Council of Europe: Recommendation Rec(2000)18 of the Committee of Ministers on criteria for the development of health promotion policies




Recommendation Rec(2000)18

of the Committee of Ministers to member states on criteria

for the development of health promotion policies


 (Adopted by the Committee of Ministers

on 21 September 2000

at the 722nd meeting of the Ministers' Deputies)


The Committee of Ministers, under the terms of Article 15.b of the Statute of the Council of Europe,

Considering that the aim of the Council of Europe is to achieve greater unity between its members and that this aim may be pursued, inter alia, by the adoption of common action in the area of public health;

Bearing in mind Article 11 of the European Social Charter on the right to the protection of health;

Recalling that Article 3 of the Convention on Human Rights and Biomedicine requires that contracting parties provide “equitable access to health care of appropriate quality”;

Noting moreover the relevance of the World Health Organization's Targets for Health for All for the European region and of its recent policy documents on health promotion and prevention policies;

Noting the importance of the Ottawa Charter for Health Promotion (1986), the Djakarta Declaration on Leading Health Promotion into the 21st Century (1997) and the Verona Declaration on the implementation of investment for health as statements on the guiding principles of public health;

Noting that the 5th Global conference on Health Promotion (2000) in Mexico pledged to bridge the equity gap and to monitor progress made in incorporating health promotion strategies into national and local policy and planning; 

Noting that the strengthening and maintaining of health is a key priority for all member states, as an investment which helps people to reach their full potential and countries to maintain social cohesion as well as the competitiveness of the economy;Aware that non-communicable diseases linked to unhealthy lifestyles and environments are overtaking communicable diseases, mental health disturbances and problems related to ageing;

Conscious that health promotion is a process which enables people to increase control over and improve their health, contributes to their individual and collective well-being and helps to reduce inequities in health;

Aware that carefully planned health promotion policy is therefore an investment for all countries, whatever their economic situation, which has the potential to reduce the demand for and cost of some community health and hospital services;

Considering that health promotion is an essential element of a citizen's right to health care and therefore is a responsibility of the government;

Conscious that health promotion is a dynamic concept which is constantly evolving and which has to be adapted to the culture and situation of each member state;

Considering also that citizens have a responsibility to put into practice the message transmitted by health promotion and prevention activities as a tool for avoiding ill-health;

Aware that measures aimed at reducing the incidence of health problems depend to a large extent on situations and factors beyond the immediate control of health and social services activities;

Recommends that the Governments of member states:

 - develop comprehensive and coherent strategies for the promotion of health at a countrywide level;

 - monitor health and its determinants with a view to identifying priority needs and improving the health of the population and reducing inequalities;

 - adopt, where necessary, policies, legislative and other measures necessary for:

 - integrating health promotion into the activities and decision-making processes of government, public sector, private sector and non-governmental organisations;

 - ensuring that the impact on health of the relevant major policies in decision making are foreseen, measured and taken into account in planning;

           - facilitating the participation of all those involved;

           - improving health education and the dissemination of information;

 - implement all aspects of health promotion, including preventative action, for the benefit of the whole population and particularly of vulnerable groups, who would be underprivileged even further if health promotion were not  developed;

 - take into account the concept of quality of life in health promotion. 

In pursuit of these goals governments should take into account the criteria set out in the appendix to this recommendation.


Appendix to Recommendation Rec(2000)18 

I. Establishing an evidence-based health promotion policy and plan of action 

1. When developing health promotion programmes for the population in general and/or specific target groups, member states should:

- establish with a high degree of certainty which are the determinants of health, and, in particular, of inequalities of health within the community;

- have clear and feasible goals and objectives supported by available evidence;

- define the measures likely to be taken;

- have reliable evidence that the proposed policies and interventions are efficient and sustainable;

- ensure that the programme is cost/effective;

- undertake an assessment of alternative actions.

2. Providers should be trained to adopt evidence-based health promotion practices and the public should be educated and encouraged to demand and accept evidence-based medicine and health policy. 

II. Impact of other policies on health

1. All government sectors should acknowledge the influence of the socio-economic determinants on health and recognise the real cost of the absence of a planned health promotion.

The role and impact on health of other policies, systems and services (transport, food production, housing, employment, education, environment, communication) should be taken into account in developing health promotion policies and the systems and services should be organised and adapted accordingly.

2. Priority needs to be given to reducing or eliminating the major avoidable causes of disability and death in countries and to the most significant pre-determinants of health (sufficient and healthy food, pure water, clean air, a guaranteed basic minimum income for families, housing, maternal and child care, good general education, labour protection and health at work). 

