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Health promotion

Health promotion(Health promotion, Health promotion),Health promotionIt is,whoAdvocated by peopleHealthIs a way to manage your health and explore the possibilities of being healthier[1][2].The United States of AmericaIn this sense, health promotion is considered in a narrower sense as "science and technology that supports lifestyle modification for the purpose of obtaining appropriate health conditions".[3].

Health promotion spirit and significance

The records of the World Health Organization draft conference on the definition of health promotion cleverly express the spirit, significance and challenges of health promotion. Below is a quote from the beginning[4].

"Health promotion requires a unified idea of ​​health promotion and improvement of lifestyle and living environment. Health promotion adopts mediating strategies between people and the environment and integrates individual choices and social obligations towards a healthy future.

Sources of health are income, housing, and food. A healthy foundation that supports these foundations is necessary for the promotion of health. Also important are information and life skills, opportunities to seize health, supportive environments that bring goods, equipment and facilities, and economic, physical, social and cultural “general” environments.

The link between people and the environment is the basis of a socio-economic approach to health, which is the conceptual framework of the plenary session. In this plenary session, the four themes of the spirit of health promotion, target areas, development priorities, and the dilemma of health promotion will be the subject.


back ground

The idea of ​​health promotion is from the 19th century to the 20th century社会Changes in the wayIndividualThe rise of the concept, and being influenced by various medical discoveries, it began to shake and converge to the way it is now[5].

Impact of the Industrial Revolution

The idea of ​​health promotion dates back to the work of public health pioneers in the 19th century. 19th centuryUnited KingdomThen,Industrial revolutionUnder the influence of poverty, workers in large cities were burdened with poverty, harsh working conditions, poor living conditions and many burdens. This terrifying social situation inevitably resulted in several social challenges. One of them ischolera,influenzaIt is a pandemic of infectious diseases. Illness spread widely to citizens and became a threat to social stability[6].

Edwin Chadwick,Thomas Southwood SmithReformers like those urged to improve the social situation through reforms of local governments.1875And their appeal results in a decree. Public health laws and regulations governing urban water supply, sewage treatment, and animal treatment management (en: Public Health Act of 1875) Is adopted[7].. The improvement of the environment based on the law had a great influence on the reduction of infectious diseases.Thomas McCuneAs we discussed, this was long before clinical medicine discovered infectious agents and antimicrobials.[8].

Impact of medical discoveries

By the late 19th century, the threat of disease epidemics had diminished somewhat. Also, numerous medical discoveries were revealing the biomedical nature of humans. In addition, the way the individual lives has changed with the times, and the idea of ​​health promotion has begun to focus on individual education from environmental means. Eventually, health promotion became biased toward this educational method.[9].. Educational health promotion will gradually develop into a climate that emphasizes prevention of heart disease, cancer, prevention of high blood pressure, prevention of diabetes and each prevention of many diseases that threaten health. Become. Information campaigns and methods to identify and prevent people who are more likely to get sick have also become popular.

Prospects by Laronde Report

However, the idea of ​​supporting health promotion from the social environment did not cease, although it could have diminished.1974In Canada, a report was issued from Canada to help integrate educational health promotion, which was already global at the time, with health promotion based on improving the social environment. That is the Canadian Health MinisterMarc Laronde"A major cause of death and illness is not due to biomedical characteristics, but to environmental factors, personal behavior, and lifestyle," reports.[10].. This report played a major role in directing the perspective of health promotion, which tended to be biased towards individuals, to both people and the environment. Following this trend, in 1986 the World Health OrganizationOttawaAt 1stInternational Conference on Health Promotion[11]Will be held.

International Conference on Health Promotion

On November 1986, 11, the 26st International Conference on Health Promotion was held in Ottawa, Canada, in response to rising expectations for the new public health trends that began with the La Ronde Report. The Ottawa Charter adopted for health promotion adopted the concept of health promotion, such as health policy and support environment, with the goal of achieving health for all by 1. The perspective and method to comprehensively control the influencing factors were presented.[12]. AlsoOttawa Charter symbol markHas been created and has been treated as a symbol of health promotion advocated by the World Health Organization to date.

