Gerlinde Rohrauer-Näf, Fonds Gesundes Österreich
With the release of the Ottawa Charter in 1986, the setting approach has been defined as a core strategy of health promotion. During a period of almost thirty years, Austria has gained a substantial record of working with this approach. At first, it was quite difficult to go beyond previously known approaches that only target individual behavior. In the 80s, the WHO initiated health promotion in traditional settings, such as schools and workplaces. However, other environments for health promotion have emerged since then and continue to arise.
The setting approach is a core strategy for the implementation of health promotion. It is based on the idea of the Ottawa Charter (1986) that health is created within the settings of everyday life. Creating supportive environments in settings is one of the five strategies for action that are defined in the Ottawa Charter. Other strategies are to develop healthy public policies, strengthen community actions (on the group level), develop personal skills (individual level) and reorient health services to serve the needs of the population better. Ideally, several of these strategies for action should be combined, starting with the settings.
A setting is a distinct socio-spatial system where people live and which has an influence on the health of individuals or groups of people. The first settings that the WHO defined were workplaces, schools, cities, regions, prisons, universities and hospitals. Subsequently, many more settings have been added. The FGÖ, for example, is involved with projects in settings, such as municipalities, neighborhoods, day care centers for children, educational institutions, social and health services, nursing homes and counseling centers, communities (e.g., citizens with a migrant background) and families.
Certain conditions must be met to integrate health promotion in a setting effectively. These include:
- At the outset, the setting as a whole (and not only its health problems) should be analyzed.
- People should be encouraged to make their own setting healthier - a process only moderately supported and accompanied by health promotion experts.
- Health promotion must also plan for improvements in the important core business.
- Interventions must seek change on both the environmental and individual behavioral level, i.e., on several of the five levels of action of the Ottawa Charter. (Conrad, 2013, Altgeld 2004)
When comparing these with the conditions that are needed to create sustainable projects, we recognize that, in essence, they are the same. Projects with the setting approach have a better chance to continue after the initial project ends. (FGÖ 2013)
A setting is often used mainly for access to a target group for which defined services have been planned, i.e., small projects and information sessions (add-on strategy and health promotion in the setting). Health promotion with a real setting approach is directed at the structures and core processes of a setting, and changes them somewhat. For example, it can change them by introducing a comprehensive health management (add-in strategy and health promoting setting). (see Dür et al., 2014)
In 2009, an analysis of completed FGÖ projects revealed that, the proportion of measures offering services or targeting individual behavior was still very strong. In schools and communities, the focus was mainly on approaches, such as workshops, seminars, lectures, events, outreach work or public relations. Measures aimed at changing the environment by participatory change processes were most likely to be found in the workplace setting (Simek, 2013). In the meantime, much has happened. More projects are planned according to the setting approach today and new constellations arise:
In the workplace setting, a standard that comes close to health-related organizational development is gaining acceptance. This is due, at least in part, to the support of the quality development programs of the "Austrian Network for Health Promotion in the Workplace” and the FGÖ.
- Österreichisches Netzwerk BGF Stufen des Qualitätsmanagements: http://www.netzwerk-bgf.at/portal27/portal/bgfportal/content/contentWindow?contentid=10007.752617&action=2&viewmode=content
- FGÖ Projektdatenbank: http://www.fgoe.org/projektfoerderung/gefoerderte-projekte
By focusing more on equal health opportunities, there has been increased engagement from providers of social facilities / social services in Austria.
Community health promotion with social services
The “To a healthy neighborhood!”initiative has seen social services (providers of social facilities) and health promotion organizations link up in “tandem.” The goal is to encourage social participation and support for disadvantaged pregnant women, families with small children or older people in villages, towns and cities. The measures include needs assessments, surveys of existing offers and facilities, training of multipliers, initial approaches of participatory developments (e.g., in the children’s town council) and establishing networks of local social and health facilities.
