Over time, approaches to health change and progress in response to research and the improved understanding of disease and illness. Traditionally, a biomedical approach was prioritised to understand where and how disease and illness spread. In more recent years, other approaches have been adopted to better address the health needs of all Australians. The following tables highlight the five key approaches and models of health and how health promotion has incorporated these into campaigns, initiatives and strategies.

The World Health Organization (WHO) and the United Nations Educational, Scientific and Cultural Organization (UNESCO) have developed various global health policies that significantly impact health promotion in Australia. These policies collectively enhance Australia's health promotion efforts by providing strategic guidance, setting global standards, and encouraging best practices in public health. Below are five key policies and their impacts:

Ottawa Charter for Health Promotion (1986) This foundational document outlines key strategies for health promotion, including creating supportive environments, strengthening community action, and reorienting health services. In Australia, the Ottawa Charter has guided the development of comprehensive health promotion programs and public health initiatives that emphasise prevention and community engagement.

Global Strategy on Diet, Physical Activity and Health (2004) This strategy addresses the growing burden of non-communicable diseases (NCDs) by promoting healthy diets and physical activity. Australia has adopted this strategy through initiatives such as the ‘Healthy Weight Guide’ and national dietary guidelines, which aim to reduce obesity rates and encourage active lifestyles.

WHO Framework Convention on Tobacco Control (FCTC) (2005) The FCTC provides a framework for reducing tobacco consumption and exposure to tobacco smoke. Australia's tobacco control measures, such as plain packaging laws, smoking bans in public places, and public education campaigns, align with FCTC recommendations and significantly reduce smoking rates and related health issues.

Global Strategy to Reduce Harmful Use of Alcohol (2010) This strategy focuses on reducing alcohol-related harm through policy measures, public awareness, and health service responses. Australia has implemented various initiatives in line with this strategy, including stricter alcohol advertising regulations, increased alcohol taxes, and community-based programs to reduce alcohol misuse.

Education 2030 Framework for Action (UNESCO, 2015) This framework aims to ensure inclusive and equitable quality education and promote lifelong learning opportunities. In Australia, the focus on health education within this framework has led to the integration of comprehensive health education programs in schools, emphasising mental health, wellbeing and healthy lifestyles, thereby fostering a healthier younger generation.

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

The Ottawa Charter for Health Promotion (1986) has been instrumental in shaping health promotion in Australia. It outlines five key action areas: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services.

These action areas can be recalled using the acronym B.E.E.P.S. 

• Building healthy public policy
• Creating supportive Environments
• Empowering community action
• Developing Personal skills
• Reorienting health Services

The principles of the Ottawa Charter have guided numerous health initiatives in Australia.

Below are three examples.

1. The National Tobacco Campaign: This campaign focuses on reducing tobacco use through public education, smoking bans in public places, and plain packaging laws. The campaign has significantly reduced smoking rates in Australia, leading to improved public health outcomes and reduced healthcare costs associated with smoking-related illnesses.

2. Healthy Spaces and Places Initiative: A collaboration between the Heart Foundation, Planning Institute of Australia and Australian Local Government Association; this initiative promotes the design of urban environments that encourage physical activity. By creating walkable communities, enhancing green spaces and improving access to recreational facilities, the initiative supports physical activity and reduces the incidence of lifestyle-related diseases.

3. Closing the Gap: A national strategy aimed at reducing health disparities between Indigenous and non-Indigenous Australians. It involves community engagement, culturally appropriate health services and targeted health programs. The initiative has led to improvements in various health indicators among Indigenous communities, including better access to healthcare, improved maternal and child health and reductions in chronic disease rates.

Health promotion in partnerships with communities strengthens the health of individuals and communities by ensuring that health initiatives are culturally appropriate, effective, and sustainable. This is particularly vital for diverse cultural groups, including Aboriginal and Torres Strait Islander Peoples.

The ‘Deadly Choices’ program is an example of a community led health program that empowers Aboriginal and Torres Strait Islander Peoples to make healthy lifestyle choices through culturally relevant activities. This program, involving local leaders and health workers, promotes physical activity, healthy eating and regular health check-ups.

Aboriginal Community Controlled Health Services (ACCHS) is another example that provides comprehensive and culturally sensitive primary health care. Governed by local Indigenous communities, ACCHS address medical issues and the social determinants of health, to improve outcomes in maternal and child health, chronic diseases and mental health.

Another example is the ‘Respecting the Difference’ program, which trains healthcare providers in cultural competence. This enhances their ability to meet the specific needs of Aboriginal and Torres Strait Islander patients. The training fosters better communication, trust and respect, leading to increased health service utilisation and improved health outcomes.