketing professionals to “target” those who are already in a state of readiness to adopt the recommended health practice by contemplating or engaging in it (Lee & Kotler, 2015 ). Alternatively, it may be decided to focus the efforts on those with the greatest need, who are considered “hard to reach” and less likely to adopt the recommendations, thus raising concerns associated with utility and the inefficient use of limited resources that are available to health promotion, as well as not addressing the needs of other groups (Newton, Newton, Turk, & Ewing, 2013 ).

Equity and Trust

Health promotion scholars concerned with ethics raise an interesting point regarding equity and the issues of trust, particularly in public health emergencies. Some populations do not obtain health information that could be beneficial to them because they do not trust the sources. Thus, there is an ethical obligation regarding earning legitimacy and trust from populations believing they have been discriminated against, stigmatized, or marginalized in the past. Otherwise, their lack of trust in the authorities will serve as an unfair barrier, and thus, they will not benefit from the health promotion initiative (Lee et al., 2008 ).

Ethical Approaches of Caring and Connectedness

Some ethical frameworks introduce an overall approach to connectedness and caring rather than focusing on particular principles of justice. One such approach is referred to as narrative ethics (Tong, 1998 ), which stresses the importance of understanding people by learning their perspective. A related approach is the ethic of care, which draws on feminist studies and focuses on the importance of maintaining relationships, connectedness, and attachment between people, on receptivity, and a person’s responsiveness to others (Nodding, 1990 ; Veatch, 1998 ). Similarly ethical approaches found in cultures referred to as traditional (Cortese, 1990 ), as well as in the communitarian approach, also emphasize caring and a sense of community (Etzioni, 1998 ). These ethical perspectives have implications for both health promotion interventions that take place in community settings and the development of a discourse that raises issues of caring for others and mutual obligations in health promotion (e.g., mutual obligations for reducing alcohol consumption, helping others quit smoking, or encouraging physical activity). Another ethical framework has been noted as central to the communitarian approach, which stresses social relations and interdependence, kinship, and a sense of common purpose and tradition among members of the community. This framework prioritizes values such as generosity, compassion, peace, stability, solidarity, sympathy, and reciprocity. Thus, people’s choices take into consideration the way that they live within a community (Bouman & Brown, 2010 ). This can have implications for health promotion interventions, which means that drawing on this approach could emphasize adopting health promotion practices or social norms as a means to help others in the community or emphasize mutual support, instead of focusing on individual responsibility.

Communication Stipulations for Ethical Communication: Truth, Completeness, Sincerity, and Inclusion

The literature on communication ethics also provides stipulations that can be used to identify and guide the consideration of ethical issues in health promotion interventions. Ethical issues are inherent in any instance of communication between humans; this is the case whether or not the communicators seek to present information, facilitate others’ decision making, persuade people about important values, or advocate particular solutions. Even in an open discussion or dialogue, people may seek to influence others’ views and opinions. According to philosophers and ethicists, an ethical perspective regarding influence in communication must be practiced in a noncoercive, nonmanipulative manner, which respects other people’s free choice and individuality (Johannesen, 1996 ). This is also explored in the work of Jurgen Habermas ( 1987 ), in his framework referred to as the Ideal Speech Situation , in which he outlines stipulations for a communication interaction that is as free from coercion as possible.

In the context of health promotion interventions, it is particularly important from an ethical perspective to avoid manipulation and coercion for several reasons. One important reason is that the interventions often take place in diverse and pluralistic social contexts, and in situations where there are significant power differences. The choice of the intervention goals might serve those who have more authority and power. Another reason is that much of health promotion communication aims to persuade people to change their practices. Therefore it is important to have guidelines to help ensure that the persuasion process is not coercive. This does not contradict policy regulations that are based on public discourse and democratic processes that might restrict people’s actions, such as regulations regarding mandatory safety devices or prohibitions in using certain chemicals. The stipulations outlined in the framework of the Ideal Speech Situation include truth, correctness, sincerity, comprehensibility, and inclusion. Each of these stipulations can contribute to the design of communication interventions or to the identification of potential ethical issues. The following sections briefly explain each of these as it relates to health promotion interventions and has been adapted for this purpose.

Stipulations as to the Truth of Health Information

Being truthful is one of the tenets of Western morality that is assumed to be shared universally. Concealment or misrepresentation of what is believed to be true, even for what is considered a good cause, is considered an infringement on the ethical principle of respect for autonomy (Beauchamp, 1996 ). However, in different cultures, the notion of autonomy differs as it relates to telling the truth or conveying all the information about a health issue when certain people do not choose to hear it. Thus, considerations of culture might be relevant in certain situations or among people of various cultures (Cortese, 1990 ).

In health promotion interventions, inaccuracies or exaggerations are often represented in slogans or visual images. It is also argued, particularly by practitioners, that it is more effective to disseminate simple and clear messages, and that for the purpose of effectiveness in message design, giving more detailed information should be avoided. However, these assertions could be contested on both ethical and practical grounds.

The following guidelines can serve to develop more ethical health promotion communication interventions:

Do not imply that the expertise of those who are cited in the intervention is the only legitimate authority to make the health recommendations. By implication, this could entail allowing or acknowledging alternative conceptions or engaging in a dialogue about them.

Avoid using jargon and technical language and relying on privileged sources of data. For example, when promoting diagnostic preventive tests, explain the risks of not taking these tests in understandable language.

Allow alternative ways of framing and prioritizing health issues. For example, sexual health of adolescents could be framed in different ways according to culture and social norms.

Ensure that the health issues that are promoted are truly relevant to the intended populations and not made to seem relevant because they are important to the interventionists. One example of this would be focusing on a particular issue when community members would prefer to look at another one, such as women’s health issues (McLeroy et al., 1995 ).

Stipulations as to Correctness and Reliability of Health Information

Health promotion often involves providing information that is intended to convince people that they should adopt particular health promoting practices. For example, having certain diagnostic procedures for early detection of diseases or changing their diet. However, the correctness or reliability of this type of information could be contested: It might not always be up to date, might be tentative or incomplete, or might be subject to different scientific and cultural interpretations. Over time, new studies and new modeling technique recommendations related to the benefits and risks of particular foods or medical treatments have changed as new research findings emerge. For instance, recommendations have changed on the use of female replacement hormones, how to reduce the risk of infant crib death, and the consumption of cholesterol in food, among other topics. Scientific backing for health recommendations thus, may be tentative, and the benefits and risks of adopting certain recommended practices may have a degree of uncertainty.

According to the stipulation of correctness, health promoters should avoid asserting certainty in their health claims when tentativeness or degrees of probability would be more accurate. However, this requirement raises concerns regarding efficiency and effectiveness because information that is presented in a tentative way or in probabilities might deter people from adopting the health recommendation, which could be beneficial to them. The stipulation of correctness also implies that health promotors should refrain from exaggerating negative or positive consequences, the magnitude of the problem, or the degree of the expertise of the authorities upon which it relies, even when such a presentation is believed to be more persuasive and serve the purpose of the intervention (Johannesen, 1996 ).

Stipulations as to Comprehensibility, Clarity, and Completeness

Information that is meant to promote people’s health clearly needs to meet the stipulation that it will be understood by those who are meant to use it in order for it to be beneficial. Drawing on ethical obligations associated with equity, this stipulation points to the importance of presenting the information in a way that people with limited competencies in literacy and numeracy can understand. Further, based on the findings of studies on risk perception, it is important to present risks to people in ways that are relevant to them, or they will not relate to the information (Rossi & Yuell, 2012 ).

These stipulations point to an additional challenge: Trying to present health promotion information that is both easy to understand and complete and serve to encourage people to adopt the recommended health practice might be difficult. As noted in the section “ Stipulations as to the Truth of Health Information ”, it is a common assumption among practitioners that it is more effective to disseminate short, simple, and clear messages and to refrain from giving more detailed information for the purpose of effectiveness in message design,. However, this approach does not enable conveying unbiased information to the public (McCartney, 2010 ). Further, in matters of health, oversimplification of health information infringes on the obligation of respecting people’s autonomy and their right to make informed decision based on complete information. It might also not be efficient because people might want to understand the rationale for the health recommendation and consider its pros and cons.

Further, if the decision is based on comprehension, they might be more committed to following through on it (e.g., according to the theoretical conceptions of the Elaboration Likelihood Model and the empirical evidence of studies that use it) (Petty & Cacioppo, 1984 ). The ethical standard of completeness also suggests that it would be unethical to present a one-sided argument, selecting only favorable supporting evidence. In addition, these stipulations imply that potentially undesirable consequences of the recommended practice should not be hidden or misrepresented. However, providing complex information, including information on the tentativeness or limitations of the scientific evidence, which is the basis for the health recommendation might deter people from adopting it, although it could be beneficial to them.

Stipulations as to Sincerity: What Are the Actual Goals?

The reasons for the communicative initiative for changing health need to be made clear, including the goals and implicit agenda of sponsors and the identity and motives of stakeholders who are likely to benefit from the outcomes of the intervention. This type of obligation is particularly important when the health promotion intervention concerns members of diverse groups who may feel that they have been exploited in the past or that there are hidden agendas in the intervention that are meant to serve the purpose of others rather than themselves.

Stipulations as to Inclusion: Participation and Deliberation

Health communication activities are often initiated by agencies or organizations that come from outside the intervention community or represent only particular sectors. According to the inclusion stipulation, the communication process should include respect for others’ point of view, beliefs, and suggestions. This is particularly important for members of diverse groups who, by definition, may hold diverse views of the issues and have different capacities to address it. This stipulation is also associated with the moral obligation to respect people’s autonomy and self-determination, as well as with democratic values such that people should be given the opportunity to participate in decisions that affect their lives (Brenkert, 2002 ). Involving people in the design and implementation of health promotion interventions could be important for utilitarian reasons as well because it can help create a sense of ownership and is more likely to meet the needs of the people for whom the intervention is intended (Castleden, Garvin, & Huu-ay-aht First Nation, 2008 ).

The stipulation for inclusion could be expanded to participative and deliberative communication, which can enable individuals and groups to articulate their values and to consider choices between competing obligations rather than to approach them with predetermined prescriptions (Dutta, 2011 ). Participative and deliberative strategies for message production are increasingly adopted in health communication interventions, particularly in the context of community programs (Papa & Singhal, 2006 ) and more recently in the use of digital media (Korda & Zena, 2013 ; Neiger et al., 2012 ). Health promotion interventions that employ an entertainment-education format have also been using dialogue, narrative, and plot as means to elicit critical reflection and different perspectives or value orientations (Slater and Rouner, 2002 ; Sood, Menard, and Witte, 2004 ). Further, they can involve population representatives in the articulation of ethical issues. Yet the use of entertainment education raises its own slew of ethical concerns as well (Bouman & Brown, 2010 ).

Ethical Issues Related to Appeals to Personal Responsibility

Personal responsibility is commonly used directly or indirectly in many health promotion interventions. For example, people are urged to make prudent and more responsible choices when they consume food or beverages, when they engage in sexual relations, and when they make choices regarding transportation or which kind of games their children play. However, personal responsibility is a highly contentious issue in health promotion interventions, and its use as a persuasive argument raises several important ethical concerns on the individual level, as well as political and cultural levels (Guttman & Ressler, 2001 ; Turoldo, 2009 ). One important assumption related to the use of personal responsibility as a positive motivator in health promotion draws on the notion of the right to autonomy, which is based on the assumption that individuals should be free to make their own choices about many health-related practices, so they should be encouraged, but not forced, to make responsible ones.

An emphasis on personal responsibility from this perspective could be viewed as an effective means to promote desired behaviors and to enhance people’s sense of efficacy and autonomy. A related conception of personal responsibility is that it can serve to empower individuals and populations and promote a sense of agency. Similarly, it can emphasize people’s ability to help others. From this perspective, an emphasis on personal responsibility plays a strong positive role in promoting the lives of individuals and communities. Researchers have found that although messages on personal responsibility were associated with increased intake of fruit and vegetables, those that emphasized the importance of social responsibility appeared to be more motivating (e.g., Williams-Piehota et al., 2004 ). For example, parents might be more willing to change what their children eat for lunch at school when the change is framed as a collective effort by all parents.

One example of ethical issues that emerge with the emphasis on personal responsibility can be seen as it relates to nutrition. With the increasing emphasis in health promotion on the prevention of obesity and cancer through better nutrition, interventions urge the public to make “healthy” food choices. Communicating about the importance of healthier food choices is often couched in the language of moral “obligation” and “responsibility” to adopt these healthier choices. Critics of this type of approach raise concerns that this emphasis can serve to burden families for whom the healthier choices are not easily available, causing them to feel that they are not fulfilling their obligations, while denigrating the pleasure and comfort that they derive from communal meals that they are told are not nutritious (Mayes & Thompson, 2014 ). Further, people’s food choices are highly dependent on the options made available to them in terms of access and cost, as well as social and cultural factors, such as social norms and the influence of commercial advertising and marketing strategies, particularly as they influence children and youth. This has implications for health promotion interventions that relate to public policy (Kotler, Shiffman, & Hanson, 2012 ; Story & French, 2004 ; Anjali, 2010 ; Cairns, Angus, Hastings, & Caraher, 2013 ).

