4.3 Explain the nature of health promotion in Australia

1. How have various approaches to health influenced health promotion?

Health promotion in Australia aims to improve health and wellbeing by helping people and communities increase control over their health and the conditions that shape it. It is preventive and proactive. This means it tries to reduce risk before illness or injury happens, reduce harm when risk already exists, and strengthen protective conditions over time.

Over the past four decades, Australian health promotion has moved towards a more holistic approach. Medical prevention and early detection still matter, but there is now stronger focus on the determinants of health, equity, and coordinated action across different settings. This helps explain why Australia has improved life expectancy, while also still facing serious and unacceptable health inequities, including poorer outcomes for Aboriginal and Torres Strait Islander Peoples.

Health promotion works at different levels and across different sectors. It can include legislation, public campaigns, education, settings-based programmes (such as schools and workplaces), environmental design (such as walkways and cycle paths), and prevention delivered through health services. It can also support people living with chronic disease and disability through risk reduction and self-management support, aiming to prevent complications and support quality of life and participation.

Example: If a community has high rates of type 2 diabetes, an individual approach focuses on advice about food choices. A health promotion approach also considers food affordability, safe places to walk, public transport to shops, culturally safe nutrition programs, and whether workplaces allow time for health appointments.

1.1 Aboriginal and Torres Strait Islander approaches to health and their influence on health promotion

Aboriginal and Torres Strait Islander approaches to health are holistic. Health is understood as the social, emotional, cultural and spiritual wellbeing of the whole community, not only the physical health of an individual. This view highlights the importance of family and community, connection to Country, cultural identity, and the continuation of culture as protective for health and wellbeing.

This perspective has influenced Australian health promotion by strengthening the importance of self-determination, cultural safety, community leadership, and strengths-based approaches. These approaches build on cultural knowledge and local priorities, rather than focusing only on problems or deficits.

In practice, effective health promotion with Aboriginal and Torres Strait Islander communities prioritises shared decision-making, trust, and community control. It also recognises the continuing impacts of colonisation, including dispossession, intergenerational trauma, racism, and barriers to culturally safe services.

Example: A mainstream nutrition message that focuses only on calorie intake may not work in an Aboriginal community if it ignores food access, cultural obligations, connection to Country, and community priorities. A culturally safe approach is more likely to succeed when it is co-designed with community, uses local leadership, and aligns with local cultural practices, including a yarning circle and the use of respected community voices.

1.2 The Biomedical model and its influence on health promotion

The Biomedical model views health mainly as the absence of disease. It focuses on biological causes and medical treatment. In Australia, it has influenced health promotion through clinical strategies that prevent, detect, or treat disease, including immunisation, screening, early diagnosis, and evidence-based treatment pathways. It also supports investment in medical research, medicines, and technologies that reduce death rates and improve survival and function.

Biomedical approaches can be very effective when risk can be reduced through medical action. This is especially true for preventing infectious diseases and detecting some cancers and chronic conditions early. However, on its own, the Biomedical model can understate the impact of social conditions and environmental barriers. This can lead to health promotion that relies too heavily on individuals following medical advice, even when people face obstacles such as cost, transport, stigma, language barriers, low health literacy, or limited access to culturally safe services.

Example: Australia’s national immunisation program and population screening programs (such as cervical screening and bowel cancer screening) reflect Biomedical thinking because they prevent disease or detect it earlier through medical intervention. Their success still depends on health promotion strategies such as clear public communication and equitable access.

1.3 The Sociocultural model and its influence on health promotion

The Sociocultural model explains health as strongly shaped by social and cultural conditions. This includes the social determinants of health, such as education, employment, housing, income, nutrition access, discrimination, social support, and access to care. In Australia, this model has influenced health promotion by reinforcing that improving health outcomes often requires reducing disadvantage and improving the conditions in which people live.

