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Health promotion is the process of enabling individuals and communities to increase control over the determinants of health, and thereby improve their health (1). This definition was incorporated into the Ottawa Charter on Health Promotion (1986), which has guided much health promotion strategy and action in developed countries since that time (2). Health promotion, as described in the Charter, is based upon a combination of actions by individuals, communities, and governments designed to have optimal impact on lifestyles and living conditions which influence health status and the quality of life. Health is conceived of as a resource for life, rather than an end in itself. Key themes for health promotion include the need for government leadership and action to ensure healthy public policy, particularly that which is directed at creating supportive environments for health. A major component of healthy public policy, emphasised in the Ottawa Charter, is the need for the re-orientation of health services to ensure that
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Nutbeam et al. (1994) studied this question.
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