Evaluation in health promotion : principles and perspectives / edited

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WHO Regional Publications 

European Series, No. 92

Evaluation in health promotion 

Principles and perspectives

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Evaluation in health promotion 

Principles and perspectives 

Edited by: 

Irving Rootman, Michael Goodstadt, 

Brian Hyndman, David V. McQueen, 

Louise Potvin, Jane Springett 

and Erio Ziglio 

Health 

Canada 

Santé 

Canada 

WHO Regional Publications, European Series, No. 92

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Part 1 

Introduction and framework

Introduction to the book 

Irving Rootman 

WHO European Working Group on Health Promotion 

Evaluation 

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Table 1.1. Definitions of health promotion 

Source and date Definition (emphasis added) 

Lalonde, 1974 (3) A strategy “aimed at informing, influencing and assisting both individuals 

and organizations so that they will accept more responsibility and be 

more active in matters affecting mental and physical health” 

US Department of 

Health, Education, and 

Welfare, 1979 (19) 

“A combination of health education and related organizational, political 

and economic programs designed to support changes in behavior and in 

the environment that will improve health” 

Green, 1980 (20) “Any combination of health education and related organizational, political 

and economic interventions designed to facilitate behavioral and 

environmental changes that will improve health” 

Green & Iverson, 1982 

(21) 

“Any combination of health education and related organizational, economic, 

and environmental supports for behavior conducive to health” 

Perry & Jessor, 1985 (22) “The implementation of efforts to foster improved health and well-being in 

all four domains of health [physical, social, psychological and personal]” 

Nutbeam, 1985 (23) “The process of enabling people to increase control over the determinants 

of health and thereby improve their health” 

WHO, 1984 (24), 1986 

(4) and Epp, 1986 (25) 

Goodstadt et al., 1987 

(26) 

“The process of enabling people to increase control over, and to improve, 

their health” 

“The maintenance and enhancement of existing levels of health through 

the implementation of effective programs, services, and policies” 

Kar, 1989 (27) “The advancement of wellbeing and the avoidance of health risks by 

achieving optimal levels of the behavioral, societal, environmental and 

biomedical determinants of health” 

O’Donnell, 1989 (28) “The science and art of helping people choose their lifestyles to move 

toward a state of optimal health” 

Labonté & Little, 1992 

(29) 

“Any activity or program designed to improve social and environmental 

living conditions such that people’s experience of well-being is increased” 

'HILQLWLRQV DQG FRQFHSWV RI KHDOWK SURPRWLRQ KDYH GLIIHUHG LQ JRDOV REMHF 

WLYHV SURFHVVHV DQG DFWLRQV 7DEOH DQDO\VHV WKH FRQFHSWV RI KHDOWK SUR 

PRWLRQ DV FRQWDLQHG LQ WKH GHILQLWLRQV OLVWHG LQ 7DEOH 7KHVH GHILQLWLRQV DUH 

GHFRQVWUXFWHG DFFRUGLQJ WR WKHLU WHUPLQDO JRDOV DQG WKHLU LQVWUXPHQWDO REMHF 

WLYHV SURFHVVHV DQG DFWLRQV

Source and date Activities 

(programmes, policies, etc.) 

Winslow, 1920 (2) “Organized community effort for the education 

of the individual in personal 

health, and the development of the social 

machinery” 

Table 1.2. Definitions of health promotion deconstructed 

Processes 

(underlying mechanisms) 

Objectives 

(instrumental outcomes) 

“... to ensure everyone a 

standard of living” 

Goals 

(ultimate outcomes) 

“... the maintenance or 

improvement of health” 

Sigerist, 1946 (1) “... by providing a decent 

standard of living, good labor 

conditions, education, physical 

culture, means of rest and recreation” 

“Health is promoted” 

Lalonde, 1974 (3) “... informing, influencing and assisting 

both individuals and organizations” 

US Department of Health, 

Education, and Welfare, 

1979 (19) 

