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“Healthy settings” – review

Petya Boncheva, Klara Dokova


The application of the philosophy for health promotion of the Ottawa Charter, led to the creation of the concept of „healthy settings“ related to people’s lives. They are based on the settings approach, according which health is created as a result of the dynamic interaction between personal, environmental and organizational factors. The aim of this article is to present to Bulgarian readers basic concepts and principles related to health promotion in a particular setting, as well as more widely established settings and new opportunities for health promotion, based on the principle of supportive environments, initiated by the Ottawa Charter philosophy. Methods: a search in Pubmed and Google scholar with keywords: healthy settings, healthy cities, schools, universities, hospitals, prisons for health promotion, published between 1986 - 2021; review of the lists of literature sources of the selected publications. The review includes: beginning, initiators, goals, scope, achievements and some difficulties of the application of the idea of a supportive environments in the discussed healthy settings. Conclusions: The presented healthy settings are initiated and continuously supported by the WHO. Some of the established healthy settings are evolving and some of the health promoting networks have been proven effective for over three decades. Modern and varied activities in people’s lives challenge the concept of “healthy settings”and put on the agenda the need to discuss updating the Ottawa Charter, 1986.


healthy settings, healthy cities, health promoting schools, health promoting universities, health promoting virtual setting, health promoting prisons, health promoting hospital

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Бончева П, Докова К. „Университети за промоция на здраве“ – преглед на развитието и реализирането на инициативата. Социална медицина. 2019; (2): 13-19.

Бончева П, Докова К. Университети за промоция на здравето – практическо приложение на подхода. Сборник доклади от юбилейна научна конференция с международно участие „Нови подходи в общественото здраве и здравната политика“. Плевен: Издателски център на МУ-Плевен; 2020:157-162.

Виденова Ж, Ванкова Д. Българските народни танци в контекста на концепцията промоция на здраве. Социална медицина. 2019; (2):20-25.

Георгиева С. Промоция на здравето в училище. Плевен: Издателски център на МУ-Плевен; 2016:16.

Попова С. Социална медицина. Варна: Стено; 2010:85.

Фесчиева Н, Ванкова Д. Промоция на здраве – необходимата предпоставка за активно стареене. в: Найденова П, Михова Г. (съст.). Възрастните хора като ресурс в развитието. Варна: Славена; 2016:289-309.

Abercombrie N, Gatrell T, Thomas C. Universities and health in the twenty-first century. In: Tsouros A, Dowding G, Tompson J, Dooris M. (eds) Health promoting universities. Concept, experience and framework for action. Copenhagen: WHO/Euro. 1998:33-39.

AFROHUN. Africa one health university network. 2020. Available in:

Arsenijevic J, Groot W. Health promotion policies for elderly – some comparisons across Germany, Italy, the Netherlands and Poland. Health Policy. 2020;

Baybutt M, Chemlal K. Health-promoting prisons: theory to practice, Global Health Promotion. 2016;23(1): 66-74.

Baybutt M, Dooris M, Farrier A. Growing health in UK prison settings, Health Promot Int. 2019;34 (4): 792 – 802

Bellis M, Hughes K, Lowey H. Healthy nightclubs and recreational substance use: From a harm minimization to a healthy settings approach. Addictive Behaviors. 2002; 27 (6):1025-1035.

Bloh P, Toft U, Reinbach H, Clausen L, Mikkelsen B, Poulsen K, et al. Revitalizing the setting approach – supersettings for sustainable impact in community health promotion. Int J Behav Nutr Phys Act. 2014;11 (118)

CDC. Healthy places terminology (last reviewed 2009). Available in:

CDC. Healthy schools (last reviewed 2019). Available in:

Chou W, Prestin A, Lyons C, Wen K. Web 2.0 for health promotion: reviewing the current evidence. Am J Public Health. 2013;103(1):9-18. doi:10.2105/AJPH.2012.301071

Chu C, Breucker G, Harris N, Stitzel A, Gan X, Gu X, et al. Health-promoting workplaces-international settings development. Health Promotion International. 2000; 15(2):155–167.

Crimeen A, Leeuw E, Freestone R. Towards a health promotion paradigm for airport development. Cities & Health. 2019; 2 (2);134-142

DASH. Dedicated action for school health. 2020. Available in:

Dirieto A, Carraça E, Rawstorn J, Whittaker R, Madison R. mHealth Technologies to influence physical activity and sedentary behaviors: behavior change techniques, systematic review and meta-analysis of randomized controlled trials. Annals of Behavioral Medicine, 2017;51(2):226–239

Dokova K. Health promotion – historical development, theoretical basis & practical application. Varna: Medical university “Prof. d-r Paraskev Stoyanov” – Varna; 2018:115-117.

Dooris M, Farrier A, Doherty S, Holt M, Monk R, Powell S. Healthy universities self-review tool: Whole system impact. Health Promot Int. 2018; 32(3): 448-457.

Dooris, M. Joining up settings for health: a valuable investment for strategic partnerships? Critical Public Health. 2004; 14(1), 49–61.

