New times, new challenges for health promotion

We embark on our stewardship as the new Editor-in-Chief and Chair of the Editorial Board of Health Promotion International at a critical time for both the planet and all those who live on it. In doing so, we are privileged to follow many colleagues who have made exceptional contributions to both the journal and health promotion more broadly. Now, as when the journal was launched in 1986, it is appropriate to draw public attention to the need for health-based public policy, and action based on the best available evidence. The science and the planet are showing us that in many ways the window for transformational change is growing smaller at an alarming rate. When our successors look back after the next four decades, what do we want history to say about the legacy of the health promotion community, and the role that we played in contributing to the paradigm shifts that we know are needed to plan and realise a better and fairer future. In an editorial in the inaugural issue of the journal, the first Chair of the Editorial Board, Ilona Kickbusch, highlighted the central role that health promotion plays in addressing complex public health issues: “Health promotion is positive and dynamic. It opens up the field of health to become an inclusive social, rather than an exclusive professional activity. Its major feature—and here lies its hard edge—is the challenge to move beyond health services into those areas of both policy and everyday life that regulate access to health.” (Kickbusch, 1986, p. 3) While health promotion has always played an important role in community level interventions, Kickbusch continued by emphasising the important advocacy role that health promotion plays in the formulation and implementation of healthy public policy, imposing ‘public accountability for health matters on those in power’ (Kickbusch, 1986, p. 3). This emphasised a choice and a challenge. Should we continue to endorse the power structures that contribute to the status quo? Or should we as health promotion and public health communities raise our voices about the fundamental structural and systems issues that both contribute to and exacerbate health inequalities across the globe, working to ensure that those whose voices have been marginalised are heard as well. The broader role of health promotion has never been more relevant than now, 3 years since the World Health Organisation declared a Public Emergency of International Concern in relation to a novel coronavirus that has affected and challenged us all both professionally and personally. The COVID-19 pandemic has demonstrated that complex public health problems cannot be solved by simply focussing on individual responsibility and behavioural interventions. While it has taught us about the value of the public health community in responding to these challenges, it has also shown yet again that health promotion must be responsive to and active in the broader environmental, commercial, and political determinants that are often the vectors of poor health and wellbeing (van Schalkwyk et al., 2021). It has also highlighted that while modern technology has enabled rapid scientific responses to new public health issues, it has created new challenges. Speaking at the start of the COVID-19 pandemic, the Director General of the World Health Organisation Dr Tedros Adhanom Ghebreyesus warned that we were fighting not only an ‘epidemic’ but also an ‘infodemic’. He cited the role of social media platforms in enabling rumours, misinformation, and fake news to spread ‘faster and more easily than this virus, and (is) just as dangerous’, and to significantly hamper public health efforts to protect and promote the health of communities (Ghebreyesus, 2020). It is incumbent on the health promotion community to be alert to the opportunities modern media technologies offer us—but also to the ways in which they can be abused, including for the promotion of harmful industries and their products. In 2004, reflecting on the previous twenty years of health promotion, former Editor-in-Chief Professor John Catford (Catford, 2004) proposed the following questions for the health promotion community: But how could we act differently and better? Where should we be spending our efforts? Is there a new dimension of thinking and action that we should be moving into? Nearly 2 decades later, and facing the most complex health challenges of modern times, the same questions remain relevant. Which new critical areas of focus are essential in promoting the health and wellbeing of communities, and protecting them from any unnecessary risks of harm? What role can health promotion play as a ‘critic and conscience of society’ (NZ Ministry of Education, 1989), putting forward new and innovative ideas, and presenting views that may be unpopular with vested interests and decision makers, but ultimately are in the interests of public good? And how can we engage and support communities in playing a stronger role in advocacy for health, and enabling them to have a seat at the policy table in relation to the decisions that impact them the most? The starting point, as set out in the Ottawa Charter (World Health Organisation, 1986), is the core principles of human rights, social justice, health equity, and collective responsibility. These values provide us with a strong basis for action, in advocating for, enabling, and mediating the health and wellbeing of our communities. The health promotion community has been strong in many areas including community engagement, settings approaches, and the social determinants of health. But the increased threats posed by complex health and social issues, and the extent to which responses to these are influenced by powerful vested interests, call for new bold and