“A combination of health education and 

related organizational, political and economic 

programs” 

Green, 1980 (20) “Any combination of health education 

and related organizational, political and 

economic interventions” 

Green & Iverson, 1982 (21) “Any combination of health education 

and related organizational, political and 

economic supports” 

“... so that they [individuals 

and organizations] will accept 

more responsibility and be 

more active in matters affecting 

mental and physical 

health” 

“… designed to support 

changes in behavior and in the 

environment” 

“... designed to facilitate 

behavioral and environmental 

changes” 

“… that will improve health” 

“... that will improve health” 

“… for behavior” “… conducive to health”

Source and date Activities 

(programmes, policies, etc.) 

Perry & Jessor, 1985 (22) “The implementation of efforts” “... to foster improved health 

and well-being in all four 

domains of health [physical, 

social, psychological and personal]” 

Nutbeam, 1985 (23) “The process of enabling people 

to increase control” 

WHO, 1984 (24), 1986 (4) 

Epp, 1986 (25) 

Goodstadt et al., 1987 (26) “… through the implementation of 

effective programs, services, and policies” 

“The process of enabling people 

to increase control over 

[their health]” 

“… over the determinants of 


Kar, 1989 (27) “… and the avoidance of 

health risks by achieving optimal 

levels of the behavioral, 

societal, environmental, and 

biomedical determinants of 


O’Donnell, 1989 (28) “The science and art of helping people 

choose their lifestyles” 

Green & Kreuter, 1991 (7) “The combination of educational and 

environmental supports for actions and 

conditions of living” 

Processes 

(underlying mechanisms) 

Objectives 

(instrumental outcomes) 

Goals 

(ultimate outcomes) 

“... and thereby improve their 


“… and thereby to improve 

their health” 

“The maintenance and 

enhancement of existing levels 

of health” 

“The advancement of wellbeing” 

“... to move toward a state of 

optimal health” 

... conducive to health”

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Fig. 2.1. programme components and evaluation questions 

Environmental conditions 

Target of change Programme components 

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Resulting conditions Activities/Services 

Source: adapted from Contandriopoulos et al. (19) 

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evaluation 

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interactions 

Fig. 2.2. Programme phases and evaluation questions 

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phase 

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out 

Source: adapted from unpublished course material developed by S. Haddad and L. Albert, 

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Table 4.1. Characteristics of positivism andhermeneutics 

Positivism Hermeneutics 

Objective observation Critical subjectivity 

Explanation and prediction Understanding and finding meaning 

Search for general knowledge and 

standardization 

View of social organization as combinations 

of similar things 

Surface view 

Hypothesis testing through formal definition 

of ideas and measurement 

Mechanistic, with a focus on an object that 

has no voice and is submissive 

Aim: the power to control the collection of 

facts 

View of every situation as unique 

Stress on richness, variety and depth 

Dialectical cycle to gain knowledge 

Emphasis on quantity Emphasis on quality 

Dialogue and subjective participation (understanding 

is not real unless it is mutual) 

Aim: enlightenment, edification, enrichment, personal 

growth 

Source: adapted from Dahlbom & Mathiassen (4). 

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Fig. 4.1. Action research and the learning cycle 

Active 

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future action) 

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experience 

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Abstract 

conceptualization 

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Table 4.2. Differences between the natural and social sciences in 

approach to and methods of programme evaluation 

Question Natural sciences Social sciences 

Who performs evaluation? External experts Community, project staff facilitator 

What is examined? Predetermined indicators of 

success, principally cost and health 

outcomes/gains 

How? Focus on objectivity, distancing 

evaluators from other participants; 

uniform, complex procedures; 

delayed, limited distribution of 

results 

When? Usually at programme completion; 

sometimes also mid-term 

Why? To ensure accountability, usually 

summative, to determine whether 

funding continues 

Indicators of success identified by 

participants, which may include 

health outcomes and gains 

Self-evaluation, simple methods 

adapted to local culture; open, 

immediate sharing of results 

through local involvement in evaluation 

processes 

Merging of monitoring and evaluation; 

