WHO Cares?!?: Prioritising Health Promotion for Global Health Equity Advancement

Abstract

The World Health Organization (WHO) has played a fundamental role in the advancement of health promotion for well over four decades [1]. This commitment has been reflected through various iterations of the WHO Department of Health Promotion, which, in broad terms, provides global stewardship of health promotion advancement. While there is always room to strengthen health promotion leadership, structures and resourcing, the current Department of Health Promotion has played a critical role in offering visibility of, and stability for, the global health promotion community, as does the parallel Department of Social Determinants of Health. Key achievements of WHO over this period are plentiful [1], with more recent examples including: the championing of the Ottawa Charter [2], investing in a Commission on Social Determinants of Health from 2005 to 2008 [3], advancing the global Health-in-All-Policies agenda [4, 5], prioritising health literacy with respect to Non-Communicable Diseases [6] and tackling concepts relating to the wellbeing economy [7-10]. This demonstrates that WHO has been a steadfast global leader in health promotion and instrumental in working towards the United Nations Sustainable Development Goals [11, 12]. Importantly, these commitments have shaped responses within the six WHO regional offices where local action and place-based approaches have consistently focused on addressing the social, economic, environmental, ecological, cultural, commercial and political determinants of health and wellbeing at national and regional levels. This demonstrates that WHO cares about health promotion! But all this is threatened by a reorganisation of health promotion at the WHO headquarters in Geneva, where there is movement towards disbanding the vital global infrastructure provided through its Department of Health Promotion.

It is unfathomable that WHO would be considering a shift away from health promotion at this critical juncture. There is simply too much at stake. We are facing multiple health crises, many of which will be reliant on health promotion foundations to seek tangible solutions. Key areas of relevance include the wellbeing economy [8-10], the impact of climate change on planetary health [13-16], digital health [17, 18], Indigenous health and wellbeing [16, 19, 20], and disaster preparedness, including that relating to pandemics and natural disasters such as bushfires, floods, cyclones and droughts [21, 22]. Ongoing investment in healthy cities, schools and hospitals, and the creation of healthier built environments, is also fundamental to health promotion advancement.

The recent withdrawal of the United States of America as a member state of WHO has yielded significant influence on the resources, and subsequently the structure and operations of WHO [23]. The proposed closure of the Department of Health Promotion reflects an explicit erosion of the functions and visibility of health promotion, particularly those relating to diversity, equity and inclusion. This is both troubling and problematic. It increases the potential for further lifestyle drift [24], and threatens the underlying values of health promotion, and broader cross-sectoral goals to improve health and social equity internationally. It has left the global health promotion community wondering whether WHO really cares?

There is ample research and evidence to demonstrate that (a) addressing health and social inequities is, and continues to be, a significant global health issue [25]; and (b) WHO has published multiple position statements, frameworks and strategies that refer to health promotion as a critical enabler for creating fairer and more equitable societies [3, 5, 6–8.20, 25]. Indeed, WHO recently released its World Report on Social Determinants of Health Equity [25], which consistently emphasised that investment in health promotion makes good economic sense, with recurrent calls for greater investment in health promotion and the need for parallel strategies to address social and commercial determinants of health [25]. This has relevance for driving responses within the WHO/IUHPE Western Pacific region [26-29] and broader global contexts [3, 5, 25]. Yet, we also know the structural and systemic focus of health promotion strategy through research, policy and practice investments is often premised on a longer-term, sometimes generational, vision. While incremental health promotion actions support short-term and medium-term gains, they are too often undermined by structural health system changes such as those being proposed by WHO. This too often prevents the realisation of long-term goals.

In Australia and New Zealand, we have seen cyclical government investments in health promotion. In general, these changes to the health promotion landscape stifle and stall equitable health improvement for the communities we serve, whether that is at a state/provincial, national or regional level. We are seeing the same unfold at a global level at present with the changes proposed by WHO. We need to learn from past challenges and current successes to guide advocacy efforts when engaging with WHO and its member states to preserve the visibility and leadership of the WHO Department of Health Promotion.

Within Australia, we have seen the rise and fall of bodies such as the Australian National Preventive Health Agency, and major funding injections such as the National Partnership Agreements on Preventive Health [26-30]. We have also seen major state-based disinvestments that have devastated decades of health promotion progress at the local level [26-28]. However, in some instances, this destabilisation has resulted in advocacy that has led to positive outcomes long-term (often over many years). For example, we have recently seen the establishment of health promotion foundations in South Australia and Queensland, where we are now seeing Preventive Health SA and Health and Wellbeing Queensland flourish. We also have examples of thriving foundations such as VicHealth in Victoria and Healthway in Western Australia that have both weathered such storms, providing critical health promotion resourcing and infrastructure for decades.

The International Union for Health Promotion and Education (IUHPE), the Australian Health Promotion Association (AHPA), the Health Promotion Forum of New Zealand, the Australian Prevention Partnership Centre, VicHealth, National Heart Foundation, multiple research institutions and many other health promotion foundations and organisations are united in their call to ensure both the preservation of the Department of Health Promotion at WHO, but also the bolstering of health promotion resources to sustain and drive innovative systems change that promotes health equity globally.

We look forward to working with WHO in strengthening (not weakening!) its leadership in global health promotion by building on the strong legacy and ongoing potential of its Department of Health Promotion.

The authors declare no conflicts of interest.