Personal Responsibility, Accountability, and Blame

One important concern in the use of personal responsibility in health promotion interventions is that focusing on it might carry negative connotations reminiscent of ancient exhortations to overcome vices such as gluttony, sloth, and lust (Berkman & Breslow, 1983 ). A related concern is that it could serve to blame individuals and populations for the emergence and spread of infectious diseases and pandemics (Nelkin & Gilman, 1991 ).

Similarly, some health promotion interventions imply that illness or disability results from the failure to adopt a so-called responsible lifestyle and that irresponsible individuals are responsible for the adverse outcome. However, ethicists maintain that in the health context, people can be held accountable only when their actions are completely under their volition or control. Attributing blame to those who do not adopt the promoted health practices could inadvertently become “victim blaming,” or holding them accountable for the consequences of behaviors and circumstances that led to these behaviors over which they have had only limited control (Wikler, 1987 ). This corresponds to the previous discussion on autonomy that pointed to the limitations of autonomy when people cannot overcome barriers and obstacles, as well as to the discussion on justice and equity and the existence of social gaps where those who are better off can more easily adopt health practices than those who are less economically and socially well off. It is important, therefore, to make a distinction between blaming people for their medical/health problems and encouraging them to have a sense of agency to try to change circumstances and practices in a way that can promote their health.

According to ethicists, for people to be held responsible, they need to have the ability to exercise their own will, they need to have the capacities to make moral choices, they should be able to actively interpret what is happening, and they must be knowledgeable about the potential consequences of action or nonaction. Thus, for individuals to be truly responsible, they would need to have “response-ability.” This has practical implications as well. The stipulation of having the capacity to make choices corresponds to the previous discussion on stipulations of capacities to exercise one’s autonomy. By implication, people should not be blamed for not being responsible if they do not have the capacity to make what health promoters or society consider responsible choices.

Beyond Personal Responsibility

Even when health promotion messages do not explicitly blame people for taking full responsibility for their health, they might frame the notion of responsibility for disease or injury prevention as if it were primarily under individuals’ control. This can deemphasize the role of structural and institutional factors such as the work environment, housing conditions, or pollution in the etiology of many health-related problems. Historically, personal responsibility is a central notion in discussions of justice, ethics, and social regulation of behavior. From a political, cultural, and social perspective, scholars note that responsibility is a core concept for understanding how people and governments can sanction and try to control people’s conduct (Crawshaw, 2012 ).

Responsibility for Others

Many health promotion interventions refer to responsibility for others. For example, people may be called upon to promote or protect the health of significant others (e.g., children, spouses). Thus, on the one hand, appealing to people’s sense of obligation can help reinforce moral commitments such as caring, solidarity, and compassion. On the other hand, it might serve to reinforce particular gender roles or cultural stereotypes and also place a burden on people who have limited control over others’ behavior (Guttman & Ressler, 2001 ).

Harm Reduction Approaches and Health Promotion

Numerous health promotion programs apply, often inadvertently, what has been called a “harm reduction” approach, described by some of its advocates as “compassionate pragmatism.” The harm-reduction approach justifies health promotion interventions that aim to help people avoid serious harm, while not urging them to change other practices associated with it. This approach is based on an ethical conception that prioritizes the obligation to protect people from greater harm, while not aiming to stop the lesser harmful practice. Proponents of this approach often refer not only to the obligation to help people with special needs to avoid serious harm, but also to the utility of this approach. They explain that it helps enlist the trust of particularly vulnerable populations, and that if they did not ignore the lesser harmful practice, the people at risk would not adopt their recommendation for the one that is most harmful. Further, they argue that this promotes trust in the relation between the health promoters and members of these hard-to-reach populations as a basis for the development of health promotion interventions in the future. This approach has been applied in the prevention of substance abuse and sexually transmitted infections among young adults, or in syringe-exchange programs for injection drug users to prevent HIV infection, and more recently regarding alcohol consumption (Howard, Griffin, Boekeloo, Lake, & Bellows, 2007 ).

Harm Reduction and Corporate Interests

The use of this approach in programs in the road safety context raises additional ethical concerns. For example, programs that promote the use of a designated driver mainly focus on encouraging people to rely on a driver that does not consume alcoholic beverages, and do not refer at all to the harm of consuming a large amount of alcohol. In fact, many of these initiatives are sponsored by alcohol companies (Dejong, Atkin, & Wallack, 1992 ; Ditter et al., 2005 ). Further, health promotion in workplaces might also be seen as adopting a harm reduction approach when they basically promote practices that fit into the corporate work schedule. The lifestyle associated with long workdays are not beneficial to most people’s health and well-being. For example, it does not enable many people to spend much time with their families or to develop a healthy and self-actualizing and meaningful life. Health promotion interventions mainly focus on particular aspects that can be changed, but not the overall institutional context that affects people’s well-being. In fact, these programs might simply help people to adapt better to current constraints of work schedules rather than reduce work hours.

Ethical Issues in Adopting Marketing Approaches for Health Promotion

Commercial marketing strategies have been shown to be hugely successful in influencing people to purchase various products and services and to adopt particular lifestyle trends. This has prompted many health promotion programs to adopt methods and tactics used in commercial marketing as a means to enhance the reach and impact of their programs. The application of commercial marketing strategies to health promotion interventions raises a host of ethical concerns. These include (a) the ethics of using slogans and simplistic messages, which are not likely to meet the stipulations of completeness and reliability; (b) appealing to strong emotions, which might infringe on respect for people’s autonomy and privacy or cause people emotional harm; (c) employing celebrities and advancing commercialism (for example, by using prizes and incentives). Because these tactics have become the staple of many health promotion interventions, they often appear to be ethically “neutral” or morally justified because of their presumed effectiveness (drawing on the assumption that “the ends justify the means”). Because of this presumption, it is important to scrutinize each communication and marketing tactic used in health promotion interventions for potential ethical concerns.

Labeling, Shaming, and Stigmatization

A prominent concern in health promotion interventions is that by presenting members of certain groups that are at risk for serious diseases, or that people who engage in particular practices are responsible for a specific health problem, this may inadvertently label these individuals or groups in a way that can negatively affect their identity, cause them to feel shame, or even stigmatize them. It should be noted that despite the sophistication of current scientific understanding of the etiology of diseases, people might adopt moral frameworks and social stereotypes when aiming to explain health-related conditions of diseases (Douglas, 1994 ). Indications of adverse societal-level effects of stigmatization can be found in the tendency of people who hold stigmatizing views to support coercive measures and discrimination against individuals with these conditions. It is suggested that health messages that warn against the risk of contracting a stigmatized medical condition may inadvertently serve to reinforce prejudice and damage the self-esteem of those who have these conditions (Glick, Crystal, & Lewellen, 1994 ). Even school-based programs for weight loss have been found to stigmatize children. Similarly, messages depicting the horror of being confined to a wheelchair because of drunk driving or the use of guns were perceived by individuals with mobility disabilities as devaluing them and attacking their self-esteem and dignity (Wang, 1998 ).

Not only stigmatization, but also labeling, has been shown to affect the identity of individuals or groups. Persuasive messages can influence the way people see themselves or their sense of identity (Foucault, 1972 ). For example, labeling people by connecting their persona to their medical condition may lower their self-esteem or place them in an almost constant state of anxiety (Barsky, 1988 ). Even humorous uses of presumably harmless stereotypes in health messages need to be scrutinized for ethical implications. Similarly, the use of shaming has been used as persuasive means in various health promotion interventions, whether portraying smokers, drivers, or parents as stupid, hateful, or ridiculous, or even using sexually insulting metaphors. The use of stigma has been a contested issue because proponents argue that it is an effective approach that draws on social norms (Bayer, 2008 ). However, opponents argue that it is not ethical, and that it is an important challenge for health promotion interventions to avoid labeling, stigmatizing, or shaming (Brennan & Binney, 2010 ). Further, these types of appeals serve to distance people and, rather than elicit compassion and social connectedness, they contribute to what scholars describe as othering (Thompson & Kumar, 2011 ).

Ethical Issues in Using Scare Tactics and Graphic Appeals

It is widely believed among communication practitioners, researchers, and the public, although also strongly contested, that an effective way to influence people to adopt practices that will protect them or those they care for from risk is to elicit strong emotions of fear, anxiety, and even disgust (Lupton, 2013 ). Proponents argue these tactics are justified because they work. The dilemma of whether to use highly graphic or provocative appeals is particularly vexing when members from the intervention’s population suggest that they should be used, or when studies report that people indicate that these types of messages are the ones that are more likely to influence their intentions to adopt the recommended practice. On the one hand, it could be argued that these types of findings could be construed as indicating people’s consent. On the other hand, there are both theories and empirical evidence that counter claims regarding the effectiveness of using graphic images of mutilated bodies and other similar types of appeals. In addition, the studies mainly report on intentions or, when behavioral changes are found, the interventions include other factors (e.g., enforcement or support measures).

Further, from the perspective of ethics, several compelling arguments can be made why their use raises serious ethical concerns. These include that strong emotional appeals deny people from engaging in autonomous decision making; such appeals can create anxiety and distress, and people continue to see the images regardless of the risk message; these appeals may contribute to inequity because people in vulnerable populations are more likely to feel that they can do little about the risk about which they are warned, and it may generate in them a sense of ineptness or even fatalism (Hastings, Stead, & Webb, 2004 ).

Using Provocative Appeals and Strong Negative Emotional Appeals

One of the communication tactics to gain audience attention and to raise issues to the media and public agenda is to use provocative and shock tactics (Vezina & Paul, 1997 ), which might include graphic, violent images of acts such as self-mutilation (Donovan, Jalleh, Fielder, & Ouschan, 2009 ), or images considered disgusting (Lupton, 2015b ). Clearly, provocative ads can elicit discussion, put an issue on the public agenda, and enhance people’s memories regarding the ad or the brand (Wu & Morales, 2012 ). However, researchers note that provocative ads might not achieve the intended effects, and often their effects are limited to gaining attention rather than achieving long-term goals (Brown, Bhadury, & Pope, 2010 ; Dahl, Frankenberger, & Manchanda, 2003 ).

These types of communication tactics tend to raise objections, as in the example of complaints registered to the British Advertising Standards Authority (ASA). In this case, two of the top 10 ads that received complaints concerned health promotion. One such ad was from the British Department of Health’s antismoking campaign, which showed smokers having a fish hook pulled through their cheeks, representing their craving for cigarettes (BBC, 2008 ). Another example is the Australian White Ribbon Day 2006 campaign on the topic of family violence, which was severely criticized by mental health professionals and those working in the family and domestic violence sector because of depictions of suicide and self-harm in the television advertising and accompanying promotional materials. However, the organization rejected the requests of concerned groups, claiming that the violent imagery used was necessary to attract men’s attention (Donovan et al., 2009 ).

Another critique of provocative ads is that the strong emotional impression that they create might overshadow other types of discourse and social values. Further, studies find that the response of people from vulnerable populations to public health campaigns using negative emotional appeals were anger, retreat, guilt, passive helplessness, and despondency, rather than empowered decisions to act (Lupton, 2015b ).

Ethical Issues Regarding Cultural Sensitivity and Moral Relativism

An important tenet is respect for cultural heritage and sensitivity to cultural beliefs and customs. Often, health promotion programs incorporate cultural values, symbols, and themes into health messages, which can reflect cultural sensitivity and serve as a way to encourage the adoption of the health recommendations in question. Interventions may aim to promote behaviors or attitudes that contradict certain cultural values or be viewed by members of this group as offensive (Cortese, 1990 ). Health promotors might need to find ways to raise issues or provide information on topics considered taboo or sensitive. For example, the issue of sexually transmitted diseases is socially sensitive in various cultures, and therefore, communication about it raises ethical dilemmas. On the one hand, health promoters have the obligation to provide people with information related to sexuality so that they can prevent or treat sexually transmitted diseases and to destigmatize these diseases; on the other hand, exposing people to such information might offend them.

Research in certain Asian communities indicates that advertisements that refer to the use of condoms can offend members of the community and cause embarrassment to them when shown in public. Similarly, other “unmentionables” are birth control products and contraceptives, and clinic services for sexually transmitted diseases (Waller & Fam, 2011 ). This poses challenges on how to provide people from marginalized social groups with relevant information on such topics. Further, it raises the question of whether the importance of providing this data might override cultural considerations that are highly important to a particular social group.

Health promotion interventions also might have to address the contentious issue concerning moral relativism: whether to respect particular cultural values that are cherished by members of a certain cultural group, but which conflict with moral precepts people outside it considered to be universal (Macklin, 1999 ). These might include gender equity and children’s health issues. There are situations in which health promoters may consider overriding the consideration of cultural sensitivity because they believe that it is essential to address the health topic, or even to abolish a certain practice if they conceive it as unhealthy and immoral.