hence frequent small-scale 

evaluation 

To empower local people to initiate, 

take and control corrective action 

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Table 4.3. The advantages and disadvantages 

of external and internal evaluators 

External evaluators Internal evaluators 

Can take a fresh look at the programme Know the programme well 

Are not personally involved Find it harder to be objective 

Are not part of the programme’s normal power 

structure 

Gain nothing from programmes, but may gain 

prestige from evaluations 

Are trained in evaluation methods, may have 

experience with other evaluations, are regarded 

as experts by programme participants 

Are outsiders who may not understand programmes 

or the people involved 

Are part of the programme’s normal power structure 

Source: Fuerstein (29). 

May be motivated by hopes of personal gain 

May not be trained in evaluation methods, have 

little or no more training than others in the programme 

Are familiar with and understand programmes 

and can interpret personal behaviour and attitudes 

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Table 6.1. Lindström’s model for the quality of life of children 

in Nordic countries 

Spheres Dimensions Examples 

Global 1. Macro environment Physical environment 

2. Culture 

3. Human rights 

Source: Lindström (66). 

Responsiveness to the United Nations 

Convention on the Rights of the Child 

4. Welfare policies Welfare distribution 

External 1. Work Parental education and satisfaction 

with employment 

2. Income Income distribution 

3. Housing Quality of and satisfaction with housing 

Interpersonal 1. Family structure and function Satisfaction with family, lack of 

negative events 

2. Intimate friends 

Support from friends, neighbours and 

3. Extended social networks society 

Personal 1. Physical Growth, activity 

2. Mental Self-esteem and mood 

3. Spiritual Meaning of life

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Table 6.2. The Centre for Health Promotion’s domains of quality of life 

Domains Subdomains Contents 

Being Physical Physical health, mobility, nutrition, exercise, fitness and 

appearance 

Psychological Independence, autonomy, self-acceptance and freedom 

from stress 

Spiritual Personal values and standards and spiritual beliefs 

Belonging Physical Physical aspects of the immediate environment 

Social Relationships with family, friends and acquaintances 

Community Availability of societal resources and services 

Becoming Practical Home, school and work activities 

Leisure Indoor and outdoor activities, recreational resources 

Growth Learning things, improving skills and relationships, 

adapting to life 

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ZLWK SK\VLFDO GLVDELOLWLHV DGROHVFHQWV HOGHUO\ SHRSOH DQG DGXOWV 

LQ JHQHUDO ,Q WKHVH DSSOLFDWLRQV VHOI UHSRUW LQYHQWRULHV DUH DSSOLHG 

WKURXJK WUDGLWLRQDO VXUYH\ PHWKRGV 

Key issues 

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LWHPV WKHVH LWHPV DUH WKHQ XVHG WR FROOHFW GDWD DFFRUGLQJ WR WUDGLWLRQDO LQVWUX 

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LFHV ,Q DGGLWLRQ WKH PRGHO KDV XVHG FRQVWUXFWLYLVW DSSURDFKHV WR KHOS VWXG\ 

WKH TXDOLW\ RI OLIH RI FRPPXQLWLHV 

The community quality-of-life project: understanding communities 

through a health promotion approach 

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D SURFHVV WR LQFUHDVH FRPPXQLW\ EDVHG KHDOWK ZRUNHUV XQGHUVWDQGLQJ RI FRP

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WR LQGLFDWH QHHGV DQG KHOS WR GHYHORS VROXWLRQV 7KH H[SHFWHG RXWFRPHV RI WKH 

VWXG\ DUH 

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TXDOLW\ RI OLIH 

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FDUU\ RXW VLPLODU DFWLYLWLHV 

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Key issues 

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Evaluation issues 

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PHQWV PDGH VHH &KDSWHU 

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Guidelines for evaluations of health promotion initiatives 

