Health promotion as a systems science and practice.
BACKGROUND
Health promotion is where clinical practice and prevention science intersect to address complex or 'wicked' problems that have multiple sources and require a broad perspective to address. This means focusing on the social determinants of health and the complex individual, community and environmental interactions that influence health and wellbeing. Health promotion research and practice recognizes that social change is not linear and involves multiple communities of interest working together in a coordinated manner in order to address health problems. An approach that acknowledges this non-linear system of interaction in its data gathering, strategic planning, and program implementation is necessary to addressing this complexity in practice.


METHODS
Concepts such as chaos theory, self-organization, social emergence can inform how health promotion is practiced at multiple levels. Evaluation approaches such as social network analysis, system dynamics modeling combined with social organizing strategies like communities of practice and unconferences provide opportunities to leverage social capital effectively to promote health in complex environments with diverse populations.


CONCLUSIONS
Health promotion's focus on the multi-layered, complex interactions that create or limit health and wellbeing require knowledge and action that match this complexity. Approaches to engagement and evaluation that are based on systems theories and methodologies provide the means of addressing this complexity, while framing health promotion as a systems science and practice.
Norman
Cameron D
CD
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. cameron.norman@utoronto.ca
D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D011315:Preventive Medicine; D011320:Primary Health Care; D012922:Social Change; D012944:Social Support; D013597:Systems Analysis