Digital Media in Health Promotion: Issues of Privacy and Democracy

Developments in digital technology offer opportunities to tailor it to one’s own circumstance. They can also be used to help people manage their personal practices or receive support in order to promote their health or fitness. Using such personalized digital devices typically necessitates disclosing personalized information on one’s activities, preferences, weight, food and alcohol consumption, and even relationships. This raises issues regarding respect for privacy and infringement on people’s autonomy via the ability of organizations, corporations, and government agencies to obtain personal data, in particular since these platforms tend not to offer tight security of these data. Critics contend that these data can be used by corporations and government agencies for monitoring or commercial purposes. This poses an additional challenge associated with autonomy, to provide access to such data (on an aggregate level) for the purpose of advocacy and to enhance the capacity of autonomy to individuals and organizations to promote changes that are important to them. The emphasis on digitized personalized health promotion strategies raises an additional concern because it serves to focus on individual responsibility for health. This could serve to deemphasize social, cultural, and political determinants of health and also deemphasize inequities in the use of digital technology for health promotion due to social, cultural, and economic inequities among individuals and groups (Lupton, 2015a ). Another issue concerns democracy and the ability of people to have access to information that is not controlled by commercial interests, given the commercial nature of mass media and the increasing commodification of internet and digital channels, whether in terms of search engines or social media. This also raises ethical issues regarding commercial companies’ use for public health promotion communication.

Denial of Gratification

Health promotion activities often call upon people to give up practices that they enjoy, which may serve as stress-coping practices or have become part of their identity or daily routine. These practices may have cultural significance or emotional importance, even when they may be viewed as risky or even immoral. Such practices might offer members of vulnerable groups not only pleasure, but also an important coping mechanism that is not easily replaced. This has been observed regarding smoking, food consumption, or engagement in practices that provide high sensations (MacAskill, Stead, MacKintosh, & Hastings, 2002 ; Hove, 2014 ). Those who are less economically or socially privileged may have fewer options for healthier substitutions. An ethical issue is whether health promoters are morally obligated to help find alternative practices when they aim to eliminate practices that serve social or emotional functions, particularly among members of diverse cultural or economically disadvantaged groups.

Turning Health into an Overriding Value and the Discourse About Health

Even ardent proponents of health promotion have noted with concern the moral impact of health promotion messages on culture and society, as people and governments conceptualize health as an overriding value (Becker, 1993 ). Critics maintain that industrialized societies have become obsessed with the promotion and protection of health and that the pursuit of health has turned into a crusade with moral overtones. When health becomes an overriding value, it can turn into something that people pursue relentlessly at the expense of other things in their lives, or in turn, they may feel inadequate when they do not do so. An emphasis on good health as a value can turn those who have no serious health problems into the “worried well” and may contribute to people’s escalating expectations from medicine and the healthcare system. This may raise concerns regarding equity because the more powerful groups will be able to demand that the healthcare system meet their needs at the expense of programs that meet the needs of underserved populations.

Another concern is that a cultural preoccupation with personal health practices may distract people and health promotors from other social issues, causes of ill health, and issues of justice (Carter et al., 2011 ). It is feared that an emphasis on personal health as a value may serve to promote self-interest at the expense of equity and concern for others. This raises the dilemma of how to promote health issues without them turning health into an overall value. Because health promotion communication interventions increasingly have a strong presence in society and are pervasive in the media on the national and local levels, in the workplace, at school, and in community settings, this raises a concern regarding their role in the appropriation of the political, social, and moral realms of the public consciousness and discourse.

Collaborations and Sponsorships

Health promotion interventions are often done in collaboration with organizations from the public and private sector, including work organizations, corporations, and commercial media companies. This is a growing phenomenon because of corporations aiming to be involved in activities that show their corporate social responsibility (also for economic reasons). Whereas these collaborations might be deemed beneficial and even necessary to reach various segments of the population, to obtain funds, or to make health promoting changes within these organizations, inevitably they raise ethical concerns as well. Organizations that market food products collaborate in health promotion interventions to promote healthier eating. One prominent example was the collaboration between a heart disease prevention organization and a large company that produces breakfast cereals (Glanz et al., 1995 ). Another prominent and contentious example is the partnerships of road safety organizations with alcohol companies in encouraging road safety. These companies support road safety initiatives such as promoting the use of designated drivers or providing rides for drivers who had consumed alcoholic beverages. These initiatives not only provide them with legitimacy, but they can also continue promoting their product and increase sales (Hastings, 2007 ). There are also collaborations that take place with organizations that could be considered in the “opposite camp” or the “competition”—for example, working on health promotion interventions with religious groups that oppose sex education (Truss & White, 2010 ). Some organizations or individuals might be against providing information and education to youth about the prevention of sexually transmitted diseases, although these youth might be at risk for these diseases. Each type of collaboration raises ethical issues that need to be identified and considered.

Another type of collaboration takes place when health promotion communication interventions are developed and implemented in collaboration with media professionals, which presents ethical challenges associated with this type of collaboration. For example, advertising media professionals might believe that it is their professional duty to be creative, which to them often means that they should develop appeals that are considered provocative. Advertising professionals might also aim to guard against using so-called preachy messages, which they believe would irritate the intended audiences, whereas health promotors might believe that it is their duty to emphasize the recommended health practices, which could come off as preaching (Bouman & Brown, 2010 ).

Health promotion communication interventions invariably raise different types of ethical issues that are important to consider from the outset. They pose dilemmas and ethical concerns on each level of the intervention, from its articulation of goals; decisions of who represents the intended population in order to gain trust, collaboration, and inclusion; the channels and content of the health-related information; and the assessment of the intervention outcomes. Ethical frameworks and stipulations can be used to identify and debate ethical issues and find ways to address them. It is important to identify ethical issues, especially in goals that appear to be most important or in strategies that are considered the most effective. It is important to be able to consider adverse unintended consequences on the individual, cultural, and social levels, as well as on democratic ideals. This requires a systematic ethical analysis to elucidate value considerations and requires scrutiny of the health promotion messages for ethical issues, which should become a routine part of health promotion activities.

