available and that one third of the decline occurred before the cause was known. This argument for refocusing on the environmental determinants of health and personal prevention coincided with an emerging emphasis on ecological thinking that moved beyond the mechanistic sanitary approach of the old public health. This new movement for public health found expression in three related WHO initiatives: the 1977 Declaration of Alma-Ata which described a (8) – vision of primary health care integrating public health, population and environmental concerns; the strategy for health for all by the year 2000 with its emphasis on equity, public participation, intersectoral (9) – collaboration and the need to reorient heath systems and services; and the 1986 Ottawa Charter for Health Promotion with its focus on (10) – supportive environments and public policies to support health development. The new and ecological public health has led naturally to a focus on settings as environments or habitats within which people live and work. One of the first practical attempts to operationalize the new way of thinking on a systematic basis came with the WHO Healthy Cities project, the intention of which was to take the health for all strategy off the shelves and into the streets of Europe This has been (11,12). followed and complemented by a developing focus on other settings, as witnessed by the publication of a national health strategy for England that specifically advocated action within homes, schools, cities, (13) workplaces, hospitals, prisons and environments. In some ways this can be seen as a shift from vertical thinking whereby individual public – heath problems remain compartmentalized, to horizontal thinking – whereby links and interactions are made explicit and a synergistic approach is adopted through coordinated action on a range of health determinants. DEVELOPING SETTINGS Although each setting is unique, drawing on the experience of other settings-based work is valuable in developing the concept of the healthpromoting university. The framework developed in the of England for healthy prisons offers one possible model (14) – looking at the setting from the perspective of five parameters:
available and that one third of the decline occurred before the cause was known. This argument for refocusing on the environmental determinants of health and personal prevention coincided with an emerging emphasis on ecological thinking that moved beyond the mechanistic sanitary approach of the old public health. This new movement for public health found expression in three related WHO initiatives: the 1977 Declaration of Alma-Ata (8) – which described a vision of primary health care integrating public health, population and environmental concerns; the strategy for health for all by the year 2000 (9) – with its emphasis on equity, public participation, intersectoral collaboration and the need to reorient heath systems and services; and the 1986 Ottawa Charter for Health Promotion (10) – with its focus on supportive environments and public policies to support health development. The new and ecological public health has led naturally to a focus on settings as environments or habitats within which people live and work. One of the first practical attempts to operationalize the new way of thinking on a systematic basis came with the WHO Healthy Cities project, the intention of which was to take the health for all strategy off the shelves and into the streets of Europe (11,12). This has been followed and complemented by a developing focus on other settings, as witnessed by the publication of a national health strategy for England (13) that specifically advocated action within homes, schools, cities, workplaces, hospitals, prisons and environments. In some ways this can be seen as a shift from vertical thinking – whereby individual public heath problems remain compartmentalized, to horizontal thinking – whereby links and interactions are made explicit and a synergistic approach is adopted through coordinated action on a range of health determinants. DEVELOPING SETTINGS Although each setting is unique, drawing on the experience of other settings-based work is valuable in developing the concept of the healthpromoting university. The framework developed in the of England for healthy prisons (14) offers one possible model – looking at the setting from the perspective of five parameters:
healthpromotinguniversities-concept,experience,framework.docx