Health Promotion Beyond Individual Choices

What determines our health? During the Nordplus Trollnet network intensive week in Kaunas, Lithuania, we had the opportunity to explore health promotion from an international perspective. Discussions with students and educators from different countries broadened our understanding of how health is influenced not only by individual choices but also by social, cultural, economic, and environmental factors that shape opportunities for health and well-being. 

What does health mean to you?

The World Health Organization (WHO 2021) defines health promotion as a process that enables people to improve their health by addressing not only behaviours but also the social, economic, and cultural factors that shape health opportunities. The broader perspective is reflected in the Ottawa Charter for Health Promotion (WHO 1987), which highlights the importance of personal skills, supportive environments, community action, public policies and responsive health services. These principles emphasize that health promotion is a shared responsibility that requires supportive environments, active communities, effective policies and responsive healthcare services. 

Health is shaped by more than individual choices

The Dahlgren-Whitehead “Rainbow Model” illustrates how health is shaped by multiple interacting factors, including individual characteristics, lifestyle, social relationships, living conditions and wider socioeconomic, cultural and environmental influences. (Dahlgren & Whitehead 2007.)

The model highlights that health is not determined solely by individual choices, as factors such as income, education, employment, housing, and access to healthcare strongly influence health opportunities and inequalities (WHO 2025). Social relationships also play an important role by providing support during difficult situations, while social isolation can negatively affect health and well-being (Dahlgren & Whitehead 2007).

Cultural and social environments also influence how people understand health and illness and how they access and use healthcare services. This reminds healthcare professionals that effective health promotion requires attention not only to individual behaviours but also to the circumstances that support or limit a person’s opportunities for health. 

Another concept that stood out to us was salutogenesis developed by Aaron Antonovsky. It focuses on the resources and strengths that help people cope with challenges and maintain health rather than solely on disease and risk factors (Moksnes 2021).

A key concept is the sense of coherence, which consists of comprehensibility, manageability and meaningfulness. People with a strong sense of coherence are better able to understand challenges, use available resources, and find meaning in difficult situations. This perspective is important in health promotion, as healthcare professionals can support not only disease prevention but also individuals’ strengths, resilience and coping abilities. (Moksnes 2021.)

Health promotion and sustainable development

Health promotion is closely linked to the United Nations Sustainable Development Goals (SDGs). While SDG 3 focuses on good health and well-being, health is also influenced by goals related to poverty reduction, quality education and reduced inequalities (United Nations 2015).

The SDGs highlight that improving health requires action beyond healthcare services alone. Communities, educational institutions, policymakers and other sectors all play an important role in creating conditions that support health and well-being.

This broader understanding of health promotion is highly relevant for both public health professionals and nursing educators. Health promotion is not only about encouraging healthy behaviours but also about recognizing the social, cultural and environmental factors that shape people’s opportunities to achieve good health. Understanding these wider determinants helps explain why the same health advice may not be equally effective for everyone.

Nursing educators play a key role in helping future healthcare professionals develop the skills to identify not only challenges but also individuals’ strengths, resources and social, cultural and environmental factors that influence health. By fostering this holistic understanding, nursing education can prepare students to deliver more person-centred, equitable and effective health promotion across diverse healthcare and community settings.