• Andreasen, A. R. (Ed). (2001). Ethics in social marketing . Washington, DC: Georgetown University Press.
• Anjali Jain . (2010). Temptations in cyberspace: New battlefields in childhood obesity. Health Affairs , 29 (3), 425–429.
• Ayo, N. (2012). Understanding health promotion in a neoliberal climate and the making of health conscious citizens. Critical Public Health , 22 , 99–105.
• Barsky, A. J. (1988). Worried sick: Our troubled quest for wellness . Boston, MA: Little, Brown.
• Bayer, R. (2008). Stigma and the ethics of public health: Not can we but should we. Social Science & Medicine , 67 (3), 463–472.
• BBC . (2008, April 30). Article on 10 most controversial ads . BBC News.
• Beauchamp, D. , & Childress, J. F. (2001). Principles of biomedical ethics (5th ed.). New York: Oxford University Press.
• Beauchamp, T. (1996). Moral foundations. In S. S. Coughlin & T. L. Beauchamp , Ethics and Epidemiology (pp. 24–52). Oxford: Oxford University Press.
• Beauchamp, T. L. (2009). Principle of biomedical ethics. New York: Oxford University Press.
• Beauchamp, T. L. , & Childress, J. F. (1994). Principles of biomedical ethics (4th ed.). New York: Oxford University Press.
• Becker, M. H. (1993). A medical sociologist looks at health promotion. Journal of Health and Social Behavior , 34 , 1–6.
• Berkman L. , & Breslow, L. (1983). Health and ways of living . New York: Oxford University Press.
• Bouman, M. P. , & Brown, W. J. (2010). Ethical approaches to lifestyle campaigns. Journal of Mass Media Ethics: Exploring Questions of Media Morality , 25 (1), 34–52.
• Brenkert, G. G. (2002). Ethical challenges of social marketing. Journal of Public Policy and Marketing , 21 (1), 14–25.
• Brennan, L. , & Binney, W. (2010). Fear, guilt, and shame appeals in social marketing. Journal of Business Research , 63 , 140–146.
• Brown, M. R. , Bhadury, R. K. , & Pope, N. K. L. (2010). The impact of comedic violence on viral advertising effectiveness. Journal of Advertising , 39 (1), 49–66.
• Buchanan, D. (2008). Autonomy, paternalism, and justice: Ethical priorities in public health. American Journal of Public Health , 98 (1), 15–21.
• Buchanan, D. R. (2000). An ethic for health promotion: Rethinking the sources of human well-being . New York: Oxford University Press.
• Burris, S. (2008). Stigma, ethics, and policy: A commentary on Bayer’s “stigma and the ethics of public health: Not can we but should we.” Social Science & Medicine , 67 , 473–475.
• Cairns, G. , Angus, K. , Hastings, G. , & Caraher, M. (2013). Systematic review of the evidence on the nature, extent, and effects of food marketing to children: A retrospective summary. Appetite , 62 , 209–215.
• Callahan, D. , & Jennings, B. (2002). Ethics and public health: Forging a strong relationship. American Journal of Public Health , 92 , 168–175.
• Carter, S. M. (2015). The ethics of menu labelling. Public Health Ethics , 8 (1), 94–97.
• Carter, S. M. , Rychentnik, L. , Lloyd, B. , Kerridge, I. H. , Baur, L. , & Zask, A. (2011). Evidence, ethics, and values: A framework for health promotion. American Journal of Public Health , 101 (3), 465–472.
• Castleden, H. , Garvin, T. , & Huu-ay-aht First Nation . (2008). Modifying Photovoice for community-based participatory indigenous research. Social Science and Medicine , 66 , 1393–1405.
• Chapman, S. , & Mackenzie, R. (2012). Can it be ethical to apply limited resources in low-income countries to ineffective, low-reach smoking cessation strategies? A reply to Bitton and Eyal. Public Health Ethics , 5 (1), 29–37.
• Cho, H. , & Salmon, C. T. (2007). Unintended effects of health communication campaigns. Journal of Communication , 57 (2), 293–317.
• Christians, C. G. (2007). Utilitarianism in media ethics and its discontents. Journal of Mass Media Ethics , 22 , 113–131.
• Cortese, A. (1990). Ethnic ethics: The restructuring of moral theory . Albany: State University of New York Press.
• Crawshaw, P. (2012). Governing at a distance: Social marketing and the (bio)politics of responsibility. Social Science & Medicine , 74 , 200–207.
• Cribb, A. , & Duncan, P. (2002). Health promotion and professional ethics . Oxford: Blackwell.
• Dahl, D. W. , Frankenberger, K. D. , & Manchanda, R. (2003). Does it pay to shock? Journal of Advertising Research , 43 (3), 268–280.
• Daniels, N. (1985). Just health care . New York: Cambridge University Press.
• Dawson, A. , & Grill, K. (2012). Health promotion: Conceptual and ethical issues. Public Health Ethics , 5 (2), 101–103.
• Dejong, W. , Atkin, C. K. , & Wallack, L. (1992). A critical analysis of “moderation” advertising sponsored by the beer industry: Are “responsible drinking” commercials done responsibly? Milbank Quarterly , 70 (4), 661–677.
• Ditter, S. M. , Elder, R. W. , Shults, R. A. , Sleet, D. A. , Compton, R. , & Nichols, J. L. (2005). Effectiveness of designated driver programs for reducing alcohol-impaired driving. American Journal of Preventive Medicine , 28 (5), 280–287.
• Donovan, J. R. , Jalleh, G. , Fielder, L. , & Ouschan, R. (2009). Ethical issues in pro-social advertising: The Australian 2006 White Ribbon Day campaign. Journal of Public Affairs , 9 (1), 5–19.
• Douglas, M. (1994). Risk and blame: Essays in cultural theory . London: Routledge.
• Dutta, M. J. (2011). Communicating social change: Structure, culture, and agency . New York: Routledge, Taylor & Francis Group.
• Eagle, L. , & the National Social Marketing Centre . (2009). Social marketing ethics: Report prepared for the National Social Marketing Centre . London: National Social Marketing Centre.
• Etzioni, A. (1998). Introduction. In A. Etzioni and E. Frazao (Eds.), The essential communication reader (pp. ix–xxxix). Lanham, MD: Rowan & Littlefield.
• Foucault, M. (1972). The archaeology of knowledge and the discourse on language . New York: Pantheon.
• Foucault, M. (1984). The Foucault reader . Hamondsworth, U.K.: Penguin.
• Gagnon, M. , Jacob, J. D. , & Holmes, D. (2010). Governing through (in)security: A critical analysis of a fear-based public health campaign. Critical Public Health , 20 , 245–256.
• Ginossar, T. , & Nelson, S. (2010). Reducing the health and digital divides: A model for using community‐based participatory research approach to e‐health interventions in low‐income Hispanic communities. Journal of Computer‐Mediated Communication , 15 (4), 530–551.
• Glanz, K. , Lankenau, B. , Foerster, S. , Temple, S. , Mullis, R. , & Schmid, T. (1995). Environmental and policy approaches to cardiovascular disease prevention through nutrition: Opportunities for state and local action. Health Education Quarterly , 22 , 512–527.
• Glick Schiller, N. , Crystal, S. , & Lewellen, D. (1994). Risky business: The cultural construction of AIDS risk groups. Social Science and Medicine , 38 (10), 1337–1346.
• Guttman, N. 2000. Public health communication interventions: Values and ethical dilemmas . Thousand Oaks, CA: SAGE.
• Guttman, N. , & Ressler, W. H. (2001). On being responsible: Ethical issues in appeals to personal responsibility in health campaigns. Journal of Health Communication , 6 , 117–136.
• Guttman, N. , & Salmon, C. T. (2004). Guilt, fear, stigma, and knowledge gaps: Ethical issues in public health communication interventions. Bioethics , 18 (6), 531–552.
• Habermas, J. (1987). The theory of communicative action. Vol. 2: Lifeworld and system: A critique of functionalist reasoning ( T. McGarthy , Trans.). Boston, MA: Beacon Press.
• Hargittai, E. (2002). Second-level digital divide: Differences in people’s online skills. First Monday , 7 (4).
• Hastings, G. (2007). Social marketing: Why should the devil have all the best tunes ? Oxford: Elsevier.
• Hastings, G. , Stead, M. , & Webb, J. (2004). Fear appeals in social marketing: Strategic and ethical reasons for concern. Psychology and Marketing , 21 (11), 961–986.
• Hiller, M. D. (1987). Ethics and health education: Issues in theory and practice. In P. M. Lazes , L. H. Kaplan , & K. A. Gordon (Eds.), The handbook of health education (2d ed., pp. 87–107). Rockville, MD: Aspen.
• Holden, S. S. , & Cox, D. (2013). Public health marketing: Is it good and is it good for everyone? International Journal of Marketing , 52 , 17–26.
• Hornik, R. C. , & Ramirez, A. S. (2006). Racial/ethnic disparities and segmentation in communication campaigns. American Behavioral Scientist , 49 (6), 868–884.
• Hove, T. (2014). Ethical influence in health promotion: Some blind spots in the liberal approach. Public Health Ethics , 7 (2), 134–143.
• Howard, D. E. , Griffin, M. , Boekeloo, B. , Lake, K. , & Bellows, D. (2007). Staying safe while consuming alcohol: A qualitative study of the protective strategies and informational needs of college freshmen. Journal of American College Health , 56 (3), 247–254.
• Johannesen, R. L. (1996). Ethics in human communication (4th ed.). Prospect Heights, IL: Waveland Press.
• Johannesen, R. L. , Valde, K. S. , & Whedbee, K. E. (2008). Ethics in human communication (6th ed.). Long Grove, IL: Waveland Press.
• Khuse, H. , & Singer, P. (2001). What is bioethics? A historical introduction. In H. Kuhse & P. Singer (Eds.), A companion to bioethics (pp. 3–11). Oxford: Blackwell.
• Kirby, S. D. , & Andreasen, A. R. (2001). Marketing ethics to social marketers: A segmentation approach. In A. R. Andreasen , (Ed), Ethics in social marketing (pp. 160–183). Washington, DC: Georgetown University Press.
• Korda, H. , & Zena, I. (2013). Harnessing social media for health promotion and behavior change. Health Promotion Practice , 14 (1), 15–23.
• Kotler, J. A. , Shiffman, J. M. , & Hanson K. G. (2012). The influence of media characters on children’s food choices. Journal of Health Communication: International Perspectives , 17 , 886–898.
• Kreps, G. L. (2005). Disseminating relevant health information to underserved audiences: Implications of the Digital Divide Pilot Projects. Journal of the Medical Library Association , 93 (4 Suppl.): S68–S73.
• Kulkla, R. (2006). Ethics and ideology in breastfeeding advocacy campaigns. Hypatia , 21 , 157–181.
• Lee, C. , Rogers, W. A. , & Braunack-Mayer, A. (2008). Social justice and pandemic influenza planning: The role of communication strategies. Public Health Ethics , 1 (3), 223–234.
• Lee, N. R. , & Kotler, P. A. (2015). Social marketing: Changing behaviors for good . (5th ed.). Thousand Oaks, CA: SAGE.
• Lefebvre, R. C. (2013). Social marketing and social change: Strategies and tools for improving health, well-being, and the environment . San Francisco, CA: John Wiley.
• Lupton, D. (1993). Risk as moral danger: The social and political functions of risk discourse in public health. International Journal of Health Services , 23 , 425–435.
• Lupton, D. (2013). Risk and emotion: Towards an alternative theoretical perspective. Health, Risk, & Society , 15 (8), 634–647.
• Lupton, D. (2015a). Health promotion in the digital era: A critical commentary. Health Promotion International , 30 (1), 174–183.
• Lupton, D. (2015b). The pedagogy of disgust: The ethical, moral, and political implications of using disgust in public health campaigns. Critical Public Health , 25 (1), 4–14.
• MacAskill, S. , Stead, M. , MacKintosh, A. M. , & Hastings, G. (2002). “You cannae just take cigarettes away from somebody and no’ gie them something back”: Can social marketing help solve the problem of low-income smoking? Social Marketing Quarterly , 8 (1), 19–34.
• Macklin, R. (1999). Against relativism: Cultural diversity and the search for ethical universals in medicine . New York: Oxford University Press.
• Makau, J. , & Arnett, R. (Eds.). (1997). Communication ethics in an age of diversity . Urbana, IL: University of Illinois Press.
• Mayes, C. , & Thompson, D. B. (2014). Is nutritional advocacy morally indigestible? A critical analysis of the scientific and ethical implications of “healthy” food choice discourse in liberal societies. Public Health Ethics , 7 (2), 158–169.
• McCartney, M. (2010). Selling health to the public. BMJ , 341 , c6639.
• McLeroy, K. R. , Clark, N. M. , Simons-Morton, B. G. , Forster, J. , Connell, C. M. , Altman, D. , & Zimmerman, M. A. (1995). Creating capacity: Establishing a health education research agenda for special populations. Health Education Quarterly , 22 , 390–405.
• Mittelmark, M. B. (2008). Setting an ethical agenda for health promotion. Health Promotion International , 23 (1), 78–85.
• Neiger, B. L. , Thackeray, R. , Van Wagenen, S. A. , Hanson, C. L. , West, J. H. , Barnes, M. D. , & Fagen, M. C. (2012). Use of social media in health promotion: Purposes, key performance indicators, and evaluation metrics. Health Promotion and Practice , 13 (2), 159–164.
• Nelkin, D. , & Gilman, S. (1991). Placing blame for devastating disease. In A. Mack (Ed.), In time of plague: The history and social consequences of lethal epidemic disease (pp. 39–56). New York: New York University Press.
• Newton, J. D. , Newton, F. J. , Turk, T. , & Ewing, M. T. (2013). Ethical evaluation of audience segmentation in social marketing. European Journal of Marketing , 47 (9), 1421–1438.
• Nodding, N. (1990). Ethics from the standpoint of women. In M. Pearsall (Ed.), Women and values: Reading in recent feminist philosophy (2d ed., pp. 379–390). Belmont, CA: Wadsworth.
• Olufowote, J. O. (2008). A structural analysis of informed consent to treatment: Societal evolution, contradiction, and reproductions in medical practice. Health Communication , 23 , 292–303.
• Owens, J. , & Cribb, A. (2013). Beyond choice and individualism: Understanding autonomy for public health ethics. Public Health Ethics , 6 (3), 262–271.
• Papa, W. H. , & Singhal, A. (2006). Organizing for social change: A dialectic journey of theory and praxis. Thousand Oaks, CA: SAGE.
• Petty, R. E. , & Cacioppo, J. T. (1984). The effects of involvement on responses to argument quantity and quality: Central and peripheral routes to persuasion. Journal of Personality and Social Psychology , 46 , 69–81.
• Rossi, J. , & Yuell, M. (2012). The use of persuasion in public health communication: An ethical critique. Public Health Ethics , 5 (2), 192–205.
• Rothschild, M. L. (2001). Ethical considerations in the use of marketing for the management of public health and social issues. In A. R. Andreasen , (Ed.), Ethics in social marketing (pp. 39–69). Washington, DC: Georgetown University Press.
• Seedhouse, D. (2001). Health promotion’s ethical challenge. Health Promotion Journal of Australia , 12 , 135–138.
• Slater, M. D. , & Rouner, D. (2002). Entertainment-education and elaboration likelihood: Understanding the processing of narrative persuasion. Communication Theory , 12 , 173–191.
• Smith, W. A. (2001). Ethics and the social marketer: A framework for practitioners. In A. R. Andreasen (Ed.), Ethics in social marketing (pp. 1–16). Washington, DC: Georgetown University Press.
• Sontag, S. (1989). AIDS and its metaphors . New York: Farrar, Straus, & Giroux.
• Sood, S. , Menard, T. , & Witte, K. (2004). The theory behind entertainment-education. In A. Singhal , M. J. Cody , E. M. Rogers , & M. Sabido (Eds.), Entertainment-education and social change (pp. 117–145). Mahwah, NJ: Lawrence Erlbaum Associates.
• Story, M. , & French, S. (2004). Food advertising and marketing directed at children and adolescents in the US. International Journal of Behavioral Nutrition and Physical Activity , 1 , 3.
• Thompson, L. , & Kumar, A. (2011). Responses to health promotion campaigns: Resistance, denial, and othering. Critical Public Health , 21 , 105–117.
• Tong, R. (1998). The ethics of care: A feminist virtue ethics of care for healthcare practitioners. Journal of Medicine and Philosophy , 23 (2), 131–152.
• Truss, A. , & White, P. (2010). Ethical issues in social marketing. In J. French , C. Blair-Stevens , D. McVey , & R. Merritt (Eds.), Social marketing and public health: Theory and practice (pp. 139–149). Oxford: Oxford University Press.
• Turoldo, F. (2009). Responsibility as an ethical framework for public health interventions. American Journal of Public Health , 99 (7), 1197–1202.
• van Deursen, A. J. , & Van Dijk, J. A. (2014). The digital divide shifts to differences in usage. New Media & Society , 16 (3), 507–526.
• Veatch, R. M. (1998). The place of care in ethical theory. Journal of Medicine and Philosophy , 23 (2), 210–224.
• Vezina, R. , & Paul, O. 1997. Provocation in advertising: A conceptualization and an empirical assessment. International Journal of Research in Marketing , 14 (2), 177–192.
• Viswanath, K. , & Ackerson, L. K. (2011). Race, ethnicity, language, social class, and health communication inequalities: A nationally-representative cross-sectional study. PLoS One , 6 (1), e14550.
• Viswanath, K. , Breen, N. , Meissner, H. , Moser, R. P. , Hesse, B. , Steele, W. R. , & Rakowski, W. (2006). Cancer knowledge and disparities in the information age. Journal of Health Communication , 11 (Suppl. 1), 1–17.
• Viswanath, K. , & Kreuter, M. W. (2007). Health disparities, communication inequalities, and ehealth. American Journal of Preventative Medicine , 32 , 131–133.
• Waller, D. D. , & Fam, K. (2011). Reducing offensiveness of STD prevention advertisements in China. Social Work in Public Health , 26 , 621–634.
• Wang, C. (1998). Portraying stigmatizing conditions: Disabling images in public health. Journal of Health Communication , 3 , 149–159.
• Wikler, D. (1987). Who should be blamed for being sick? Health Education Quarterly , 14 , 11–25.
• Williams-Piehota, P. , Cox, A. , Navarro S. , Mowad, L. , Garcia, S. , Katulak, N. , & Salovey, P. (2004). Casting health messages in terms of responsibility for dietary change: Increasing fruit and vegetable consumption. Journal of Nutrition Education and Behavior , 36 (3), 114–120.
• Wu, E. C. , & Morales, A. C. (2012). How disgust enhances the effectiveness of fear appeals. Journal of Marketing Research , 49 , 383–393.

Related Articles

• Appeal to Bystander Interventions: A Normative Approach to Health and Risk Messaging
• Appeals to Morality in Health and Risk Messaging
• Positive Deviance: A Non-Normative Approach to Health and Risk Messaging
• Rehabilitation Groups
• Humor in Health and Risk Messaging
• Social Marketing Applied to Health and Risk Messaging
• Big Data's Role in Health and Risk Messaging
• Cultivation in Health and Risk Messaging
• Advocacy Groups as Agents for Change in Health and Risk Messaging

Printed from Oxford Research Encyclopedias, Communication. Under the terms of the licence agreement, an individual user may print out a single article for personal use (for details see Privacy Policy and Legal Notice).

date: 26 March 2024

• Cookie Policy
• Privacy Policy
• Legal Notice
• Accessibility
• [66.249.64.20|185.80.148.109]
• 185.80.148.109

Character limit 500 /500

Search for sound, actionable information, vetted by the CDC and experts, to help employers launch or expand a workplace health promotion program.

Available Now as an Online Application Learn More

Walking Campaign Tools Learn more

Search results of the first national employer workplace health promotion survey in 13 years. Learn more

Workplace Health Promotion

On average, Americans working full-time spend more than one-third of their day, five days per week at the workplace. The use of effective workplace programs and policies can reduce health risks and improve the quality of life for American workers. Learn more about workplace health promotion and how to design, implement, and evaluate effective workplace health programs.

Searchable, research-based tools and resources to help employers develop or expand a workplace health promotion program that supports their employees’ physical, mental, emotional, and financial well-being.

A comprehensive approach with interventions that address multiple risk factors and health conditions at the same time. The model recognizes that the interventions and strategies chosen influence each employee and the organization as a whole.