At the International Conference on Health Promotion, the concept of the Ottawa Charter is emphasized each time, and the importance of addressing the (social) determinants of health has been emphasized since the 1997th meeting in 4.[13].

Way of thinking that constitutes health promotion

Health promotion consists of various concepts, but it is broadly divided into prerequisites for health, three basic strategies, and five areas of activity. The ideas and methods shown in the Ottawa Charter for Health Promotion will not be promoted at the 3 International Conference based on changes in the world situation since 5, which was the original goal, and new findings and research results. Even if it is done, it is not denied.

Prerequisites for health

Prerequisites for health are the basic conditions and resources of health, which consist of:

  1. 平和
  2. Residence
  3. Education
  4. Food
  5. income
  6. StableEnvironment
  7. Sustainable resources
  8. Social justiceとfair

These health prerequisites were made in 1998Social determinants of healthOrganized as[14].

Basic strategy

  1. Recommendations: Promote the creation of a healthy environment by revealing the benefits of health
  2. Enable: Secure health opportunities and resources to unlock your health potential
  3. Mediation: Mediate conflicting positions in the pursuit of health and seek compromises for health promotion

The basic strategy for health promotion is applied in consideration of the actual needs and feasibility of the local area, as well as each society, culture, and economy.

Area of ​​activity

  1. Enactment of health policy
  2. Improvement of support environment
  3. Strengthening local activities
  4. Development of personal skills through information and educational skills
  5. Resetting medical care for disease prevention and health promotion

About health policyAdelaide Recommendations on Health PolicyRegarding the improvement of the support environmentSuntubal Statement on Health Support EnvironmentIn, it is dug deeper.

Thinking related to health promotion

Here are some of the relevant ideas to help you better understand health promotion. Some of these are not directly related to health promotion, but they are useful in understanding health promotion.

Social determinants of health

The social determinants of health are the economic and social conditions that govern people's health.[15].. Diseases are generally社会OfEconomyOfPoliticsOfEnvironmentThere is an effort to promote health promotion through efforts to address these situations.

Social determinants of health suggest that an individual's health depends on situations that cannot be managed by the individual. This is by the World Health OrganizationHealthIt is an idea that fits the definition of.

1997Jakarta Declaration Inviting Health Promotion to the 21st CenturyEmphasizes the importance of health determinants[16]And 1998 with Michael MarmotRichard WilkinsonBy organizing the knowledge byHealthと社会It has matured as a realistic and policy concept that connects with.

Limited resources

In developing countries, the shortage of resources and medical resources will be indisputable. It is often cited to emphasize the perception that health promotion is a challenge unique to developing countries, where medical resources are scarce.

One of the prerequisites for health in the Ottawa Charter for Health PromotionSustainable resourcesIs listed. Bangkok Charter for Health Promotion One of the health promotion strategies is to manage the determinants of health.Sustainable policyAre listed.

The law of medical inverse proportion

Medical Inverse Proportional Law (en: Inverse care law) Shows as a law that the availability (supply) of medical care and the needs (demand) are inversely proportional.The law of medical inverse proportional works best when medical care is exposed to market dynamics.Health care has been left out of society, primitive and obsolete, resulting in improper allocation of health resources.[17].

Pay attention to the upstream!

Public health may consider where attention should be paid to disease management and control by comparing it to water accidents.[18][19].

Suddenly, when I was standing on the bank of a fast-flowing river, I heard the screams of a drowning person. So I jumped into the river, reached out to him, raised him to the shore, and gave him artificial respiration. As the drowned man came back to life, he heard another cry for help. Again, I jumped into the river, reached out to him, raised him to the shore, and gave him artificial respiration. As the drowned man came back to life, he heard another cry for help. Of course there is no choice. I jumped into the river and this repetition went on and on. All I had to do was dive into the river, lift them to the shore and give them artificial respiration. Please understand. I didn't have time to break upstream and see what hell was dropping them into the river.

The points of this idea are the following two.

  1. Current medical care is striving downstream
  2. The real challenge is upstream

As a more concrete expression, many people like the following slogans[20].

