Promoting health and evaluating change.

Health promotion is a term that includes a range of approaches aimed at maintaining and promoting the population's health. In its broadest sense health promotion includes: health protection legislation and enforcement; healthy public policy; mass media communications; community development in health; health education; and preventive health services. The use of these approaches has been associated with improved health in Australia, but evaluating the effectiveness of health promotion is not easy. Multi-faceted approaches are most effective, but are difficult to evaluate using experimental or quasi-experimental designs. In addition, health promotion has yet to meet the challenge of measuring progress towards improving health and well-being, as distinct from reductions in disease and in behavioural risk factors for disease. This paper discusses health promotion, its strategies and impacts, and some issues involved in its evaluation.