An employer-based training program to improve the health of participating employers and certified trainers, with an emphasis on reducing chronic disease and injury risk and improving worker productivity.

A tool designed to help employers assess if they are implementing science-based health promotion interventions in their worksites to prevent heart disease, stroke, and related health conditions such as hypertension, diabetes, and obesity.

Evidence-based programs, policies, and practices

Current CDC-supported research projects

Facts, statistics, and the Workplace Health in America survey

Recommendations, fact sheets, core elements, health topics, toolkits

• Hospital Employees' Health • Strengthening Workplace Health

CDC Workplace Health Program, goals, what we do, future directions

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

Research identifies characteristics of cities that would support young people's mental health

As cities around the world continue to draw young people for work, education, and social opportunities, a new study identifies characteristics that would support young urban dwellers' mental health. The findings, based on survey responses from a global panel that included adolescents and young adults, provide a set of priorities that city planners can adopt to build urban environments that are safe, equitable, and inclusive.

To determine city characteristics that could bolster youth mental health, researchers administered an initial survey to a panel of more than 400, including young people and a multidisciplinary group of researchers, practitioners, and advocates. Through two subsequent surveys, participants prioritized six characteristics that would support young city dwellers' mental health: opportunities to build life skills; age-friendly environments that accept young people's feelings and values; free and safe public spaces where young people can connect; employment and job security; interventions that address the social determinants of health; and urban design with youth input and priorities in mind.

The paper was published online February 21 in Nature .

The study's lead author is Pamela Collins, MD, MPH, chair of the Johns Hopkins Bloomberg School of Public Health's Department of Mental Health. The study was conducted while Collins was on the faculty at the University of Washington. The paper was written by an international, interdisciplinary team, including citiesRISE, a global nonprofit that works to transform mental health policy and practice in cities, especially for young people.

Cities have long been a draw for young people. Research by UNICEF projects that cities will be home to 70 percent of the world's children by 2050. Although urban environments influence a broad range of health outcomes, both positive and negative, their impacts manifest unequally. Mental disorders are the leading causes of disability among 10- to 24-year-olds globally. Exposure to urban inequality, violence, lack of green space, and fear of displacement disproportionately affects marginalized groups, increasing risk for poor mental health among urban youth.

"Right now, we are living with the largest population of adolescents in the world's history, so this is an incredibly important group of people for global attention," says Collins. "Investing in young people is an investment in their present well-being and future potential, and it's an investment in the next generation -- the children they will bear."

Data collection for the study began in April 2020 at the start of the COVID-19 pandemic. To capture its possible impacts, researchers added an open-ended survey question asking panelists how the pandemic influenced their perceptions of youth mental health in cities. The panelists reported that the pandemic either shed new light on the inequality and uneven distribution of resources experienced by marginalized communities in urban areas, or confirmed their preconceptions of how social vulnerability exacerbates health outcomes.

For their study, the researchers recruited a panel of more than 400 individuals from 53 countries, including 327 young people ages 14 to 25, from a cross-section of fields, including education, advocacy, adolescent health, mental health and substance use, urban planning and development, data and technology, housing, and criminal justice. The researchers administered three sequential surveys to panelists beginning in April 2020 that asked panelists to identify elements of urban life that would support mental health for young people.

The top 37 characteristics were then grouped into six domains: intrapersonal, interpersonal, community, organizational, policy, and environment. Within these domains, panelists ranked characteristics based on immediacy of impact on youth mental health, ability to help youth thrive, and ease or feasibility of implementation.

Taken together, the characteristics identified in the study provide a comprehensive set of priorities that policymakers and urban planners can use as a guide to improve young city dwellers' mental health. Among them: Youth-focused mental health and educational services could support young people's emotional development and self-efficacy. Investment in spaces that facilitate social connection may help alleviate young people's experiences of isolation and support their need for healthy, trusting relationships. Creating employment opportunities and job security could undo the economic losses that young people and their families experienced during the pandemic and help cities retain residents after a COVID-era exodus from urban centers.

The findings suggest that creating a mental health-friendly city for young people requires investments across multiple interconnected sectors like transportation, housing, employment, health, and urban planning, with a central focus on social and economic equity. They also require urban planning policy approaches that commit to systemic and sustained collaboration, without magnifying existing privileges through initiatives like gentrification and developing green spaces at the expense of marginalized communities in need of affordable housing.

The authors say this framework underscores that responses by cities should include young people in the planning and design of interventions that directly impact their mental health and well-being.

• Child Psychology
• Mental Health
• Child Development
• Sustainability
• Environmental Policy
• Environmental Awareness
• Urbanization
• Public Health
• World Development
• Urban planning
• Public health
• Social psychology
• Social inequality
• Collaboration
• Social inclusion

Story Source:

Materials provided by Johns Hopkins Bloomberg School of Public Health . Note: Content may be edited for style and length.

Journal Reference :

• Pamela Y. Collins, Moitreyee Sinha, Tessa Concepcion, George Patton, Thaisa Way, Layla McCay, Augustina Mensa-Kwao, Helen Herrman, Evelyne de Leeuw, Nalini Anand, Lukoye Atwoli, Nicole Bardikoff, Chantelle Booysen, Inés Bustamante, Yajun Chen, Kelly Davis, Tarun Dua, Nathaniel Foote, Matthew Hughsam, Damian Juma, Shisir Khanal, Manasi Kumar, Bina Lefkowitz, Peter McDermott, Modhurima Moitra, Yvonne Ochieng, Olayinka Omigbodun, Emily Queen, Jürgen Unützer, José Miguel Uribe-Restrepo, Miranda Wolpert, Lian Zeitz. Making cities mental health friendly for adolescents and young adults . Nature , 2024; 627 (8002): 137 DOI: 10.1038/s41586-023-07005-4

Cite This Page :

Explore More

• Night-Time Light and Stroke Risk
• Toward Secure Quantum Communication Globally
• Artificial Nanofluidic Synapses: Memory
• 49 New Galaxies Discovered in Under Three Hours
• Rays Surprisingly Diverse 150 Million Years Ago
• Paint Coatings That Help You Feel Cool
• A Self-Cleaning Wall Paint
• Early Human Migration Out of Africa
• Unintended Consequences of Fire Suppression
• Wild Bird Gestures 'After You'

Trending Topics

Strange & offbeat.

• International edition
• Australia edition
• Europe edition

Workplace AI, robots and trackers are bad for quality of life, study finds

Tech such as laptops, tablets and instant messaging has more positive effect on wellbeing, says thinktank

Exposure to new technologies including trackers, robots and AI-based software at work is bad for people’s quality of life, according to a groundbreaking study from the Institute for the Future of Work.

Based on a survey of more than 6,000 people, the thinktank analysed the impact on wellbeing of four groups of technologies that are becoming increasingly prevalent across the economy.

The authors found that the more workers were exposed to technologies in three of these categories – software based on AI and machine learning; surveillance devices such as wearable trackers; and robotics – the worse their health and wellbeing tended to be.

By contrast, use of more long-established information and communication technologies (ICTs) such as laptops, tablets and instant messaging at work tended to have a more positive effect on wellbeing.

“We found that quality of life improved as the frequency of interaction with ICTs increased, whereas quality of life deteriorated as frequency of interaction with newer workplace technologies rose,” the report said.

While the authors did not directly investigate the causes, they pointed out that their findings were consistent with previous research which showed, “such technologies may exacerbate job insecurity, workload intensification, routinisation and loss of work meaningfulness, as well as disempowerment and loss of autonomy, all of which detract from overall employee wellbeing”.

Economists at Goldman Sachs speculated last year that 300m jobs worldwide could be automated out of existence by 2030 as a result of the development of generative AI, with many more roles radically transformed.

Dr Magdalena Soffia, the study’s lead author, said it was not necessarily the technologies themselves that are the problem, but the way in which they are adopted.

“We don’t want to claim that there is some sort of determinism in what technology causes, in terms of wellbeing,” she said. “We say it really depends on the context: on lots of structural factors, on environmental conditions, how it is designed and how it is deployed. So lots of human decisions.”

She added that the researchers used a well-established measure of quality of life, EuroQoL EQ-5D-3L, which asks respondents about factors such as their mobility, mental health and pain levels.

“We wanted to give a more multidimensional, nuanced understanding of what was happening in terms of wellbeing. So we used this measure which is a very validated measure, used by the UK public health sector,” Soffia said.

Discussing the fillip to quality of life from ICTs, she suggested “one possible potential mechanism is that actually what they do is to streamline work processes, and they make working life a bit more efficient. And that in turn, gives you kind of a sense of achievement.”

after newsletter promotion

By contrast, the findings about trackers and surveillance technologies chime with recent warnings from trades unions and campaigners about the negative impact on workers whose performance is being constantly monitored.

Mary Towers, the TUC’s lead on AI, said: “These findings should worry us all. They show that without robust new regulation, AI could make the world of work an oppressive and unhealthy place for many.

“Things don’t have to be this way. If we put the proper guardrails in place, AI can be harnessed to genuinely enhance productivity and improve working lives.”

The new report forms part of the Pissarides Review into the Future of Work and Wellbeing , being carried out by the the Institute for the Future of Work in collaboration with Warwick Business School and Imperial College London.

Prof Sir Christopher Pissarides, the veteran economist overseeing the review, said: “As new technologies rapidly reach further into our working lives it is vital that we understand how our interactions with them impact our quality of life.”

• Work & careers
• Artificial intelligence (AI)
• Health & wellbeing

Most viewed

NIH grant funds research on work-related asthma among nurses

A researcher at the Zuckerman College of Public Health will use a $750,000 grant to develop methodology to inform cleaning and disinfecting protocols and help educate nurses about asthma risks.

A National Institute of Health grant will fund a new study, “Work-related Asthma Risk for Nursing Staff Conducting Cleaning and Disinfection: Translation of Risk-risk Tradeoff Methodology,” at the Mel and Enid Zuckerman College of Public Health.

A researcher at the  University of Arizona Mel and Enid Zuckerman College of Public Health received a $750,000 National Institutes of Health grant to study the asthma risks associated with the use of cleaning and disinfecting products among nurses.

Cleaning processes in health care facilities involve an inherent “risk-risk tradeoff.” Increased use of cleaning and disinfection products leads to increased work-related asthma risks and simultaneously a decrease in occupational-infection risks.

Preliminary survey data indicate that nurses are generally willing to increase infection risks to maintain lower asthma risks if they think they will recover.

Early career researchers Amanda Wilson, PhD, will use a mentoring grant to investigate cleaning and disinfecting protocols used by nurses and their work-related asthma risks.

“Translating these concerns into cleaning and disinfection protocol changes is challenging due to logistical constraints and the lack of awareness about asthma risks,” said principal investigator  Amanda Wilson, PhD , an assistant professor in the Zuckerman College of Public Health’s  Department of Community, Environment and Policy .

Wilson will use the five-year National Heart, Lung and Blood Institute grant to gather data that can advance methodologies for relating tolerable occupational respiratory-disease risks to nurses and guide public health policies. 

In 2022, there were more than 3 million registered nurses in the United States and more than 56,000 of them worked in Arizona, according to the U.S. Bureau of Labor Statistics. Asthma affects more than 27 million people in the United States, or about 1 in 12 Americans, according to the Asthma and Allergy Foundation of America.

The study, “Work-related Asthma Risk for Nursing Staff Conducting Cleaning and Disinfection: Translation of Risk-risk Tradeoff Methodology,” is funded through a K01 Mentored Research Scientist Career Development Award that provides support for early-career researchers.

“Dr. Amanda Wilson earned her PhD with us here in the Zuckerman College of Public Health, and she is on her way to becoming an outstanding public health researcher,” said  Iman Hakim, MD, PhD, MPH , dean of the Zuckerman College of Public Health. “We are so proud of all she has accomplished. This new award shows that she is on her way to making a real difference in public health and respiratory research.”

Wilson’s mentors from the Zuckerman College of Public Health include adjunct professor  Lynn Gerald, PhD ; professor  Paloma Beamer, PhD ; and adjunct professor  Phil Harber, MD, MPH . Other mentors include Benjamin Wilfond, MD, of the University of Washington, Susan Chilton of Newcastle University and David Resnik, JD, PhD, of the National Institute of Environmental Health Sciences.

This research is supported in part by the National Heart, Lung and Blood Institute, a division of the National Institutes of Health, under award number K01HL168014.

Shipherd Reed Mel and Enid Zuckerman College of Public Health 520-626-9669, [email protected]

Dell workers can stay remote — but they're not going to get promoted

• Dell's strict new RTO mandate excludes fully remote workers from promotion. 
• Some live hours from offices and say they would now have to move states to advance their careers.
• The policy is disproportionately affecting women, one employee with access to staff data told BI. 

Dell has had a hybrid working culture in place for more than a decade — long before the pandemic struck.

"Dell cared about the work, not the location," a senior employee at Dell who's worked remotely for more than a decade, told Business Insider last month. "I would say 10% to 15% of every team was remote."

That flexibility has enabled staff to sustain their careers in the face of major life changes, several employees told BI. It has also helped Dell to be placed on the "Best Place to Work for Disability Equality Index" since 2018.