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Explicit assumptions 

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Table 7.1. Different types of full economic evaluation 

Type of study Treatment of alternatives 

Cost-minimization 

analysis 

Cost–effectiveness 

analysis 

Measurement/ 

Valuation of costs 

in alternatives 

Identification of 

consequences 

Monetary terms Identical in all relevant 

respects 

Monetary terms Single effect of interest, 

common to both 

alternatives, but achieved to 

different degrees 

Cost–utility analysis Monetary terms Single or multiple effects, 

not necessarily common to 

both alternatives 

Cost–benefit analysis Monetary terms Single or multiple effects, 

not necessarily common to 

both alternatives 

Source: adapted from Drummond et al. (1). 

Measurement/ 

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consequences 

None 

Natural units (life years 

gained, numbers stopping 

smoking, etc.) 

Healthy years or 

(more often) QALYs 

Monetary terms 

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Table 7.2. An example of cost–benefit analysis: 

legislation for bicycle helmets in Israel 

Benefits and costs 

Benefits 

Values (US $) 

Value of lives saved 8 939 979 

Reduced health care costs 17 412 622 

Reduced long-term care costs 25 263 243 

Reduced need for special education 1 527 131 

Productivity gain from reduced disabilities 

Costs 

7 545 779 

60 688 754 

Health education programme and helmets (20 143 984) 

Total social benefits 40 544 770 

Source: adapted from Ginsberg & Silverberg (17). 

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Fig. 8.1. The starting point for quality in health promotion planning 

Consult 

stakeholders 

Clarify the health promotion 

issue or problem 

Agree the target groups 

Formulate precise programme 

objectives: usually educational, 

behavioural, environmental or 

organizational 

Quantify desired outcome 

within given period of time 

(target setting) 

Rewiew possible 

methodological approaches 

Agree intervention approach 

Determine precise resources 

required 

Acquire funding and other 

resources 

Allocate tasks 

Pilot-test progamme where 

unproven methods are proposed 

Execute programme 

Evaluate programme 

Take account of the nature 

of the issues, level of 

intervention required and 

time limits 

Take account of existing 

knowledge, attitudes, 

behaviour, environmental 

factors and organizational 

systems 

Have due regard of 

approximate costs, time limits 

and social, economic and 

environmental constraints 

Determine immediate target 

groups, significant mediators 

and support systems 

Determine skills deficit and 

training required 

Modify programme if 

necessary

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References 

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9 

Investigating policy 

networks for health: 

theory and method in a larger 

organizational perspective 

Evelyne de Leeuw 2 

Introduction 

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analysis 

Fig. 9.1. Study of the national debate on health policy 

in the Netherlands, 1980s 

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of the policy

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Evaluating community initiatives 

for health and development 

Stephen B. Fawcett, Adrienne Paine-Andrews, 

Vincent T. Francisco, Jerry Schultz, Kimber P. Richter, 

Jannette Berkley-Patton, Jacqueline L. Fisher, 

Rhonda K. Lewis, Christine M. Lopez, Stergios Russos, 

3 

Ella L. Williams, Kari J. Harris and Paul Evensen 3 

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Fig. 11.1. The community initiative as a catalyst for change 

More distal 

outcomes 

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Source: adapted from Fawcett et al. (26). 

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Fig. 11.3. Community changes (intermediate outcomes) from work to prevent 

adolescent pregnancy in Geary County, Kansas, 1993–1996 

120 

110 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

Grant 

awarded 

Strategic 

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worker 

hired 

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in director 

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leave 

Change 

in director 

Outreach 

worker on 

leave 

J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J O S O N D J F M A M J J A S O N D 

1993 

New 

outreach 

worker 

hired 

1994 1995 1996 

Change 

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Table 13.1. Participatory evaluation of a health promotion programme: main actions, associated actions and comments 

Main actions Associated actions Comments 

Step 1. Clarify the aims 

and objectives of the 

proposed programme. 

