Origin and terminology
The settings approach is a new, innovative approach in the practice of health promotion. One of the five postulates defined in the Ottawa Charter of 1986 is "to create supportive environments". The approach is based on the recognition that health problems arise from the interaction between the socio-economic and cultural environment and personal lifestyle. Somewhat simplified, this approach is expressed in the motto: health is created where people live, love and work. The aim of the settings approach is to render these life contexts health conducive.
The settings approach: interventions in social systems
A setting is a distinct social environment in which people live and which has an influence on the health of individuals and groups. Well-known examples of a setting are the school, the workplace or the neighbourhood, the commune or municipality, the hospital, the living space,....Interventions aim primarily at bringing about changes in the system by modifying communication structures, decision-making processes or collective rules. Effective interventions require that these systems be clearly delimited, i.e. a definition of who is included (as a stakeholder) - and who is not. When intervening in a city or a town, for example, the region, area or neighbourhood to be targeted needs to be identified.
Interventions in settings require specific strategies and methods. An important method in the settings approach is organisational development. It is meant to enable organisations to evolve towards a more health-promoting setting or system.
Characteristics for working in settings:
- Holistic approach (systems approach)
- Aimed at long-term changes
- Focused on the self-development of the system (self-learning organisation)
Settings are chosen not only for the settings approach, but also for other health promotion and prevention projects. These do not focus on the system, but use the setting (e.g. a school) as an access point to specific target groups. The approach is thus a target group-specific approach in a selected setting.
The most important settings
Experiences with the settings approach are abundant and well documented. The best known settings are cities / municipalities, schools, hospitals and workplaces. Cities were the first settings in which projects were implemented. Already in 1986 the WHO launched the Healthy City Project and still coordinates the resulting network today. Another European network of the WHO is the "European Network of Health Promoting Schools".
The workplace, too, is an increasingly important area of intervention, recognized both by the WHO and by the European Union (Luxembourg Declaration of the EU from 1997). Noteworthy are, for example, the "European Network For Workplace Health Promotion" or the network of "Health Promoting Hospitals".
If an intervention is planned in one of these settings, then the in-depth and specific knowledge and experience regarding tools, methods and quality criteria, available from national and European networks must be consulted.
- Dooris, M. (2006) Healthy settings: future directions. Editorial. (Promotion & Education XIII (1): 4-6)
- Green, L.; Kreuter, M. (2005) Health Program Planning: An Educational and Ecological Approach. New York: McGraw-Hill
- Hubley, J. ; Copeman, J. (2008). Practical Health Promotion. Cambridge: Polity Press.
- Simnett, I. (1999). Evidence-based Work in Settings. In E. Perkins, I. Simnett & L. Wright (Eds.), Evidence-based Health Promotion. Chichester: Wiley & Sons.
Why you would disregard these aspects
- The approach is time-consuming, complex and focused on the system and not on individual behaviour.
- There is too little experience and expertise regarding interventions in settings.
What you have to gain
You have the chance of creating health promoting framework conditions in a setting: a worthwhile and lasting investment.
What you can actually do
- Think about and justify the most appropriate and direct approach for the specific purpose of the project.
- Define what competencies and expertise are needed for the settings approach and how to fill any gaps, if any, in skills which are required.
Questions for critical reflection
- Is there sufficient information about the various stakeholder groups in the setting?
- Is there enough knowledge about the settings in order to respond appropriately to potential difficulties and obstacles?
- Were talks to clarify matters held with key individuals and representatives of the stakeholder groups in the settings?
- From the target groups' point of view, what is important in their setting in order to promote health?