But in February Dell introduced a strict return-to-office mandate, with punitive measures for those who want to stay at home.

Under the new policy, staff were told that from May almost all will be classified as either "hybrid," or "remote."

Hybrid workers will be required to come into an "approved" office at least 39 days a quarter — the equivalent of about three days a week, internal documents seen by BI show.

If they want to keep working from home, staff can opt to go fully remote. But that option has a downside: fully remote workers will not be considered for promotion, or be able to change roles.

The memo states: "For remote team members, it is important to understand the trade-offs: Career advancement, including applying to new roles in the company, will require a team member to reclassify as hybrid onsite."

"The entire company has been complaining about this behind closed doors," said one Dell staffer, who works alongside senior management. The employee asked to remain anonymous for fear of reprisals.

Dell told BI in a statement that "in-person connections paired with a flexible approach are critical to drive innovation and value differentiation."

The approach differs from founder and CEO Michael Dell's previous support for remote workers.

In 2021, he told CRN that the company's expanded homeworking culture was "absolutely here to stay." The billionaire later criticized companies that were enforcing RTO, writing on LinkedIn: "If you are counting on forced hours spent in a traditional office to create collaboration and provide a feeling of belonging within your organization, you're doing it wrong."

His office did not respond to a request for comment from BI.

By 2022, the company line had not changed: "A long-term ambition for Dell Technologies is for 60% of our workforce to operate remotely on any given day."

But in March 2023, Dell started to change its policies with a new mandate ordering all staff living within an hour of offices to come in at least three days a week, CRN reported.

Professor Cary Cooper, an organizational psychologist and cofounder of the National Forum for Health and Wellbeing at work, says Dell's pivot could be a "panicked reaction to a world economy that's not very buoyant."

"When that occurs, people turn inwards. They think, maybe if we brought everybody in, it'll make a difference. We'll perform better," Cooper told BI.

"Senior execs somehow think that people in the office are more productive than at home, even though there's no evidence to back that up."

There's also a "pack mentality" at play, says Cooper, with tech companies trying to follow what everybody else is doing, rather than continue with what has worked for them.

"First on the chopping block"

Frustrated workers at Dell spoke out anonymously to BI about how the new policy will affect them.

One said: "We're being forced into a position where either we're going to be staying as the low man on the totem pole, first on the chopping block when it comes to workforce reduction, or we can be hybrid and go in multiple days a week, which really affects a lot of us."

The staffer said she and many colleagues were hired on remote contracts during the pandemic.

The Dell worker lives about a 45-minute drive from the nearest office and works 10-hour shifts four days a week. However, traveling there would be virtually impossible given she no longer drives following a car crash.

Related stories

She said many of her colleagues would find it very challenging to get to the office three days a week.

'Approved' offices

One Dell worker is already feeling the effects of the new policy.

Dell's list of "approved" sites includes 17 offices in the US and 26 globally — but not the senior employee's nearest office. "I now know I have no office. So I am remote, or I move if I want to stay."

BI has viewed a promotion offer sent to the long-serving remote worker around the same time as the RTO mandate was announced.

To accept that promotion, the employee would not only have to start coming into the office, but move state to be near an "approved" site.

Geographically divided teams

Employees also say that Dell's claims about fostering "in-person connection" do not add up.

It is common for teams at Dell to be spread around the US and even other countries, according to BI's senior source at Dell, who works across the organization and has access to employee data.

"Every team has people in at least two states, some in three or four. I can't think of one team where everyone is in one location," the person said.

That means that even if commuting distances are feasible, many won't be able to collaborate face-to-face with their teams in the same office.

Another Dell worker told BI: "I would support that if I actually had team members that were local and would actually go on-site. With us being so spread out around the United States, there's really no point in us going in. I'm going to be in a room with a bunch of people who don't know how to do my job or how to help me."

Disproportionate impact

BI's senior source at Dell used their access to pull data about the composition of remote teams.

"I deal with many many teams across our business. Every team I work with has at least one person if not two or three affected by this policy," said the senior source at Dell.

"They are overwhelmingly women. This new policy on its face appears to be anti-remote, but in practice will be anti-woman."

"Quiet firing"

Workers who spoke to BI also said they believe the new measures are a way to push some employees out — a phenomenon known as "quiet firing."

"This level of micromanagement makes me want to leave Dell," one said, adding that since the announcement was made, dozens of staff have been discussing quitting in Discord chats.

Two other staff including one based in Germany who spoke to BI also said many people were now considering leaving Dell.

In February last year, Dell laid off about 5% of its workforce, or about 6,600 jobs, per an SEC filing, in the wake of poor PC sales.

"It's not about culture. Period," the senior Dell worker agreed. "There are headcount cuts that need to happen and we are suffering. If people leave on their own, they don't have to pay out severance."

Cooper agreed that the level of control in this policy would result in some resignations.

"An important source of ill health in the workplace is people feeling they don't have control and autonomy over their job," he said. "If they're downsizing, maybe they're saying, well, the people who are not prepared to come into the office. Well, they can go elsewhere."

Dell's move is one of the most abrupt changes to remote work policies largely introduced when the pandemic struck. Its progress will contribute to the debate over the future of work and whether working culture will evolve for good.

Are you a worker at Dell or another company pushing staff back to the office? Contact this reporter at [email protected]

Watch: Microsoft's chief brand officer, Kathleen Hall, says the company's employees are its best product testers

• Main content

Get Our Latest News!

• Join Our Community

Breaking Down Barriers to Pancreatic Cancer Research: Two New Publications Highlight PanCAN’s Work

by Erin Post  —  Mar 25, 2024

Through the SPARK health data platform , PanCAN breaks down barriers to pancreatic cancer research by making real-world patient data accessible and easy-to-use for scientists across the country. This important work is making a difference: Two recent publications highlight how SPARK stands to accelerate progress on new treatments and improve patient outcomes.

The stakes couldn’t be higher, said PanCAN Chief Science Officer Lynn Matrisian, PhD, MBA . Right now, pancreatic cancer is the third-leading cause of cancer-related death and it’s on track to become the second by 2030 .

“We need research breakthroughs for pancreatic cancer,” she said. “Our SPARK platform brings scientists together and gives them the tools and  access to data from patients treated at institutions across the country . This type of collaboration promises to get us to the next new discovery for patients facing pancreatic cancer.”

A team of PanCAN leaders, including Matrisian as well as PanCAN Director of Data Science and Informatics Kawther Abdilleh, PhD , and PanCAN Chief Business Officer Sudheer Doss, PhD , are authors on both papers, as are many PanCAN-affiliated researchers. One paper introduces SPARK and how it is useful to researchers; the second discusses how data from SPARK helped to uncover new insights into how a common gene mutation in pancreatic cancer relates to overall survival.

Here are some key facts about each paper:

 “PanCAN’s SPARK: A cloud-based patient health data and analytics platform for pancreatic cancer”

• Published in JCO Clinical Cancer Informatics in January 2024
• Although several organizations have established large oncology data resources over the past decade, none have been dedicated solely to pancreatic cancer data.
• PanCAN’s SPARK platform, powered by Velsera Seven Bridges, will include de-identified data from PanCAN’s major research initiatives. It is designed to fill this gap and make data specifically for pancreatic cancer available to all scientists.
• The pilot release introduced qualified researchers to the data resulting from PanCAN’s Know Your Tumor® precision medicine service and the analytical capabilities of the SPARK platform. Know Your Tumor tests the tumor tissue of enrolled patients for biomarkers and for some inherited mutations. The goal is to uncover treatment options that target a person’s specific biology.
• Design and development of the SPARK platform was guided by a group of representative end users, including over 80 researchers and key leaders in the pancreatic cancer research community.
• “Platforms such as SPARK are an important step toward democratization of real-world data, with potential downstream patient benefits,” said JCO Clinical Cancer Informatics Editor-in-Chief Jeremy L. Warner, MD, MS, FAMIA, FASCO.

“Impact of KRAS mutations and co-mutations on clinical outcomes in pancreatic adenocarcinoma”

• Published in Precision Oncology in February 2024
• Mutations in the gene KRAS have been shown to play an important role from the earliest formation of pancreatic tumors all the way to their progression to advanced disease.
• Using data from MD Anderson Cancer Center and Know Your Tumor, made available through SPARK, researchers compared several different KRAS co-mutations with overall survival.
• Median overall survival differed depending on the type of mutation present. For example, patients with KRAS wildtype (normal) and KRAS G12R-mutated tumors survived longer compared to patients with KRAS G12D or KRAS Q61-mutated tumors.
• Although more research is needed to understand why these differences in survival exist, the findings suggest that future treatment strategies may benefit from targeting the specific combinations of mutations present.
• By analyzing these datasets, the authors hope to provide “guidance in improving approaches to target KRAS in pancreatic cancer.”

•   biology
•   Biomarker Testing
•   genetic testing
•   Know Your Tumor
•   research
• Most popular
• Latest News

Ask a Dietitian: Helpful Hints for Smoothies

On Our Way to Goal: $20 Million in Federal Funding for Pancreatic Cancer Research

Five Simple Tips and Tools for Healthy Eating

Just Salad Returns as Premier Sponsor for PanCAN PurpleStride NYC

A New Podcast Series for Primary Care Clinicians Focuses on Early Detection

No one should face pancreatic cancer alone. Learn how we can support you.

(877) 272-6226

Mon – Fri, 7 a.m. – 5 p.m. PST You can also contact us using the below form.

Follow us on social media.

Get the latest news and updates from the Pancreatic Cancer Action Network.

1500 Rosecrans Avenue, Suite 200 Manhattan Beach, CA 90266 - Map

Phone: (310) 725-0025

Toll Free: (877) 573-9971

Fax: (310) 725-0029

Email: [email protected]

Gear, apparel, accessories and more to show off your purple pride.

• What is the Pancreas?
• What is Pancreatic Cancer?
• Living with Pancreatic Cancer
• Patient & Caregiver Services
• Stories of Hope
• PanCAN + Research
• Funding Research
• Latest Research
• Resources for Researchers
• Resources for HCPs
• Donate & Fundraise
• Be an Advocate
• Local Events
• News & Media
• Reports & Financials

©2024 Pancreatic Cancer Action Network. All rights reserved. Terms of Use | Privacy Policy

Pancreatic Cancer Action Network®, PanCAN®, PurpleStride®, Wage Hope®, Know Your Tumor®, Powerful Knowledge. Personal Treatment.®, Precision Promise℠ and Demand Better For Patients. For Survival.℠ are the trademarks of the Pancreatic Cancer Action Network, Inc.

The Pancreatic Cancer Action Network is registered as a 501©3 nonprofit organization. Contributions to the Pancreatic Cancer Action Network are tax-deductible to the extent permitted by law. The Pancreatic Cancer Action Network’s tax identification number is #33-0841281.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Indian J Community Med
• v.37(1); Jan-Mar 2012

Health Promotion: An Effective Tool for Global Health

Sanjiv kumar.

International Institute of Health Management Research, New Delhi, India

Health promotion is very relevant today. There is a global acceptance that health and social wellbeing are determined by many factors outside the health system which include socioeconomic conditions, patterns of consumption associated with food and communication, demographic patterns, learning environments, family patterns, the cultural and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. In such a situation, health issues can be effectively addressed by adopting a holistic approach by empowering individuals and communities to take action for their health, fostering leadership for public health, promoting intersectoral action to build healthy public policies in all sectors and creating sustainable health systems. Although, not a new concept, health promotion received an impetus following Alma Ata declaration. Recently it has evolved through a series of international conferences, with the first conference in Canada producing the famous Ottawa charter. Efforts at promoting health encompassing actions at individual and community levels, health system strengthening and multi sectoral partnership can be directed at specific health conditions. It should also include settings-based approach to promote health in specific settings such as schools, hospitals, workplaces, residential areas etc. Health promotion needs to be built into all the policies and if utilized efficiently will lead to positive health outcomes.

Introduction

Health promotion is more relevant today than ever in addressing public health problems. The health scenario is positioned at unique crossroads as the world is facing a ‘triple burden of diseases’ constituted by the unfinished agenda of communicable diseases, newly emerging and re-emerging diseases as well as the unprecedented rise of noncommunicable chronic diseases. The factors which aid progress and development in today's world such as globalization of trade, urbanization, ease of global travel, advanced technologies, etc., act as a double-edged sword as they lead to positive health outcomes on one hand and increase the vulnerability to poor health on the other hand as these contribute to sedentary lifestyles and unhealthy dietary patterns. There is a high prevalence of tobacco use along with increase in unhealthy dietary practices and decrease in physical activity contributing to increase in biological risk factors which in turn leads to increase in noncommunicable diseases (NCD).( 1 – 3 ) Figure 1 below illustrates how lifestyle-related issues are contributing to increase in NCDs.( 4 ) The adverse effects of global climate change, sedentary lifestyle, increasing frequency of occurrence of natural disasters, financial crisis, security threats, etc., add to the challenges that public health faces today.