Health promotion influenced by this model often involves action across sectors, such as partnerships between health services and education, housing, employment, transport, and local government. It links closely to equity, because it recognises that equal resources do not create fair outcomes when barriers are unequal. It also supports a clear point: if the determinants driving poor health stay the same, education campaigns alone usually have limited impact.

Example: If young people in a regional area experience high psychological distress, a Sociocultural approach considers transport to services, availability of youth-friendly support, school pressure, employment insecurity, and stigma, not only individual coping strategies.

1.4 The Salutogenic model and its influence on health promotion

The Salutogenic model shifts the focus from what causes disease to what helps people stay well. It views health as a continuum and highlights protective resources that support coping and functioning, including social support, skills, purpose, cultural connection, and safe environments. Salutogenic thinking is often linked to a sense of coherence, where life feels understandable, manageable, and meaningful. This model focuses on protective factors and strengths, rather than blame.

In Australia, this model supports health promotion that builds capability and protective factors, not only awareness of risk. It is useful for mental wellbeing promotion, chronic disease self-management, and youth health promotion. For example, strengthening connectedness, help-seeking confidence, and problem-solving can reduce the chance that stress turns into severe distress or risky coping behaviours.

Example: A school wellbeing approach that builds peer connection, teaches problem-solving, and develops help-seeking confidence reflects Salutogenic thinking because it strengthens protective factors, not just knowledge about risks.

1.5 The Ecological model and its influence on health promotion

The Ecological model explains health as shaped by influences across different levels. It has strongly shaped health promotion in Australia because it supports multi-level intervention design, rather than relying on one strategy. It recognises that knowledge alone rarely leads to lasting change when barriers remain in the environment.

Health influences can be understood across several levels:

• Individual influences, such as knowledge, skills, beliefs, genetics, and health status.
• Interpersonal influences, such as family expectations, peer norms, and social support.
• Organisational and community influences, such as school rules, workplace conditions, local services, and neighbourhood safety.
• Societal influences, such as laws, marketing, cultural norms, and economic conditions.

Ecological health promotion is stronger when messages, environments, and policies support each other. This creates consistent cues and supports across settings. It also helps explain why population-level change often needs coordinated action, not isolated programmes.

Example: Reducing youth vaping is more effective when education is combined with school rules, retailer compliance, social media messaging, parent communication, and broader regulation that limits marketing and access.

2. What global health policies have impacted health promotion in Australia?

Global health policies influence Australian health promotion by shaping priorities, language, and expectations for action. International organisations share evidence, set standards, and support coordinated responses to health challenges. These influences can align Australian policy with global best practice, but they still need to be adapted to Australian contexts and cultural groups.

2.1 UNESCO and health promotion influences

UNESCO influences health promotion mainly through education, human rights, and safe learning environments. This supports health promotion priorities linked to schooling, including student safety, inclusion, respectful relationships, and conditions that support learning and wellbeing. UNESCO also supports education for sustainable development, which links environmental conditions to health and wellbeing.

One clear influence is the focus on preventing violence and bullying in school settings, including cyberbullying. UNESCO reporting has suggested bullying affects many students globally, with around one in three students experiencing bullying by peers at school. This supports the health promotion idea that school environments shape wellbeing, attendance, engagement, and learning, and that prevention needs coordinated policy, education, and support.

Example: When a school improves anti-bullying procedures, increases supervision in known hotspots, and supports bystander action, it turns a global priority into local health promotion. The outcome is improved wellbeing, attendance, and learning, not only reduced conflict.

2.2 WHO and health promotion influences

The World Health Organization (WHO) influences Australian health promotion through global leadership. It sets priorities, publishes evidence-informed guidance, coordinates cooperation between countries, and develops widely used frameworks. WHO influence is visible when Australia aligns national and state strategies to shared goals in prevention, equity, and effective systems.

WHO influence is also clear during health emergencies. For example, WHO updates and recommendations during the COVID-19 pandemic supported consistent communication and public health action in Australia, while decisions still needed to be made locally.