III. Integrated approach to health promotion

1. Health promotion should be an integral part of all public policies. The status of

health as a goal should be boosted and health promotion used as a mechanism for its delivery in all sectors of society. It should be based on an integrated approach towards the better health of both whole populations and individual citizens, in partnership with a wide range of agencies and social actors.

2. At the same time the responsibility of individuals for their own health should be emphasised, and adequate skills and conditions enabling healthy choices assured.

3. Member states should ensure that health promotion strategies are implemented at all levels, from the individual citizen in specific settings (schools, workplace and health care) to local and national government.

4. All government departments and regional and local authorities should co-ordinate between them to ensure that health becomes an integral aspect of policy in all sectors of activity. Integration of health into all sectors of society is successful only if management at the highest level takes responsibility for health promotion.

5. The impact of other major policies on health and vice versa should be evaluated and monitored regularly. The necessary organisational structures therefore need to be created at the national, regional and local levels to enable real partnership to develop across all sectors.

6. Health promotion, as a major activity of health care services, should be given proper recognition at all levels from the most senior level of management to the community level.

7. The role of the health care services as a vehicle for health promotion should be recognised. Structures and processes need to be in place supporting communication between practitioners involved in prevention, treatment and care. 

IV. Participation

1. Member states should:

 - encourage political and social dialogue between the public, the providers and buyers of health promotion;

 - involve all the major agencies in health promotion planning;

 - ensure the participation and consultation of the public in such planning.

This process should not however hamper the implementation of public health measures in the event of a crisis such as a serious epidemic of infectious disease.

2. The most disadvantaged groups of the population should play an important role in the assessment of their own health needs and in the success of implementing policies.

3. Tools should be made available to individualise health promotion at the primary health care level (for example: developing personalised self-care programmes by using computer-assisted health promotion diagnosis). 

V. Information and education

1. In order to make informed choices about health promotion programmes, the public, which is the major provider of health and social care, through self-care and care of family and friends, should have free access to information about the range of treatments or policy interventions available, their outcomes and variations in outcomes.

Where possible, the existing knowledge and evidence basis should be explained in plain language. 

2. The public should be properly informed about the benefits of health promotion especially and about health protection and disease prevention programmes. They should also be informed about any accompanying risks and harmful effects. The quality criteria should also be made known.

3. Health promotion should be based on a positive approach to life, through the creation of environments (social, physical and economic environments) which do not only enhance individual responsibility but structurally promote healthy and pleasurable choices as well.

4. When health promotion and health education programmes are drawn up they should take into account the culture, the traditional beliefs and values of the communities for which they are intended.

5. Information on the effectiveness of health promotion programmes such as the WHO CINDI programme and the European Network of Health Promoting Schools (ENHPS) project (a joint WHO/Council of Europe/European Commission project) should be made more widely available. Local demonstration projects should build on knowledge gained from such projects and demonstrate the real effectiveness and transferability of knowledge to different countries and cultures.

6. The role of different professional and occupational groups (doctors, nurses, teachers, pharmacists, police, social workers) should be defined (at a countrywide level) and their training adapted and developed as appropriate. Where necessary management and incentive arrangements should be changed to support the provision of health promotion.

7. The specific roles of policy makers in many sectors including that of politicians and the media need to be recognised and supported through information, education and other approaches. 

VI. Evaluation

1. Specific indicators should be introduced to monitor the impact of the outcomes of health promotion activities including preventive policies (changes in risk factors, preventable complications of disease, improvement in functional capacity, premature mortality and morbidity, percentage of total health expenditure). 

2. Minimum databases should be constructed to monitor the promotion of health including prevention of disease as part of the normal reporting systems, vital statistics, surveys, regulatory surveillance, etc.

3. The effectiveness of health promotion measures should be supported by scientific evidence on the basis of repeatability of the results in real every day practice. 

VII. Resources

1. Health promotion policies should be planned in detail, taking into account the cost of delivering the intervention to the population as a whole or groups of the population at risk.

2. Where health promotion resources are the responsibility of health ministers, appropriate management and accountability structures should be available to protect health promotion services from the ever-rising cost pressures of providing curative services.

3. Where there is sufficient evidence, a shift of resources from curative to preventive policies should be considered, within a unified approach towards strengthening the health of the population. In the allocation of resources, the basket of essential health promotion and preventive services should be defined. Such an approach should help ensure that health promotion is affordable and sustainable.



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