Illustration of how lifestyle-related issues contribute to increase in noncommunicable diseases( 4 )

Health, as the World Health Organization (WHO) defines, is the state of complete physical, social and mental well being and not just the absence of disease or infirmity. The enjoyment of highest attainable standard of health is considered as one of the fundamental rights of every human being.( 5 ) Over the past few decades, there is an increasing recognition that biomedical interventions alone cannot guarantee better health. Health is heavily influenced by factors outside the domain of the health sector, especially social, economic and political forces. These forces largely shape the circumstances in which people grow, live, work and age as well as the systems put in place to deal with health needs ultimately leading to inequities in health between and within countries.( 6 ) Thus, the attainment of the highest possible standard of health depends on a comprehensive, holistic approach which goes beyond the traditional curative care, involving communities, health providers and other stakeholders. This holistic approach should empower individuals and communities to take actions for their own health, foster leadership for public health, promote intersectoral action to build healthy public policies and create sustainable health systems in the society. These elements capture the essence of “health promotion”, which is about enabling people to take control over their health and its determinants, and thereby improve their health. It includes interventions at the personal, organizational, social and political levels to facilitate adaptations (lifestyle, environmental, etc.) conducive to improving or protecting health.( 1 , 2 )

Health Promotion: Historical Evolution

Health promotion is not a new concept. The fact that health is determined by factors not only within the health sector but also by factors outside was recognized long back. During the 19 th century, when the germ theory of disease had not yet been established, the specific cause of most diseases was considered to be ‘miasma’ but there was an acceptance that as poverty, destitution, poor living conditions, lack of education, etc., contributed to disease and death. William Alison's reports (1827-28) on epidemic typhus and relapsing fever, Louis Rene Villerme's report (1840) on Survey of the physical and moral conditions of the workers employed in the cotton, wool and silk factories John Snow's classic studies of cholera (1854), etc., stand testimony to this increasing realization on the web of disease causation.

The term ‘Health Promotion’ was coined in 1945 by Henry E. Sigerist, the great medical historian, who defined the four major tasks of medicine as promotion of health, prevention of illness, restoration of the sick and rehabilitation. His statement that health was promoted by providing a decent standard of living, good labor conditions, education, physical culture, means of rest and recreation and required the co-ordinated efforts of statesmen, labor, industry, educators and physicians. It found reflections 40 years later in the Ottawa Charter for health promotion. Sigerist's observation that “the promotion of health obviously tends to prevent illness, yet effective prevention calls for special protective measures” highlighted the consideration given to the general causes in disease causation along with specific causes as also the role of health promotion in addressing these general causes. Around the same time, the twin causality of diseases was also acknowledged by J.A.Ryle, the first Professor of Social Medicine in Great Britain, who also drew attention to its applicability to non communicable diseases.( 7 )

Health education and health promotion are two terms which are sometimes used interchangeably. Health education is about providing health information and knowledge to individuals and communities and providing skills to enable individuals to adopt healthy behaviors voluntarily. It is a combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes, whereas health promotion takes a more comprehensive approach to promoting health by involving various players and focusing on multisectoral approaches. Health promotion has a much broader perspective and it is tuned to respond to developments which have a direct or indirect bearing on health such as inequities, changes in the patterns of consumption, environments, cultural beliefs, etc.( 3 )

The ‘New Perspective on the Health of Canadians’ Report known as the Lalonde report, published by the Government of Canada in 1974, challenged the conventional ‘biomedical concept’ of health, paving way for an international debate on the role of nonmedical determinants of health, including individual risk behavior. The report argued that cancers, cardiovascular diseases, respiratory illnesses and road traffic accidents were not preventable by the medical model and sought to replace the biomedical concept with ‘Health Field concept’ which consisted of four “health fields”-lifestyle, environment, health care organization, human biology as the determinants of health and disease. The Health Field concept spelt out five strategies for health promotion, regulatory mechanisms, research, efficient health care and goal setting and 23 possible courses of action. Lalonde report was criticized by skeptics as a ploy to stem in the governments rising health care costs by adopting health promotion policies and shifting responsibility of health to local governments and individuals. However, the report was lapped up internationally by countries such as USA, UK, Sweden, etc., who published similar reports. The landmark concept also set the tone for public health discourse and practice in the decades to come.( 7 – 10 ) Health promotion received a major impetus in 1978, when the Alma Ata declaration acknowledged that the promotion and protection of the health of the people was essential to sustained economic and social development and contributed to a better quality of life and to world peace.( 5 )

Conferences on Health Promotion

Growing expectations in public health around the world prompted WHO to partner with Canada to host an international conference on Health Promotion in 1986. It was held in Ottawa, and produced not only the “Ottawa Charter for Health Promotion” but also served as a prelude to subsequent international conferences on health promotion. The Ottawa Charter defined Health Promotion as the process of enabling people to increase control over and to improve their health. To reach a state of complete physical, mental and social well being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. The fundamental conditions and resources for health are: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. Health promotion thus is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well being. The Charter called for advocacy for health actions for bringing about favorable political, economic, social, cultural, environmental, behavioral and biological factors for health, enabling people to take control of the factors influencing their health and mediation for multi sectoral action. The Charter defined Health Promotion action as one a) which builds up healthy public policy that combines diverse but complementary approaches including legislation, fiscal measures, taxation and organizational change to build policies which foster equity, b) create supportive environments, c) support community action through empowerment of communities - their ownership and control of their own endeavors and destinies, d) develop personal skills by providing information, education for health, and enhancing life skills and e) reorienting health services towards health promotion from just providing clinical and curative services.( 11 )

This benchmark conference led to a series of conferences on health promotion - Adelaide (1988), Sundsvall (1991), Jakarta (1997), Mexico-City (2000), Bangkok (2005) and Nairobi (2009). In Adelaide, the member states acknowledged that government sectors such as agriculture, trade, education, industry and communication had to consider health as an essential factor when formulating healthy public policy. The Sundsvall statement highlighted that poverty and deprivation affecting millions of people who were living in extremely degraded environment affected health. In Jakarta too poverty, low status of women, civil and domestic violence were listed as the major threats to health. The Mexico statement called upon the international community to address the social determinants of health to facilitate achievement of health-related millennium development goals. The Bangkok charter identified four commitments to make health promotion (a) central to the global development agenda; (b) a core responsibility for all governments (c) a key focus of communities and civil society; and (d) a requirement for good corporate practice.( 12 , 13 ) The last conference in October 2009 in Nairobi called for urgent need to strengthen leadership and workforce, mainstream health promotion, empower communities and individuals, enhance participatory processes and build and apply knowledge for health promotion.

The health promotion emblem [ Figure 2 ] adopted at the first international conference on health promotion in Ottawa and evolved at subsequent conferences symbolizes the approach to health promotion. The logo has a circle with three wings. It incorporates five key action areas in health promotion (build healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills and reorient health services) and three basic HP strategies (to enable, mediate and advocate).

Health promotion emblem

• The outer circle represents the goal of “Building Healthy Public Policies” and the need for policies to “hold things together”. This circle has three wings inside it which symbolise the need to address all five key action areas of health promotion identified in the Ottawa Charter in an integrated and complementary manner.
• The small circle stands for the three basic strategies for health promotion, “enabling, mediating, and advocacy”.
• The three wings represent and contain the words of the five key action areas for health promotion – reorient health services, create supportive environment, develop personal skills and strengthen community action.( 14 )

True to its recognition of health being more influenced by factors outside the health sector, health promotion calls for concerted action by multiple sectors in advocacy, financial investment, capacity building, legislations, research and building partnerships. The multisectoral stakeholder approach includes participation from different ministries, public and private sector institutions, civil society, and communities all under the aegis of the Ministry of Health.( 3 )

Approaches to Health Promotion

Health promotion efforts can be directed toward priority health conditions involving a large population and promoting multiple interventions. This issue-based approach will work best if complemented by settings-based designs. The settings-based designs can be implemented in schools, workplaces, markets, residential areas, etc to address priority health problems by taking into account the complex health determinants such as behaviors, cultural beliefs, practices, etc that operate in the places people live and work. Settings-based design also facilitates integration of health promotion actions into the social activities with consideration for existing local situations.( 3 )

The conceptual framework in Figure 3 below summarizes the approaches to health promotion. It looks at the need of the whole population. The population for any disease can be divided into four groups a) healthy population, b) population with risk factors, c) population with symptoms and d) population with disease or disorder. Each of these four population groups needs to be targeted with specific interventions to comprehensively address the need of the whole population. In brief, it encompassed primordial prevention for healthy population to curative and rehabilitative care of the population with disease. Primordial prevention aspires to establish and maintain conditions to minimize hazards to health. It consists of actions and measures that inhibit the emergence and establishment of environmental, economic, social and behavioral conditions, cultural patterns of living known to increase the risk of disease.( 15 )

Conceptual framework for health promotion

Examples of Health Promotion in Communicable and Non-communicable Diseases

Health promotion measures are often targeted at a number of priority disease – both communicable and noncommunicable. The Millennium Development Goals (MDGs) had identified certain key health issues, the improvement of which was recognized as critical to development. These issues include maternal and child health, malaria, tuberculosis and HIV and other determinants of health. Although not acknowledged at the Millennium summit and not reflected in the MDGs, the last two decades saw the emergence of NCD as the major contributor to global disease burden and mortality. NCDs are largely preventable by effective and feasible public health interventions that tackle major modifiable risk factors - tobacco use, improper diet, physical inactivity, and harmful use of alcohol. Eighty percent of heart diseases and stroke, 80% of diabetes and 40% of cancers can be prevented by eliminating common risk factors, namely poor diet, physical inactivity and smoking.( 16 ) Against this background health promotion as the “the science and art of helping people change their lifestyle to move toward a state of optimal health” is a key intervention in the control of NCDs. The following paragraphs showcase the application of an issue based approach of health promotion, using communicable and NCDs as examples capturing the components of individual and community empowerment, health system strengthening and partnership development.

Communicable Diseases

These diseases can be adequately addressed through health promotion approach. Here is one example:

Improving use of ITNs to prevent malaria: Insecticide-treated bed-nets (ITNs) are recommended in malaria endemic areas as a key intervention at the individual level in preventing malaria by preventing contact between mosquitoes and humans. (a) The individual level health promotion action would include providing access to ITNs and encouraging their regular and proper use every night from dusk to dawn. Available evidence points to the fact that this can be best achieved by social marketing campaigns to promote demand of ITNs. The messages should be tailored to cultural beliefs, for example the belief in some communities that mosquitoes have no role in the etiology of malaria. Distribution of ITNs to the community should ideally be followed by ‘hang up’ campaigns by trained health care workers educating the community on how to use the nets and helping them hang the nets, especially for the most vulnerable groups. (b) The community empowerment efforts, a collaborative initiative with the community to understand the cultural beliefs and behaviours and educating them about the disease would produce desirable results. There are documented examples of how women in a community empowerment program in Thailand developed family malaria protection plans, provided malaria education to community members, mosquito-control measures in a campaign, scaled-up use of insecticide-impregnated bed nets, instituted malaria control among migrant labourers, as well as activities to raise income for their families. Another program in Papua New Guinea empowered community members to take responsibility for the procurement, distribution and effective use of bed nets in the village, which led to a significant decrease in the incidence of malaria-related mortality and morbidity. (c) Strengthen health systems, integration of malaria vector control and personal protection into the health system through innovative linkages to ongoing health programs and campaigns is likely to lead to strong synergies, economies, and more rapid health system strengthening compared to new vertical programmes.. Successful examples of this include piggybacking the distribution of ITNs through antenatal care or immunization campaigns for measles and polio. (d) Partnerships are key in malaria control because of the involvement of multiple sectors. Action outside the health sector to remove barriers to the uptake of malaria prevention strategies has included lobbying for reduction or waiver of taxes and tariffs on mosquito nets, netting materials and insecticides and stimulating local ITN industries. Intersectoral collaboration has played an integral role in vector control measures for malaria prevention, including environmental modification, larval control, etc.( 17 )

Noncommunicable Diseases

In NCDs, two path-breaking studies need special mention. These studies are the Framingham Heart Study (started in 1951) and study on smoking among British doctor (started in 1948) have helped us in understanding how lifestyle affects various NCDs. The study in British doctors showed that prolonged cigarette smoking from early adult life tripled age-specific mortality. The excess mortality associated with smoking mainly involved vascular, neoplastic and respiratory diseases caused by smoking. The Framingham Heart Study has led to the identification of major CVD risk factors such and blood pressure, blood triglycerides and cholesterol level, age, gender and psychosocial issues (Framingham Heart Study).( 18 )