brave approaches. The Geneva Charter for Wellbeing (World Health Organisation, 2021) has stressed the urgent need for action to create ‘sustainable “well-being societies”, committed to achieving equitable health now and for future generations’, and the need to recognise that health is ‘the outcome of the policies, institutions, economies and ecosystems in which people live’. This also calls for new critical thinking about how we respond to threats for our communities. These range from the climate crisis to technological advances which have rapidly transformed the ability for harmful and predatory industries to reach new generations of consumers. While evidence on the harms caused by a wide range of industries and their products has become ever clearer, this has been matched by ever more determined and sophisticated efforts by the industries involved to oppose and undermine action that will reduce the harms, along with direct and indirect attacks on organisations and individuals exposing their activities and promoting evidence-based measures. Partly as a result of this, many of the responses to these issues have remained stubbornly focussed on individualised, micro-level interventions. Individualised and discrete framings of health are of course convenient for governments, allowing them to place the responsibility for health and wellbeing largely with individuals, to avoid offending powerful interests, and to fund truly transformative preventive and upstream approaches at derisory levels. We hope that Health Promotion International can build on the work of our predecessors in encouraging a broad and ambitious purpose for health promotion. Health promotion is and should be inclusive. We are keen to hear from those at any level, and from any aspects of health and related areas who can provide contributions that will help and inform the broad health promotion and public health communities. It is important to encourage critical thinking, engage in debate and difficult conversations, and hear about the challenges that face us. But we should also hear about the successes that those engaged in health promotion have achieved and continue to achieve, despite all the challenges they face. There is much to learn from these, not least that the benefits of preventive action often take time to materialise, and that even when there are good outcomes, there is never room for complacency. We hope to see contributions that address issues of current concern—ranging from the health and wellbeing of young people to the climate crisis; from evidence on public health action that can make a difference to evidence on the approaches that achieve little or may be counter-productive; from the role and activities of harmful industries to effective public health advocacy; and to suggestions for ways in which this journal can further support the progress of health promotion at all levels. This includes tackling the vast challenges that health misinformation and disinformation pose for our communities. Harmful industries and complacent and complicit governments can create doubt and frame the public debate with devastating consequences—as the climate crisis has clearly shown. While some of these practices are being challenged by public health advocates and legal experts they cannot do it alone. We all have a role to play in continuing to expose harmful practices and providing the evidence base to help others in their efforts to counter those forces that undermine health and equity. Providing communities with reliable and evidence-based information has always been a core part of health promotion. However, the need for this is even more pressing now given the speed with which those with vested interests can disrupt and erode trust through the deliberate spread of misinformation on multiple new media platforms. With this in mind we will seek to ensure speedy review and response times for contributors, and options for the rapid dissemination of expert opinion and policy advice, and will welcome any suggestions about how the journal can continue to be relevant and helpful for those working in the field. We are also especially keen to ensure that this is a truly international journal that presents perspectives from a wide range of voices across the globe. This must include the wisdom and experience of First Nations authors, and we will also seek to encourage the involvement of early career researchers, who are our next generation of innovative thinkers and will have such an important role in developing and implementing the future for health promotion that we all wish to see. There are, however, some contributors who will not be so welcome. We will be rigorous in ensuring a strong conflicts of interest policy, and in following the advice of Moodie et al. (2013) that those engaged in research, prevention, and public policy should have no involvement or partnerships with unhealthy commodity industries. Health promotion is not for the faint-hearted, or those who want an easy path through life. But thanks in large part to the efforts of our precursors, colleagues, supporters and sympathisers there is overwhelming evidence of its impact and potential. We hope that readers of Health Promotion International will join us in welcoming contributions from all those who seek to develop and report on research, programs, evidence, and advocacy that will help to bring about a fairer and healthier world. ST: Has received funding for gambling research from the Australian Research Council Discovery Grant Scheme, the Victorian Responsible Gambling Foundation, and the New South Wales Office of Responsible Gambling. MD: Has received funding for gambling research from the Australian Research Council Discovery Grant Scheme, the Victorian Responsible Gambling Foundation Grants Scheme.