Step 2. Design the 

framework for evaluation 

and what questions 

to ask. 

Step 3. Design the 

framework for evaluation 

and decide how 

to measure change. 

Get the participants on board. 

Set up an evaluation group. 

Determine what the real health problem is. 

Establish baseline information. 

Decide the purpose of the evaluation and who will use the information. 

Decide what questions are useful to ask in relation to achieving aims 

and objectives. 

Decide from whom to collect information. 

Decide whether process as well as outcome information is needed. 

Decide what to measure and which methods to use. 

Decide on sample size and target population. 

Decide when to collect the information. 

Step 4. Collect the data. Make sure data collection is unobtrusive and does not add to participants’ 

workload or, if it does, they can see the value of doing it. 

Make sure participants are still on board. 

Keep participants informed by regular feedback. 

Remember that data are not information. 

The importance of spending time on this groundwork cannot be overemphasized. 

Involvement of the right people will ensure commitment 

to the use of the information generated and a good response to any 

questionnaires. The evaluation group (at least three people) should 

reflect the range of interests. Proper clarification makes the evaluation 

straightforward. 

Take this action before deciding what measures to use. If the objectives 

have been stated clearly, this should be relatively easy. Be clear 

about the aims of the evaluation; this affects what questions are 

asked. The main aim is to see whether the activities in the programme 

resulted in achieving the stated objectives. Try to look at 

process as well as outcome. 

Good measurement depends on being clear about the issues. Methods 

should be appropriate to the questions and need not be numerical. 

Be realistic and honest about limitations of time and money. 

There will be problems of confidentiality and bias. Bias is most common 

in self-reported behaviour. Problems are smaller if all stakeholders 

have been involved. Participation is a key.

Main actions Associated actions Comments 

Step 5. Evaluate the 

results to determine the 

effectiveness of the programme. 

Step 6. Make recommendations. 

Interpret data in association with the evaluation group, comparing 

what actually happened with what was expected. 

Remember that numbers are only indicators of what the world is like. 

Clarify what is useful. 

Cover practical changes for immediate implementation. 

Include the costs and benefits of not implementing as well as implementing 

the recommendations. Challenge existing beliefs. 

Look for longer-term changes that may not yet be visible. 

Source: Workplace Task Force report. London, Department of Health, 1993. 

Data are not information until they have been interpreted. This is best 

done as a collaborative process, so the participants understand how 

the results were obtained. Remember the value of so-called soft 

information, and that some health changes take time to be revealed. 

If the participants have been involved in the process, they will already 

be committed to acting on the findings and be receptive to results

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14 

Evaluation in urban settings: 

the challenge of Healthy Cities 

Lisa Curtice, Jane Springett and Aine Kennedy 

Introduction 

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Characteristics of Healthy Cities that present a challenge 

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Overview 

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References 

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Fig. 15.1. Key elements of an implementation structure 

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Fig. 15.3. Current policy implementation structure 

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Fig. 15.4. Desired implementation structure for healthy public policies 

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Evaluation: concept, problem and purpose 

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Overview of the framework 

Public policy: purpose and environment 

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Fig. 16.1. Health organizations and policy-making 

Policy environment Policy impacts 

Economy 

Demographics 

Epidemiology 

Technology–media mix 

Ideologies 

Political processes 

Policy-makers 

Stakeholder 

groups 

Communication 

and interpretive 

media 

Publics 

Policy 

processes 

Public 

policies 

Policy 

tools 

Goods and services: jobs, housing, food, education, environment 

Organizations: 

• public 

• private (profit 

and non-profit) 

Self-starting initiatives 

Health 

organizations 

policy 

action 

Coalition building: 

•lobbying 

•litigation 

•negotiation 

•opinion shaping 

Public 

policy 

responses 

Organizational 

changes: 

•fiscal 

•administrative 

•programmatic 

•informational 

Impacts: 

• on other 

organizations 

•on other 

environments 

Outcomes for: 