Cardiovascular Diseases

In the early 1970s the mortality rate from coronary heart disease was the highest in the world among men of Finland. The dietary practices of the Finnish population centered around dairy products and their food was rich in saturated fats, salt and low in unsaturated fats, fruits and vegetables. The North Karelia project, a major community-based intervention was launched in North Karelia, a fairly rural and economically poor province. This project developed comprehensive community based strategies to change the dietary habits of the population, with the main goal to reduce the high cholesterol levels in the population. The strategy focused on reduction intake of high saturated fat as well as the salt intake and to increase the consumption of fruits and vegetables. At the individual and community level, health information and nutritional counseling were made available, skills were developed, social and environmental support was provided all the while ensuring community participation. The health system was closely involved with the project. The project also developed strong partnerships with schools, health related and other nongovernmental organizations, supermarkets and food industry, community-based organizations and media. Collaborations were done with the food industry to reduce the fat and salt content of common food items such as dairy food, processed meat and bakery items. Dairy farmers were encouraged to switch to berry farming through the launching of a Berry project. The North Karelia project was extended to the entire country with the health care services also responsible along with schools and nongovernmental agencies in implementing nutrition and health education. Nation-wide nutrition education and collaboration with food industry were backed by legislative actions and were rewarded with remarkable results. Surveys showed a transformation in dietary habits with a marked reduction intake in saturated fats and salt and declared ischemic heart disease mortality declining by 73% in North Karelia and by 65% in Finland from 1971 to 1995.( 19 )

Diabetes Mellitus

Diabetes mellitus is one of the NCDs which has led to high rates of morbidity and mortality worldwide. Health promotion is being increasingly recognized as a viable, cost-effective strategy to prevent diabetes. The interventions at the individual and community level includes lifestyle modification programs for weight control and increasing physical activity with community participation using culturally appropriate strategies. The Kahnawake School's Diabetes Prevention Project (KSDPP) in Canada provides an example of a project that involved the local Mohawk community, researchers and local health service providers, in response to requests from the community to develop a diabetes prevention program for young children. The long-term goal of KSDPP was to decrease the incidence of type 2 diabetes, through the short-term objectives of increasing physical activity and healthy eating. Such preventive interventions have to be backed by strengthening of the health system which combines identification of high risk groups with risk factor surveillance and availability of trained primary health care providers for risk assessment and diabetes management. Online training courses offer an innovative approach to enhance health system capacity for diabetes health promotion, such as a course targeted at workers in remote indigenous communities in the Arctic to foster learning related to the Nunavut Food Guide, traditional food and nutrition, and diabetes prevention. Partnership and network development is key to the achievement of these measures. As part of the city-wide ‘Let's Beat Diabetes initiative’ in South Auckland, New Zealand the district health board with support from local government provided safe environments for physical activity by upgrading parks and worked with the food industry to provide healthier food options at retail outlets in order to reduce consumption of sweetened soft drinks and energy dense foods. Sugar-free soft drinks were made available as default options to customers, unless specifically requested otherwise. Intersectoral action on risk factors for diabetes also acts on the determinants of the other major risk factors for the NCD burden, such as heart disease, cancer and respiratory disease, hence health promotion activities aimed at reducing risk of diabetes mellitus have added advantages.( 17 )

Settings Based Approach to Health Promotion

The concept of ‘healthy settings’ which maximizes disease prevention through a whole system approach had emerged from WHO's Health for All strategy and Ottawa Charter. The call for supportive environments was followed up by the Sundwal statement of 1992 and the Jakarta declaration of 1997. The settings approach builds on the principles of community participation, partnership, empowerment and equity and replaces an over reliance on individualistic methods with a more holistic and multidisciplinary approach to integrate action across risk factors. The ‘Healthy Cities’ programme launched by WHO in 1986 was soon followed up by similar initiatives in smaller settings such as schools, villages, hospitals, etc.( 20 )

Health Promoting Schools

Health promoting schools build health into all aspects of life in school and community based on the consideration that health is essential for learning and development. To further this concept, WHO and other UN agencies developed an initiative, ‘Focusing Resources on Effective School Health (FRESH), emphasizing on the benefit to both health and education if all schools were to implement school health policies, a healthy school environment, with the provision of safe water and sanitation an essential first step, skills-based health education and school-based health and nutrition services.( 21 )

Healthy Work Places

Currently, globally an estimated two million people die each year as a result of occupational accidents and work-related illnesses or injuries and 268 million nonfatal workplace accidents result in an average of three lost workdays per casualty, as well as 160 million new cases of work-related illness each year.( 22 ) Healthy work places envision building a healthy workforce as well as providing them with healthy working conditions. Healthy working environments translate to better health outcomes for the employees and better business outcomes for the organizations.( 23 )

Health Promotion in India

Health promotion is strongly built into the concept of all the national health programs with implementation envisaged through the primary health care system based on the principles on equitable distribution, community participation, intersectoral coordination and appropriate technology. Nevertheless, it has received lower priority compared to clinical care. The government, through the component of IEC has always strived to address the issue of lack of information, which is a major barrier to increasing accessibility of health care services.( 24 ) The National Rural Health Mission (NRHM) called for a synergistic approach by relating health to determinants of good health such as segments of nutrition, sanitation, hygiene and safe drinking water and by revitalizing local traditions and mainstreaming the Ayurvedic, Unani, Siddha and Homeopathic systems of medicine to facilitate health care.( 25 ) NRHM offers an excellent opportunity to target and reach every beneficiary with appropriate interventions through microplanning into district planning process.( 26 )

Health promotion component needs to be strengthened with simple, cost-effective, innovative, culturally and geographically appropriate models, combining the issue-based and settings-based designs and ensuring community participation. Replicability of successful health promotion initiatives and best practices from across the world and within the country needs to be assessed. Efforts have already been initiated to build up healthy settings such as schools, hospitals, work places, etc.( 20 , 22 , 27 ) For effective implementation of health promotion we need to engage sectors beyond health and adopt an approach of health in all policies rather than just the health policy.

Conclusions

Today, there is a global acceptance that health and social well being are determined by a lot of factors which are outside the health system which include inequities due to socioeconomic political factors, new patterns of consumption associated with food and communication, demographic changes that affect working conditions, learning environments, family patterns, the culture and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. To counter the challenges due to the changing scenarios such as demographic and epidemiological transition, urbanization, climate change, food insecurity, financial crisis, etc. health promotion has emerged as an important tool; nevertheless the need for newer, innovative approaches cannot be understated. A multisectoral, adequately funded, evidence-based health promotion program with community participation, targeting the complex socioeconomic and cultural changes at family and community levels is the need of the hour to positively modify the complex socioeconomic determinants of health.

Source of Support: Nil

Conflict of Interest: None declared.

An official website of the United States government

Here's how you know

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. A lock ( ) or https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Keyboard Navigation

• Agriculture and Food Security
• Anti-Corruption
• Conflict Prevention and Stabilization
• Democracy, Human Rights, and Governance
• Economic Growth and Trade
• Environment, Energy, and Infrastructure
• Gender Equality and Women's Empowerment
• Global Health
• Humanitarian Assistance
• Innovation, Technology, and Research
• Water and Sanitation
• Burkina Faso
• Central Africa Regional
• Central African Republic
• Côte d’Ivoire
• Democratic Republic of the Congo
• East Africa Regional
• Power Africa
• Republic of the Congo
• Sahel Regional
• Sierra Leone
• South Africa
• South Sudan
• Southern Africa Regional
• West Africa Regional
• Afghanistan
• Central Asia Regional
• Indo-Pacific
• Kyrgyz Republic
• Pacific Islands
• Philippines
• Regional Development Mission for Asia
• Timor-Leste
• Turkmenistan
• Bosnia and Herzegovina
• North Macedonia
• Central America and Mexico Regional Program
• Dominican Republic
• Eastern and Southern Caribbean
• El Salvador
• Middle East Regional Platform
• West Bank and Gaza
• Dollars to Results
• Data Resources
• Strategy & Planning
• Budget & Spending
• Performance and Financial Reporting
• FY 2023 Agency Financial Report
• Records and Reports
• Budget Justification
• Our Commitment to Transparency
• Policy and Strategy
• How to Work with USAID
• Find a Funding Opportunity
• Organizations That Work With USAID
• Resources for Partners
• Get involved
• Business Forecast
• Safeguarding and Compliance
• Diversity, Equity, Inclusion, and Accessibility
• Mission, Vision and Values
• News & Information
• Operational Policy (ADS)
• Organization
• Stay Connected
• USAID History
• Video Library
• Coordinators
• Nondiscrimination Notice
• Collective Bargaining Agreements
• Disabilities Employment Program
• Federal Employee Viewpoint Survey
• Reasonable Accommodations
• Urgent Hiring Needs
• Vacancy Announcements
• Search Search Search

Health Science Specialist (Lead Emergency Response Coordinator)

Opening and closing dates.

This job opening is in the Bureau for Global Health, Office of the Assistant Administrator at the U.S. Agency for International Development (USAID).

USAID's Bureau for Global Health supports health programs in partner countries, advances research and innovation in areas relevant to overall Agency health objectives, and transfers new technologies through its own programmatic work, coordination with other donors, and a portfolio of grants.

Bureau/Office

Pay scale/grade, eligibility, share this page.

How Tiny Crystals Are Giving Solar Panels A Glow-Up

As the global conversation around renewable energy continues to heat up, Juan Guio ‘26 is looking at ways to keep things cool, at least where solar panels are concerned.

Guio spent the spring 2023 semester working on research pertaining to efficiency in photovoltaics as a member of Dr. Matthew Sheldon’s laboratory in the Department of Chemistry at Texas A&M University. While Guio’s part of the project was small — measuring and mapping how different solutions impacted the absorbance of certain wavelengths of light — the work thrilled him.

“The way I see it, small things are what make up the big things, so that makes chemistry very exciting,” he said.

The small things he was working with are a type of tiny crystals known as halide perovskite nanocrystals. “Think of them as little light boosters,” Sheldon said. Students worked on synthesizing these crystals and embedding them into thin, film-like structures to make them suitable for coating solar panels.

“Solar panels, which many of us see on rooftops or large solar farms, convert sunlight into electricity,” Sheldon explained. “One way to make these solar panels even more efficient is to use special coatings that can capture more light. In this research project, undergraduate students explored the development of coatings that can glow under light, essentially amplifying the amount of sunlight that reaches the solar panel.”

This work was very interesting to Guio, who was eager to try new solutions in the lab. “I got excited about figuring out what we could do next,” he said. “One of the properties of these nanocrystals is that when you shine a light at them at a certain energy, they emit light at a higher energy. They do that by taking in some heat.” Absorbing heat as well as light to create energy via a solar panel would be especially useful because it provides cooling as well as light, he explained.

Guio, who is originally from Bogota, Columbia, and currently resides in Houston, says he has long been attracted to chemical engineering because he loves working with chemical reactions. In addition to the science and hands-on lab work for the nanocrystals project, Guio and the other students in the Sheldon Research Group also had opportunities to analyze their results and share them through presentations, practicing the essential work of science communication.

Guio made up solutions of nanocrystals and solvents and then used a spectrophotometer to analyze how changes affected which wavelengths of light were absorbed. He also graphed results of different solutions to create an absorbance map. By the end of the semester, he was able to present the range of results to others in the lab working on different elements of nanocrystal research. He appreciated hearing about others’ research findings, as he built on their work to create a presentation that would provide value to the whole group.

Learning Through Research

While the work he was doing was minor in the larger field of photovoltaic research, Guio says it was a great introduction to the process of investigative lab work.

“I learned that research is not a linear process,” he reflected. “You work on ideas all over the place that open up room for creativity and lead you where you want to go next. You can take a risk and see ‘will this bear fruit and be helpful or not?’ and try other options.”

The experience cemented Guio’s desire to pursue a career in chemical engineering with an emphasis on energy.

“I’m fascinated by energy, in finding ways to improve the oil and gas industry, as well as renewable energy, maybe create something new that hasn’t been thought of yet,” he said.

A key takeaway from the experience for Guio was the importance of reaching out to faculty members to explore collaboration. Sheldon, one of Guio’s favorite teachers, had mentioned his research on photovoltaics in class, and Guio’s curiosity was piqued. He sent Sheldon an email asking if he could be involved in some way and was invited to participate in the lab work, though he was a freshman at the time.

“Don’t be afraid to reach out to a teacher if the topic is interesting to you,” he admonished other students. “Let them know that you’re interested and that you want to work with them, because they love working with motivated students.”

Media contact: Shana K. Hutchins, [email protected]

Related Stories

Vet School Researchers Develop Virtual Tool For Studying Gene Function

Hopes are the new technology, called Gene Knockout Inference or GenKI, will reduce the number of animals used in genetic research.

Cyclotron Institute Celebrates 60 Years Of Nuclear Science History

In 1964, Texas Gov. John B. Connally visited campus to deliver the good news that a $6 million “atom smasher” would be built at Texas A&M.

Experts At TEEX’s Inaugural Cyber Readiness Summit Discuss ‘Cyber Race’

Like the great space race of the 1960s, experts say today we're racing for operational advantage in cyberspace.

Recent Stories

Texas A&M System Partners With JED Campus To Support Student Mental Health

A survey of students, faculty and staff will be conducted as part of the four-year initiative to enhance mental health and well-being programming and resources.

Borlaug Institute Continues Life’s Work Of Agricultural Legend

On what would have been his 110th birthday, Nobel Peace Prize winner and food science pioneer Norman Borlaug continues to inspire those fighting world hunger.

Aggie Volunteers Serve More Than 2,000 Area Residents During The Big Event

The student-organized service project mobilized more than 16,000 participants to complete jobs across Bryan-College Station ranging from yard work to home repairs.

Subscribe to the Texas A&M Today newsletter for the latest news and stories every week.