The Regional Framework for Health
Promotion 2002-2005, cites the
integration of health promotion in health
systems development and health sector
reform as one of five priority areas for
action of WHO and its international
partners.1 It is widely acknowledged that
effective health promotion actions
targeted at specific risks (e.g. compre-
hensive tobacco control policies, population-based salt and cholesterol
lowering, micronutrient supplementation, safe water at point of use for
children and HIV-AIDS prevention)2 are cost effective, result in better
health outcomes and improve performance of health care systems.
Despite this, large-scale efforts to undertake these actions are limited by
low levels of spending. Currently, less than 10% of health care resources
are used for primary care3 and of this amount only a fraction goes to the
promotion of health.
There is increasing recognition that economic evaluation of the
impact of health promotion interventions can advance the argument for
more resources and thereby contribute to increased coverage and greater
effectiveness.
There are several reasons for this. In many countries, the capacity to
scale up is constrained by weak infrastructure. Health promotion is more
often seen as a vertical programme that is confined to health education
activities of a small unit within the Ministry of Health. These
programmes often have low and sporadic visibility. Activities are often
unable to demonstrate effectiveness because they are too small e.g.,
health promoting schools in one or two areas. Activities may also be
ineffective when held too infrequently e.g. mass exercise held once a
year, or short-lived e.g. monthly health campaigns without follow-up
action at the community level. These constitute a vicious cycles of under
investment, inadequate coverage and limited effectiveness.
There is increasing recognition that economic evaluation of the
impact of health promotion interventions can advance the argument for
more resources and thereby contribute to increased coverage and g