Getting the handle off the proverbial pump: communication works.

Health Promotion, Communication, Education, and Community Participation: A Theory-Based Framework During the last decades of this century, we have come to recognize that human and social development are affected by the health status of the population and that medical care alone cannot fully address all the determinants of health. Health promotion strengthens primary health care and contributes to public health by enabling people to become involved in community action for health while working to maintain healthy lifestyles and behavior. Health promotion is part of the communications effort involved in the prevention and control of emerging infections. Health promotion, as defined by various international and regional health promotion conferences (Ottawa 1986, Adelaide 1988, Sundsvall 1991, Bogota 1992, Port of Spain 1993, and Jakarta 1997), enhances intersectoral action by increasing the focus on community involvement and action for health, placing healthy public policy on the agenda, creating supportive environments, and developing personal health skills. Health promotion is one of five policy directives of the Pan American Health Organization (PAHO) Strategic and Programmatic Orientations for 1995-1998. The PAHO/World Health Organization (WHO) Regional Plan of Action for Health Promotion includes the following objectives: 1) promote social development based on principles of equity and the right of citizens to health and well-being; 2) strengthen the concept of a health culture based on healthy environments, behavior, and lifestyles; and 3) develop the health sector’s capacity to recognize, support, and lead intersectoral processes for promoting health. To fully meet the goals of health promotion and disease prevention, programs must inform and guide policies, plans, and activities for health. Health education, communication, and community participation have a wide range of theoretical frameworks. Among the more important are 1) participatory community development political theories that explain capacity building, democratic organization, and management styles; 2) community-based social support networks that facilitate interpersonal communication and consensus around healthy lifestyles; 3) learnercentered cognitive theories that describe and explain the process of acquiring and updating values, knowledge, and skills; and 4) the behavior change framework, especially persuasion theories that describe and explain the process of adoption of healthy lifestyles, both individually and collectively. These theories create supportive environments, strengthen community action, develop personal health skills, and sustain positive behavior change.