Make healthy choices easier[21]

またHealth CanadaSays that it is a delusion that verification-based selection is important and that it should be upstream.[22].

Health inequalities

Health inequalitiesRace,People,Socioeconomic statusbyHealthとMedicalQuality disparity[23].

"Avoidable, unnecessary, unfair and unfair health variability," emphasizing differences from population health variability due to chance or biological factors (age, gender, heredity).[24]There is also a definition of. More actively emphasizing the difference between chance and biological factors, "economic and health inequalities are in issues such as taxation, business regulation, welfare benefits and medical funding.Decisions made by societyIs the result of[25]There is also a claim that.

Health inequalities have been found to arise from three areas[26].

  1. Disparity in the frequency of disease occurrence
  2. Disparity in access (proximity) to medical care
  3. Disparity

2000 yearsMexican Statement for Health PromotionEmphasized the importance of addressing inequality both domestically and internationally.[27].

Victim blaming

As the social determinants of health become apparent, it is becoming clear that the cause of illness is not limited to individuals. To blame people with illness (victims) that "all the causes of illness lies with you" not only does not reduce the distress caused by the illness, but also adds to the psychological distress caused by unjustified accusations. It becomes.Victim blamingFrom this point of view, it is thought that limited waste of resources and multi-layered pain caused by illness will occur. Victim blaming also has no effect on the frequency of new illnesses.

Common risk factor method

Some prevalent diseases (obesity, diabetes, hypertension, etc.) are associated with common causes. A common risk factor method is a method that realizes health promotion by promoting the development of information campaigns and the improvement of the environment, centering on this common cause.[28].. By using this method, it is possible to prevent duplication of efforts and information contradictions in many and disjointed support activities, and to effectively utilize limited resources for health promotion. In addition, these risk factors include lack of exercise, smoking, eating habits with excess fat and lack of fiber, and cleanliness of the body.

As the social determinants of health become clearer, the importance of centralized measures rather than disease-specific measures is becoming more and more emphasized.


As stated in the Ottawa Charter, community involvement is a fundamental element of health promotion. It is important that the community is central in all aspects, from awareness of health issues to ways to make a difference. Recognizing, focusing on, and collaborating with a wide variety of social determinants of health is a key element of health promotion. Many sectors of society, such as government ministries, education, agriculture, health care, and volunteering, all have a major impact on health.

Population approach

If the outbreak of the disease is distributed throughout the population, severe illness may be concentrated in part of the population and mild or moderate symptoms may be widespread in the population. In fact, the severity of some diseases is known to be distributed in this way.[29].. Efforts to address such diseases include the idea of ​​selecting a part of the population suspected of having the disease and taking preventive measures against that population (targeted population approach) and the population. The idea of ​​taking preventive measures as a whole (hole population approach) has been justified depending on the situation.

In health promotion, the presence of mild or moderate symptoms that occur widely from the population cannot be underestimated, so measures are often taken according to the whole population approach. However, due to resource shortages, the targeted population approach may be selected.

Life course analysis

It is based on a complex analysis of biological risks in health, where chronic disease progression interacts with economic, social and psychological factors throughout life.

It is said that life has the following critical periods in relation to health.[30].

  1. Transition from elementary school to junior high school
  2. School exam
  3. Participation in the labor market
  4. Separation from parents
  5. Founding a home
  6. Transition to parent
  7. Anxiety, transformation, loss of work
  8. Exit from the labor market

The perspective of life course analysis emphasizes the social situation and the interaction between people and the environment throughout life.

Right to health

With health since the 1980shuman rightsAs the link between health and human rights becomes clear, it is becoming more and more important to expand the field of activity.[31].. Along with this, the approach that the state bears the ultimate responsibility and accountability for the challenges of health and a comfortable life under international law.[32]Is attracting attention.

International Covenant on Economic, Social and Cultural Rights(A rule)Right to healthIs described as "the highest level of physical and mental health that can be achieved," and the government's obligations are:Prerequisites for healthIs understood to consist of both maintenance and provision of medical care[33].