WHO also supports global agreements and coordinated strategies that guide policy action. This can reinforce measures that reduce exposure to harm and change social norms through population-wide approaches.

Example: A graphic health warning on packaging is not only information. It is a policy cue designed to reduce uptake, support quitting, and reduce the normalisation of smoking, especially among young people.

3. How has the Ottawa Charter been used to improve Australia’s health?

The Ottawa Charter helped shift health promotion away from a narrow focus on individual behaviour. It reinforced a broader approach that includes environments, policy, community participation, and health systems. In Australia, its influence is seen in prevention planning that targets causes of ill health, not only outcomes, and in using the Charter’s ideas to design interventions that are more sustainable and equitable.

3.1 Prerequisites for health and the Charter’s supporting strategies

The Ottawa Charter highlights that health depends on basic conditions, often described as prerequisites for health. These include peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity. This matches Australian health promotion that targets disadvantage, access, and supportive environments.

The Charter also describes three supporting strategies: advocacy (arguing for conditions that support health), enabling (reducing barriers so people can achieve health), and mediation (coordinating across groups with different interests, including commercial and political priorities).

Example: Regulating alcohol advertising can involve advocacy from health groups, enabling through policies that reduce exposure to harmful marketing, and mediation between public health priorities and commercial interests.

3.2 The five action areas in Australian health promotion

Build healthy public policy

Build healthy public policy focuses on making sure policy decisions across sectors consider health impacts. It includes legislation, regulations, and funding decisions that promote health and protect people from harm. In Australia, this is seen in tobacco regulation, road safety laws, food standards, public health regulation, and policies that expand prevention.

Australian examples include restrictions on tobacco advertising, smoke-free laws, taxation measures, plain packaging, and road safety laws such as seat belts, speed limits, and random breath testing. It also includes water fluoridation.

Healthy public policy is powerful because it reaches whole populations, including people who do not actively seek health information. It can also change social norms by making safer environments the default.

Example: A state ban on commercial solariums reflects healthy public policy because it removes access to a known carcinogen, rather than relying only on individual decision-making.

Create supportive environments

Create supportive environments includes physical spaces, social conditions, and economic settings that promote safety and wellbeing. The Ottawa Charter recognises that behaviour is shaped by what is available, affordable, safe, and socially supported.

In Australia, supportive environments are created through urban planning that supports physical activity (parks, footpaths, cycleways), school environments that reduce UV exposure (shade and sun safety policy), smoke-free public spaces, safer road design (barriers, signage, lighting), and health-supportive workplace conditions. They also include social environments, such as cultures that reduce stigma and support help-seeking.

Example: When a council installs well-lit walking paths and maintains safe parks, it supports physical activity. If parks feel unsafe or poorly maintained, activity drops even when people know the benefits.

Strengthen community action

Strengthen community action emphasises community participation and leadership in identifying priorities, planning responses, and building local capacity. Programs are stronger when they are designed with communities, not just delivered to them. This improves relevance and supports culturally safe practice.

In Australia, this is seen in community-led prevention programs, local partnerships between councils and health services, and community-controlled service models. Strong community action can increase trust, improve engagement, and make change more sustainable because local people have ownership.

Example: A youth mental wellbeing program is more likely to be used when young people help decide how it runs, where it is delivered, and what language and platforms are used.

Develop personal skills

Develop personal skills involves building knowledge, confidence, and practical capability, including health literacy. In Australia, this can include school PDHPE learning, public campaigns, community workshops, and targeted programs that teach specific skills such as first aid, mental health literacy, cooking, or quitting strategies.

Programs are strongest when they are supported by environments and policy. This makes the skills realistic to use in daily life.

Example: Quitline and structured quitting programs develop personal skills by teaching strategies for cravings, habit change, and nicotine replacement use, not only describing health risks.

Reorient health services

Reorient health services means shifting health systems towards prevention, early intervention, and responsiveness to community need, not only acute treatment. In Australia, this includes immunisation, screening programs, preventive health checks, brief interventions in general practice, and referral pathways into community supports.