- FGÖ Initiative „Auf gesunde Nachbarschaft!“: http://www.gesunde-nachbarschaft.at
Health promotion in social facilities
According to a survey that was conducted for the project "Debt and Health," there is a need to encourage closer collaboration between Austrian debt counseling services and the health sector to integrate the theme of "Debt and Health" (e.g., by training) in consulting sessions and to draw attention to the health of the consultants, themselves. Corresponding projects will be funded by the FGÖ.
- Bericht im Magazin der Österreichischen Schuldenberatungen: http://www.schuldenberatung.at/downloads/infodatenbank/das-budget/asbinfo73.pdf
A new FGÖ leaflet describes how the young trainees and staff in a vocational training facility can undergo the process of integrating health promotion in their institution. The pamphlet covers structural development, awareness raising of students and staff and diagnosis of the initial situation, etc. Corresponding projects also will be funded by the FGÖ.
- Broschüre Gesundheitsförderung für Lehrlinge: http://www.fgoe.org/der-fonds/infos/broschure-gesundheitsforderung-fur-lehrlinge/2014-09-18.6422424291/view?searchterm=lehrlinge
Adequate support and promotion in early childhood can have a positive effect on the quality of life, socio-economic situation and psychosocial health well into adult life. This is why families with small children are currently a target or target setting of large-scale health promotion and prevention programs. However, because health promotion is usually concerned with larger systems and population groups, families are addressed indirectly through other settings and systems. They are reached through early assistance by the health and social system or, as described above in the initiative "To a healthy neighborhood!," through the local setting and the health and social system.
- Nationales Zentrum Frühe Hilfen: http://www.fruehehilfen.at
- FGÖ Initiative „Auf gesunde Nachbarschaft!“: http://www.gesunde-nachbarschaft.at
Environments of consumption and leisure
Consumption has become a feature of modern life and takes place in many locations, including train stations, football stadiums and parks. In addition, some forms of recreation have become a consumer good (e.g., courses, sporting events and sports facilities, etc.). Nevertheless, there still are in this country few appropriate means to reach these settings. Is the development of health promotion in places of consumption and leisure perhaps a future field for action?
- Altgeld, T. (2004). Expertise Gesundheitsfördernde Settingansätze in benachteiligten städtischen Quartieren. Landesvereinigung für Gesundheit Niedersachsen Download am 22.09.2015 www.gesundheit-nds.de/downloads/altgeld.settingexpertise.pdf
- Bundesministerium für Gesundheit (2014) Gesundheitsförderungsstrategie im Rahmen des Bundes-Zielsteuerungsvertrags. Beschlossen durch die Bundes-Zielsteuerungskommission am 21. März 2014. Download am 22.09.2015 http://www.bmg.gv.at/home/Gesundheitsfoerderungsstrategie
- Conrad, G. (2013). Gesundheitsförderung in Settings und das Gesundheitsfördernde Setting. Journal Gesundheitsförderung, 1.
- Dür, W, Osrecki, F., Schmied, H. (2014). Die Settings Comparative Study, Teil 1: Wie und wozu kommen Gesundheitsförderungs-Programme in professionelle Organisationen? Präsentation am Jour fixe SS 2014 Gesundheitsförderungsforschung am LBIHPR. Download am 22.09.2015 http://lbihpr.lbg.ac.at/sites/files/lbihpr/scs_jour_fixe_part_1.pdf
- Fonds Gesundes Österreich (2013). Checkliste Nachhaltigkeit. Download am 22.09.2015 http://info.projektguide.fgoe.org/fileadmin/redakteure/downloads/hilfestelltungsdownloads/Checkliste_Nachhaltigkeit.pdf
- Gesundheitsförderung Schweiz. (Hrsg.) (2014). Defining settings, key-players and stakeholders. In: quint-essenz. Download am 05.10.2015 www.quint-essenz.ch/en/topics/1167
- Simek, Monika (2013): Lernen aus FGÖ-Projekten. Teilbericht zum kommunalen Setting & Vergleich zwischen betrieblichem, schulischem und kommunalem Setting. LBIHPR Forschungsbericht.