The following is Article XNUMX which is supposed to explain the right to health in the A Covenant.

  1. The States Parties to this Covenant acknowledge that all are entitled to the highest attainable levels of physical and mental health.
  2. The measures taken by the Parties to this Covenant to achieve the full realization of one right include the measures necessary to:
    1. And measures to reduce infant mortality and for the healthy development of children
    2. And all conditions of improvement
    3. Epidemic,Endemic disease,Occupational diseasePrevention, treatment and suppression of other diseases
    4. Creation of conditions that ensure medical and nursing care for all in the event of illness

Japan Federation of Bar AssociationsIs derived from the basic human rights of the Constitution, and is equally and fully guaranteed to all citizens, and no one can infringe on it. Originally, the national and local governments, and even doctors・ It is said that it is a right to actively claim the guarantee to medical institutions, etc.[34].

Examples of health promotion around us

Health promotion opportunities are everywhere around us. Even if it existed before the idea of ​​health promotion converged,Recognizing that it is related to health promotion, and promoting it in a unified manner with health promotionIs also an important component of health promotion.

For example, if you think of a society without it, you can understand how the following factors are deeply involved in health promotion. Also, many elements are complicatedConfoundingTherefore, simply tightening one of the regulations does not help to improve health. It can be said that there are difficulties and challenges in health promotion here.

平和,Equality under the law,human rightsRespect, protection and performance of社会 保障,Wealth redistributionEfficiency (Tax,Public assistance),Social insurance,Social justiceAnd fair
employmentCreation and loss of labor standards (Occupational medicine), workplace safety, workplace trust, anxiety about work
Stable environment,Sustainable developmentSecuring a rich natural environment, clean air and water source,Water supply-SewerMaintenance of theNormalization
Mass consumption, lack of exercise, interaction by smoking, high-calorie and fiber-deficient eating habits (please keep in mind that there is a limit to changes in individual lifestyles), opportunities to use parks and sports stadiums,Aid communicationExpansion of
literacy,Penmanship,Calculation,EmpowermentAcquisition of a fair education system (Health literacy), safe education,corporal punishmentSurveillance, smoking education, substance abuse, schoolFluoride mouth rinse
AppropriateEducation,Child abuse, Drug,ACCIDENT,Traffic accident,BullyingExposure (note that health effects in childhood occur before the individual's acquisition of empowerment and affect their life afterwards)
Drug society
smokingPrevalence of dependence,Substance abuse,Drug dependence,Drug addiction
Smoking society
vending machineRestrictions, age restrictions (Underage Smoking Prohibition Law), setting of non-smoking area, setting of non-smoking facility,smokingArea setting, support for smoking cessation in the workplace,World Health Organization Framework Convention on Tobacco Control(Tobacco Control Framework Convention)
Mutual trust, opportunities for residents to interact (FestivalOr etc.),Social capitalReshaping
Industrial society
Air pollution,Water pollution,PollutionRegulation against
Agricultural society
PesticideRegulations,Agricultural Products・Stable supply of livestock products
Car society
guardrail,traffic light,Direction indicator, Seat belts, helmets, safety standards,Top speed,Airbag,Drunk drivingSuppression of theNo car dayThe spread ofTransportationMaintenance
Information technology society
Dating siteThe rise ofFiltering (restriction of access to harmful sites)Spread of
Drinking society
Vending machine restrictions, age restrictions (Underage Drinking Prohibition Law), (Suppression of drunk driving)
food safety
Raw material display,Traceability (distribution),Expiration date,Restaurant industrySafety, nutritional balance,Food additiveManagement of imported goodsquarantine
Civil engineering and construction
Strength of building, maintenance of air conditioning, safety of building materials, safety of doors, safety of elevators,Barrier-free,Universal design,asbestos
Research on social determinants of health, fair medical system, securing medical resources, endemic epidemicPandemicManagement and measures

Challenge from policy

International efforts

On October 2005, 17,World Health Organization Framework Convention on Tobacco Control(Tobacco Control Framework Convention) came into effect[35].. This is the first multilateral treaty in public health globally[36].