It also includes stronger support for chronic disease prevention and self-management, and making services more accessible and culturally safe, including for Aboriginal and Torres Strait Islander Peoples. This makes prevention and early intervention more realistic.

Example: Mailing bowel cancer screening kits supports early detection through the health system rather than waiting for late-stage illness.

3.3 Australian examples of the Charter being applied to improve health

Australian strategies often align with the Ottawa Charter’s action areas, even when the Charter is not named directly. This is seen in initiatives that combine policy, environment change, skills development, community participation, and prevention-focused services.

Examples include Close the Gap commitments and partnership-based action from 2008 onwards, national approaches to chronic disease prevention and management including the National Chronic Disease Strategy (2005), and whole-of-system road safety planning including the National Road Safety Strategy (2011–2020). These examples show that lasting improvements usually come from coordinated action across multiple Charter areas, not from one intervention alone.

Road safety is a clear example: regulation (policy), safer roads (environments), community education and advocacy (community action), public campaigns and driver education (personal skills), and improved trauma response and preventive checks (health services) work together to reduce injury and death over time.

4. How does health promotion in partnerships with communities strengthen the health of individuals and communities across a range of cultural groups including Aboriginal and Torres Strait Islander Peoples?

Health promotion in partnerships with communities is stronger because it increases relevance, trust, reach, and sustainability. It connects closely to equity, because programs that do not engage communities well often benefit already advantaged groups and can widen health gaps.

4.1 Why partnerships strengthen health promotion

Partnerships improve health promotion when communities help decide priorities and design responses. Communities understand local barriers, strengths, values, language needs, and culturally safe ways to communicate. Partnership approaches can also reduce duplication, align messages across services, and build local capacity so improvements last beyond short-term funding.

Example: A healthy eating message may be ignored if it assumes people have time, money, and access to fresh food. Partnering with a community group can lead to solutions that match local reality, such as culturally appropriate cooking supports, transport solutions, or better access to affordable produce.

4.2 What effective partnerships look like in practice

Effective partnerships involve participation, shared decision-making, and accountability. This means community input is not tokenistic. It changes what is planned and how it is delivered. Strong partnerships also build capacity over time, including health literacy, confidence, and community action.

Partnerships matter across Australia’s cultural diversity because language, health beliefs, family structures, migration experiences, and discrimination shape how messages are received and whether services feel safe. Health promotion is stronger when it adapts delivery while keeping evidence-based standards.

4.3 Partnerships with Aboriginal and Torres Strait Islander communities

Partnership-based health promotion is strongest when it supports Aboriginal and Torres Strait Islander self-determination and community leadership. Aboriginal Community Controlled Health Organisations (ACCHOs) are central because they provide culturally safe care and health promotion guided by community priorities. Community-controlled models can also use culturally preferred ways of learning and healing, including the involvement of Elders, cultural knowledge holders, and culturally safe spaces that strengthen identity and belonging.

Partnerships in this context also require recognition of broader determinants and the continuing impacts of colonisation. Health promotion is stronger when it supports long-term community priorities, builds trust through relationships, and invests in culturally safe systems rather than short-term, externally imposed programs.

Example: A smoking reduction initiative is more effective when delivered through an Aboriginal community-controlled service. It can use local health workers, locally relevant communication, and strengths-based messaging that links quitting to family, culture, and future opportunities.

4.4 Partnerships across Australia’s cultural diversity

Across culturally and linguistically diverse communities, partnerships with multicultural organisations, community leaders, and local services can strengthen communication, increase trust, and improve access to prevention. Practical strategies include using trusted settings, culturally appropriate communication channels, and clear pathways into services that are responsive and respectful.

Example: A diabetes prevention program delivered with a local cultural association can improve attendance when sessions include familiar foods, culturally appropriate meal adaptations, and trusted community facilitators, rather than generic advice that does not match daily life.