• clients 

• total population

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Interest groups: 

• legislative committees 

• bureaucratic units 

• parties 

• caucuses 

• lobbies of industry, 

labour, professions, 

voluntary organizations 

Fig. 16.2. Media and policy-making processes 

Media: 

• news coverage and foci 

• editorials 

• opinion poll reports 

• political advertisements Publics: 

• consumers 

• audiences 

• taxpayers 

• voters 

• political contributors 

• potential interest-group 

members 

Public policy-making 

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Types of policies 

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Table 16.1. Strategies for disease prevention and health promotion 

Intervention strategy Focus 

Individual-directed, information-mediated change Homes and communities 

Organization settings 

Organization-directed change Policy bodies: 

• legislatural bodies 

• independent regulatory agencies 

• government administration 

Specific organizations: 

• government bodies 

• other organizations 

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A case in point: tobacco-control legislation 

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Environmental context: why there and then? 

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Policy frame and setting: how and where was the policy issue 

defined and legitimized? 

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Design, instruments and financing: what were the policy goals, 

tools and resources? 

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Organizations: who were the players? 

Interests 

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Interorganizational relations: how were players interlinked? 

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Organizations’ strategies: what action did players take? 

Types of strategic action 

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Policy evaluation issues 

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17 

Evaluation of countrywide 

health promotion policies: 

the Canadian experience 

Reg Warren, Irving Rootman and Rick Wilson 

Introduction 

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18 

Health impact assessment 

as a tool for health promotion 

and population health 

C. James Frankish, Lawrence W. Green, Pamela A. Ratner, 

Treena Chomik and Craig Larsen 

Introduction 

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of health 

Fig. 18.1. Influences of policies and programmes on health 

Policies and programmes 

(health or non-health) 

Health impact 

(outcomes) 


Source: Frankish, J. et al. Health impact assessment as a tool for population health promotion and 

public policy. A report submitted to the Health Promotion Development Division of Health Canada 

(http://www.hc-sc.gc.ca/hppb/healthpromotiondevelopment/pube/impact/impact.htm). 

Ottawa, Health Canada, 1996 (accessed 21 February 2001). © Minister of Public Works and 

Government Services Canada, 2001.

Fig. 18.2. Potential impact of policies and programmes 

Environmental 

impact 

Social 

impact 

Health 

impact 

Economic 

impact 





Government Services Canada, 2001. 

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SOCIETY 

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Government Services Canada, 2001.

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Town A 

(high social capital) 

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Newspaper Cooperative 

extension 

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survey 

Town B 

(low social capital) 

Community leaders 

A B 

Newspaper Cooperative 

C D 

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survey 

extension 

agents 

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Positive 

community 

perception supports 


Organized, timely 

implementation 

Outcomes 

realized 

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of life 

Fig. 19.2. A social capital model of community change 

Institutional 

infrastructure 

Population perceptions of social capital 

More positive Less positive 

Collaborative Less collaborative Collaborative 

Institutional 

change 

Population 

frustration 

Struggling 

programmes 

Outcomes not 

realized 

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improved 

Institutional 

infrastructure 

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frustration 

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Introduction 

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services 

Table 22.2. Sample map of health gain 

Gains in sectors 

Education Transport Social care Environment 

1 ✓✓✓ ✓ ✓✓✓ ✓ ✓✓ 

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Fig. 22.1. A health gain matrix (including criteria) 

C 1 

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involved 

C 3 

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C 4 

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care 

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sectors 

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Fig. 22.2. Goals and policy decisions shared by three sectors 

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Synthesis and conclusion

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synthesis and recommendations 