In May 2004, as a global measure against the global threat posed by non-communicable diseases,World strategy on diet, exercise and healthHas been proposed[37].


In Japan, in 1989, a public opinion survey on health promotion was conducted to investigate public awareness about health and health promotion and to refer to future measures.[38].

Health Japan 2000 (from 12)National Health Promotion Movement in the 21st Century), Specific numerical targets for health are set.[39].. In addition, with the aim of improving national health in 2002 (14)Health promotionWas enacted[40].

In addition, from the viewpoint of health promotion of Ministry of Health, Labor and Welfare staff and measures against global warming, the Ministry of Health, Labor and Welfare is conducting a "stairs use campaign" to promote the use of stairs to move inside the government building.[41].

In 2005, with the aim of cultivating a healthy mind and body, and fostering a rich humanity,Food education basic lawWas adopted[42].


First in the world in 1974Laronde ReportIn addition, in Canada, which has also created and created the 1986st International Conference on Health Promotion in 1, has promoted health promotion from various angles.[43].

The United States of America

In the United States,United States Department of Health, Education and WelfareThe report was published in 1979, five years after the publication of Canada's La Ronde Report, centered on the Ministry of Health and Human Services and the Ministry of Education in 5.[44]However, the goal of Healthy People 2000 was set.

Published in November 2000, which is a health goal for the United States for the first decade of the 11st century[45].. Healthy People 2010 is being used by a wide range of people, states, communities, professional organizations and others to help develop health promotion plans.[46].

Healthy People 2010 is based on a vision pursued in the 1980s and 90s. The 1979 United States Public Health Commissioner's Report, Healthy People and Healthy People 2000, clarified national health goals and was used as the basis for planning in states and communities. Healthy People 2010 has evolved through extensive consultation, is set on the basis of good scientific knowledge, and is designed to evaluate health planning.

Its overarching goals are:[47].

  1. Quality of life and extension of duration
    Healthy People 2010's first goal is to extend life expectancy and improve quality of life for people of all ages
  2. Health inequalitiesRelaxation
    The second goal of Healthy People 2010 is to reduce health inequalities between different populations in the country.

United Kingdom

In the United Kingdom, Our Healthier Nation and National Plan incorporate the concept of health promotion[48].


