Working Upwards

  • 14/09/1997

health is not only - or even primarily - the concern of doctors and nurses. The community has a major role to play in creating an environment that makes available better health care facilities and is conducive to prevention of diseases. In the current environmental situation, which continues to get worse, we bear greater responsibilities for the future of our planet and its people than the previous generations. The book highlights the need for community participation in health and advocates that the empowerment of individuals, local bodies and other groups is crucial for sustainable health supportive efforts.

This handbook is an outcome of the Third International Conference on Health Promotion held at Sundsvall, Sweden in 1991, organised by the World Health Organization together with the United Nations Environment Programme. The book is a compilation of stories by 350 participants drawn from 81 countries, which offer examples of ways to bring about change for a healthier environment.

The book identifies war and poverty as the main threats to health and environment. The second most common threat comes from depletion of natural resources through exploitation and misuse. Therefore, the prerequisites for environmental protection are peace, education, availability of food, a stable ecosystem, a supportive social system, social justice, equity and equality. It advocates the creation of health-supportive environments at local, national and international levels. But these changes will not come easily because to have community participation, we need to start a process of decentralisation, a process which is fundamentally challenging to the concentration of political and economic power in the hands of a few elite.

The book briefly outlines the theory and principles on which health supportive activities should be based. The link between health and environment is well established but not adequately addressed. This is where the handbook makes a useful contribution.

The book is divided into three parts. The first part, 'Strategies that work', outlines the basic framework of supportive environments and introduces strategies for analysing, describing and understanding problems related to the environment. The information presented here will be useful for decision makers at various levels in helping to identify weak links in strategies or areas that need to be strengthened or improved. The second part contains case studies. Part three combines and develops elements from part one and two. It indicates action to create, by stages, a supportive environment for health.

The handbook discusses three complementary models that represent improvements in the earlier theoretical constructs, specially designed and adapted to the changed priorities and paradigms in creating health-supportive systems. The first model, the 'health promotion strategy analysis', is effective in analysing health problems and working out solutions. The second model, the 'Sundsvall pyramid of supportive environment' is a conceptual aid - a guide to understanding health-related issues. The third model, 'supportive environment action model', illustrates a logical universal sequence of actions that take place in many areas of human activity. It is an action-oriented model.

The contents and the information base of the book will not only assist those concerned with promoting a healthy environment but also facilitate activities enumerated in Agenda 21 of the United Nations Conference on Environment and Development. The matter is presented in a simple and easy to comprehend style, and the book should prove to be a handy tool for policymakers and health workers alike.

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