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EVALUATION LOOP 

Overall impacts 

Health promotion goals 

Core perspectives 

Outcomes or 

objectives 

Action areas 

Instrumental 

objectives, 

processes and 

outcomes 

Generic strategies 

Instrumental 

activities, products 

and outputs 

MICRO-LEVEL OBJECTIVES 

Enhanced individual capacities 

Improved awareness, 

knowledge, skills, 

decision-making 

and behaviour 

Health 

education 

EVALUATION LOOP 

Developing 

personal skills 

Programme, 

marketing and 

materials 

Individuals, communities and societies 

achieve/approach their potentials 

Improved health and wellbeing 

Health 

communication 

Enhanced 


capacity 

Organizational 

development 

Increased 

community 

capacity and 

participation 

Community 

development 

Enhanced 

health 

promoting 

policies 

Reduced mortality and morbidity 

VALUES 

Positive health, holistic health, social justice, equity, participation 

MECHANISM 

Empowerment: enhancing capacities of individuals and communities to exercise control over the 

determinants of health 

PREREQUSITES (DETERMINANTS) OF HEALTH 

Income equity/inequity, social status, social support networks, education, employment and working 

conditions, physical environments, biology and genetics, personal health practices and coping skills, 

healthy/unhealthy child development, health services 

Strengthening 

community action 

Modified 


structures and 

climate 

MESO-LEVEL OBJECTIVES 

Enhanced community capacities 

Creating 

supportive 

environments 

Resource inputs 

Coordination of community 

efforts, enhanced community 

resources and capacities, and 

community coalition building 

Laws and 

regulations, 

policy 

statements 

MACRO-LEVEL OBJECTIVES 

Supportive institutional and societal environments 

Building healthy 

public policy 

Policy 

development 

INSTRUMENTAL OBJECTIVES, PROCESSES AND OUTCOMES 

Reduced health and social costs 

More equitable 

access to health 

care 

Advocacy 

Public dialogue 

on decisionmaking 

Reorienting 

health services 

Increased focus on 

prevention and health 

promotion in health 

care system 

Intersectoral 

collaboration 

Coordination of 

policies and activities 

in sectors that affect 


Increased 

knowledge on 

effectiveness 

Research/ 

Evaluation 

THE FOUNDATIONS OF HEALTH PROMOTION 

(Ottawa Charter for Health Promotion) 

Knowledge 

development and 

dissemination 

PLANNING HEALTH PROMOTION 

INITIATIVES 

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Evaluation aluation 

in in health 


pr promotion pr omotion 

Policy-makers, professionals of 

all kinds and the general public 

increasingly recognize social 

and economic factors as important 

determinants of health. Because 

health promotion approaches 

address these factors, 

they can play an increasingly 

valuable role in protecting and 

improving health. At the same 

time, funding sources increasingly 

demand evidence that initiatives give value for money. Health promotion 

initiatives need effective evaluation to realize their potential: both 

to prove their value as investments and to increase their effectiveness in 

achieving their aims. 

To help meet this need, the WHO European Working Group on Health 

Promotion Evaluation examined the current range of qualitative and 

quantitative evaluation methods to provide guidance to policy-makers 

and practitioners. This book is the result. It comprises an extensive compilation 

and discussion of the theory, methodologies and practice of evaluating 

health promotion initiatives in Europe and the Americas. The book 

takes three perspectives in examining the issues. It includes a retrospective 

examination of the evolution of health promotion evaluation. This 

provides the context for assessing and understanding the current state of 

evaluations of initiatives addressing settings, polices and systems for 

promoting health. Finally, the chapter authors and the Working Group as 

a whole make many recommendations for improvement that provide a 

look into the future. 

This book shows how a health promotion approach offers a comprehensive 

framework for planning and implementing interventions that can effectively 

address today’s major health-related problems. The authors describe 

how good evaluations assist initiatives in achieving their goals, 

provide a wealth of guidance on how to undertake them and call for 

greater investment in the evaluation of health promotion. The authors 

hope that their work will stimulate policy-makers and practitioners to invest 

in and undertake good evaluation for good health promotion. This is 

their commitment; they hope that readers share it. 

ISBN 92 890 1359 1 

Sw.fr. 122.–

Evaluation in health promotion : principles and perspectives / edited

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