  1. ^ World Health Organization Archived August 2009, 3, at the Wayback Machine. website (in pdf format), "Health Promotion Glossary", page accessed March 11, 2007
  2. ^ Ontario Health Promotion Resource system website, "Glossary", page accessed March 11, 2007
  3. ^ American Journal of Health Promotion website, page accessed March 9, 2007
  4. ^ WHO (1984). Health promotion: concepts and principles. Copenhagen, WHO. orMilestones in health promotion: Statements from global conferences WHO (2013)
  5. ^ Niyi Awofeso, American Journal of Public Health, May 2004, Vol 94, No. 5 p.705-9, What's New About the “New Public Health”?
  6. ^ Tachikawa Shoji (1971) Social history of illness NHK Books ISBN 4140011521
  7. ^ World History 4th Edition by William J. Duiker and Jackson J. Spielvogel
  8. ^ Thomas McCune The role of medicineOxford, Basil Blackwell. ISBN 0631112618
  9. ^ WHO website, "Health Promotion Emblem", page accessed March 17, 2007.
  10. ^ Marc Laronde (1974) A new perspective on the health of Canadians. Archived June 2006, 12, at WebCite Ottawa Health and Welfare Canada.
  11. ^ International Conference on Health Promotion(who)
  12. ^ Ottawa Charter for Health Promotion, PDF format(who)
  13. ^ Jakarta Declaration Inviting Health Promotion to the 21st Century, PDF format(who)
  14. ^ Social Determinants of Health: Solid Facts(who)
  15. ^ WHO European Office website (in pdf format), "Wilkinson, R., & Marmot, M. (2003). Social determinants of health: The solid facts.", Page accessed March 17, 2007.
  16. ^ Jakarta Declaration Inviting Health Promotion to the 21st Century (1997)(who)
  17. ^ Tudor Hart J. The inverse care law. Lancet 1971; i: 405-412. The law of medical inverse proportion(Socialist Health Association)
  18. ^ McKinlay, J. (1979). A case for refocusing upstream: the political economy of illness. Patients, physicians and illnesses (ed. E. Jaco). Pp. 9-25. Basingstoke, Macmillan. ISBN 0029158508
  19. ^ Hiroki Komazaki (2007) A metaphor for a drowning baby A way of life as a social entrepreneur whose job is to "change society" Eiji Press ISBN 486276018X
  20. ^ Make healthy choices easier(British Department of Health)
  21. ^ Milio, N. (1986). Promoting health through public policy. Ottawa, Canadian Public Health Association.
  22. ^ Collective health template(Health Canada, 2001)
  23. ^ US Department of Health and Human Services (HHS), Healthy People 2010: National Health Promotion and Disease Prevention Objectives, conference ed. in two vols (Washington, DC, January 2000).
  24. ^ Whitehead, M. (1991). The conceptsd and principles of equity and health. Health Promotion International, 6, 217-26.
  25. ^ Why should physicians be concerned about health inequalities? Because inequalities are unfair and hurt everyone.Alistair Woodward and Ichiro Kawachi West J Med. 2001 July; 175(1): 6-7.
  26. ^ Goldberg, J., Hayes, W., and Huntley, J. "Understanding Health Disparities." Health Policy Institute of Ohio (November 2004), pages 6-7.
  27. ^ Mexican Statement for Health Promotion,PDF format(who)
  28. ^ Grabauskas, VJ. Integrated program for community health in noncommunicable disease (Interhealth). In The prevention of noncommunicable diseases: experiences and prospects. (ed. E. Leparski), pp. 285-310. World Health Organization Regional Office for Europe, Copenhagen; 1987.
  29. ^ Rose's Strategy of Preventive Medicine, Oxford University Press. ISBN 0192630970
  30. ^ Bartley, M. (1997) Socio-economic determinants of health; health and the life course: why safety nets matter. BMJ, 314, 1194-6.
  31. ^ A Thematic Guide to Documents on Health and Human Rights ISBN 9041105441
  32. ^ Health and human rights. Health Hum Rights. 1994 Fall; 1 (1): 6-23. PMID 10395709
  33. ^ International Covenant on Economic, Social and Cultural Rights (Term A)(Ministry of Foreign Affairs)
  34. ^ Collection of Declarations and Resolutions for Human Rights Conventions Subject:1980-11-08 Declaration on establishment of "health rights" Archived August 2010, 2, at the Wayback Machine. (Japan Federation of Bar Associations)
  35. ^ World Health Organization Framework Convention on Tobacco Control(Ministry of Foreign Affairs)
  36. ^ Tobacco and health information page(Health Information Management Section, Lifestyle-related Disease Control Office, General Affairs Division, Health Bureau, Ministry of Health, Labor and Welfare)
  37. ^ World strategy on diet, exercise and health(who),full text
  38. ^ Public opinion poll on health promotion (June 6)(Cabinet Office Public Relations Office)
  39. ^ Health Japan 21 website, page accessed March 16, 2007
  40. ^ "Health Promotion Act (Law No. XNUMX of XNUMX)". e-Gov Law Search.Administrative Management Bureau, Ministry of Internal Affairs and Communications (June 2019, 6). 2020/1/14Browse. “For enforcement on June 2019, 9”
  41. ^ About stairs use campaign(Health Guidance Section, Lifestyle-related Disease Control Office, General Affairs Division, Health Bureau, Ministry of Health, Labor and Welfare)
  42. ^ For promotion of food education(Cabinet Office)
  43. ^ Health promotion(Canada Public Health Service)
  44. ^ Full text of Healthy People (1979)(US National Library of Medicine)
  45. ^ Healthy People 2010(US Department of Health and Human Services)
  46. ^ What is Healthy People?(US Department of Health and Human Services)
  47. ^ What is the purpose of Healthy People?(US Department of Health and Human Services)
  48. ^ Ewles L, Simnett I (2005) Promoting Health-a practical guide Balliere Tindall: Edinburgh

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