EDITORIAL
Principles and practice of health promotion in Brazil
Antonio Ivo de Carvalho
Director, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. aivo@ensp.fiocruz.br
Principles and practice of health promotion in BrazilHealth promotion ideas and proposals in Brazil were first launched in the mid-1980s, fueled by the debate on the National Health Reform. Discussion of such ideas was featured at the 8th National Health Conference in 1986, whose proposed concepts and objectives for Brazilian society were quite similar to those put forward previously during the 1st International Conference on Health Promotion, in Ottawa, Canada, that same year. The final reports from both meetings defined health not merely as the absence of disease, but conceiving human well-being in broader terms, taking other basic needs into consideration, including a favorable environment for growth and development and aiming at full achievement of human potential.
Another landmark during the same period was the 1st Latin American Conference on Health Promotion, sponsored by the Pan-American Health Organization, in Bogotá, Colombia. At this meeting, more than 500 representatives from member countries discussed collective strategies to raise regional health standards and achieve equity in health. Various perspectives and strategies have been discussed at different forums over the last 20 years, leading to the approval and implementation of a national policy that sets the guidelines for health promotion within the Brazilian Unified National Health System (SUS).
Health promotion should be understood as an integrated and multidisciplinary agenda that ultimately aims to foster changes at three levels: healthcare delivery, local management of public policies, and social protection and social development for all. The health promotion strategy is comprehensive insofar as it strives to promote and strengthen links between various sectors and programs, not only within the so-called "health sector" per se, but encompassing other government agencies, nongovernmental organizations, and the social movement.
Thus, all sectors of society should share the responsibility in the effort to protect and care for human life, promoting health and quality of life for all. In order to achieve these goals, a number of specific health promotion priorities have been set in Brazil: the promotion of healthy eating habits and physical activity, smoking cessation and prevention, reduction of morbidity and mortality due to substance abuse (alcohol and other drugs), prevention of traffic accidents, and the promotion of sustainable development and a "culture of peace". Despite the innovative approach and potential for social change, the principles of health promotion are still far from being fully understood and implemented by health professionals and decision-makers. To date, epidemiological studies in Brazil provide the only source of convincing evidence for the association between behavioral exposure to risk factors and disease.
The challenge remains to develop and carry out a holistic framework to fulfill the National Health Promotion policy, taking into consideration the full scope of the concepts and principles put forward at the Ottawa Conference and adopted by the SUS: equity, comprehensiveness, shared responsibility, social participation, access to education and information, and sustainable development.