Karyn Gellie: Community Health Nurse 

Acknowledgment to authors of the previous edition:  

Elizabeth Crock, Gemma Hartmann, Vickie Knight. 

This section examines health promotion in the HIV nursing context. 

• What is health promotion? 
• Health promotion in HIV nursing practice in Australia  
• Health promotion into the future in HIV nursing 
• Additional resources 

What is health promotion?  

Health promotion is “the process of enabling people to increase control over, and to improve, their health” (1). The Ottawa Charter for Health Promotion (2) provides guidance with the use of three key strategies; advocate, enable and mediate; across five priority action areas: 

1. Build health public policy. 
2. Create supportive environments for health. 
3. Strengthen community action for health. 
4. Develop personal skills. 
5. Re-orient health services. 

Individual and community health education is an important component of health promotion; however, the Ottawa Charter identifies the need for greater empowerment of communities involving building skills, relationships and creating supportive conditions for health (3). 

In recent decades, our understanding of the underlying influences on health outcomes has grown with increased recognition of inequality as a key driver of poor health (3). Health inequality results from systemic factors and the broader social determinants of health (SDH), “the conditions in which people are born, grow, work, live and age”, including social norms, policies, political and other systems (4).  

The social determinants of health can contribute in positive and negative ways to health outcomes and include, among others; income, education, employment, food security, housing, social inclusion, and non-discrimination (4). The influence of the SDH can be larger than other factors such as access to health care and lifestyle choices, accounting for as much as 30-55% of health outcomes (4). 

With the emergence of the human immunodeficiency virus (HIV) in the 1980s, the subsequent response was one of the first health promotion approaches to utilise the Ottawa Charter principles from the outset in Australia (5). Affected communities and activists were at the forefront of a rights-based movement, developing partnerships between impacted communities, governments, and health care providers (5).  There was recognition that SDH such as discrimination, violence and access to health services were impacting on both prevention of HIV and the health of people living with HIV (5). Community and peer strategies have been critical in Australia’s response to HIV, but they required the removal of structural barriers such legal and policy frameworks and access to health care to enable health gains (5).  

In recognition that health inequalities are mostly due to factors outside of the health sector, such as politics, economies, digital transformation and planetary ecology, there has been a shift to broader well-being frameworks (6). The World Health Organisation (WHO) has developed ‘Achieving Well-being: a Global Framework for Integrating Well-being into Public Health Utilizing a Health Promotion Approach’ (6). The framework continues to support health promotion as a key to well-being but establishes the roles and actions beyond the health sector in achieving health gains (6). 

In Australia, some states have created or are working toward well-being frameworks. For example, in the Victorian Well-being plan, improving sexual and reproductive health is a priority (7). In 2023, the Australian Government launched ‘Measuring What Matters’, the first Commonwealth National Well-being Framework (8). The framework is underpinned by inclusion, equity and fairness across five themes: healthy, secure, sustainable, cohesive, and prosperous. It uses well-being measures as an addition to traditional economic measures and incudes a ‘dashboard’ for interactive monitoring of outcomes (8). 

Quality of life, empowerment of communities, equitable distribution of resources and recognition of the concept of well-being and knowledge systems within Indigenous peoples are key concepts outlined in the WHO global framework (6). This is congruent with Australian Aboriginal and Torres Strait Islander concepts of well–being including social, cultural and community wellness that enable the health of the individual (9). The Australian well-being framework is a broad approach across the population and is intended to work in partnership with the National Aboriginal and Torres Strait Islander Health Plan 2021-2031 (8).