Dooris M, Powel S, Farrier A. Conceptualizing ‘whole university’ approach: an international qualitative study. Health Promot Int. 2019;1-11.

Dooris M. The university as a setting for sustainable health University of Central Lancashire in: Tsouros A, Dowding G, Tompson J, Dooris M. (eds) Health promoting universities. Concept, experience and framework for action. Copenhagen: WHO/Euro. 1998: 105-120.

Duhl J, Sanchez K & World Health Organization. Regional Office for Europe. Healthy cities and the city planning process : a background document on links between health and urban planning / by L.J. Duhl and A.K. Sanchez. Copenhagen : WHO Regional Office for Europe. 1999, (Internet) Available from:

EuroHealthNet WHO European Healthy Cities Network 2021 (Internet) Available in:

Farrier A, Baybutt M, Dooris M. Mental health and wellbeing benefits from a prisons horticultural programme. International Journal of Prisoner Health. 2018; 15(1): 91-104. doi: 10.1108/IJPH-11-2017-0055.

Ferreira F, Brito I, Santos M. Health promotion programs in higher education: integrative review of the literature. Rev Bras Enferm. 2018; 71(4)

Forsberg C, Jyrkkä I. Suomalaisten nuorten fyysinen aktiivisuus ja ruutuaika. Juväskylän Yliopisto, Liikuntapedagogiikan, Pro gradu -tutkielma. 2014. 53-61(Internet) Available from:

Freudenberg N, Manzo L, Mongiello L, Jones H, Boeri N, Lamberson P. Promoting the health of young adults in urban public universities: a case study from city university of New York. Journal of American college health. 2013;61(7):422-430.

Fung C, Kuhle S, Lu C, Pursell M, Schwartz M, Storey K, et al. From "best practice" to "next practice": the effectiveness of school-based health promotion in improving healthy eating and physical activity and preventing childhood obesity. Int J Behav Nutr Phys Act. 2012; 27 (9).

Galea G, Powis B, Tamplin S. Healthy islands in the Western Pacific – international settings development. Health Promot Int. 2000;15: 169-178.

Gather A, Moller L, Hayton P. The World Health Organization European health in prisons project after 10 years: persistent barriers and achievements. Am J Public Health. 2005; 95 10:1696-1700.

Ghalavand H, Panahi S, Sedghi S. Opportunities and challenges of social media for health knowledge management: A narrative review. J Educ Health Promot. 2020;9:144. doi:10.4103/jehp.jehp_754_19

Graham R, Boyko J, Sibbald S. Health promoting hospitals in Canada: a proud past, an uncertain future. Clinical Health Promotion. 2014;70,4(2):70-75

Green L, Poland B, Rootman I. The settings approach to health promotion. In: Poland B, Green L, Rootman I, editors, Settings for Health Promotion linking theory and practice. 2000 Sage publications, Thousand Oaks p. 1-43

Groene O, Garcia-Barbero M. Health Promotion in Hospitals: Evidence and Quality Management. Copenhagen, Denmark: WHO Regional Office for Europe; 2005(Internet) Available in: :

Hancock T, Duhl L. Healthy Cities:promoting health in the urban context. Copenhagen: WHO Europe. 1986 (Internet) Available in:

Huang N, Chien L, Chiou S. Advances in health promotion in Asia-Pacific region: promoting health through hospitals. Global Health Promotion. 2016; 23(1); 26-34

Hunter R, de la Haye K, Murray J, Badham J, Valente T, Clarke M, et al. Social network interventions for health behaviours and outcomes: A systematic review and metaanalysis. PLoS Med. 2019; 16(9): e1002890. https://doi. org/10.1371/journal.pmed.1002890

International Network of Health Promoting Hospitals & Health Services. 2021. (Internet) Available in:

International Network of Health Promoting Hospitals & Health Services. Membership 2021. (Internet) Available in:

International Network of Health Promoting Hospitals & Health Services. The 2020 standards for health promoting hospitals and health services. 2021 (Internet) Available in:

IUHPE. International Union for Education and Health Promotion. Available in:

Jaoude E , Treurnicht K, Pignatiello A. Smartphones, social media use and youth mental health. CMAJ 10. 2020;192 (6):136-141.

Joh H, Kim H, Kim Y, Lee J, Cho B, Lim C, et al. Health promotion in young adults at a university in Korea. Medicine. 2017; 96(7)

Kickbusch I. Health promotion 4.0. Health Promot Int. 2019;34(2):179-181.

Kickbusch I. Healthy Cities: a working project and a growing movement. Health Promot Int.1989; 4(2): 77–82.

Kickbusch I, Quick J. Partnerships for health in the 21st century. World Health Stat. Q. 1998; (51): 68-74

Kickbusch I. The contribution of the World Health Organization to a new public health and health promotion. Am J Public Health. 2003; 93: 383-388.

Kokko S, Green L, Kannas L. A review of settings-based health promotion with applications to sports clubs. Health Promot Int. 2013; 29(3):494–509.

Korda H, Itani Z. Harnessing social media for health promotion and behavior change. Health promoting practice 2013; 14 (1): 15-23

Kriemler S, Meyer U, Martin E, van Sluijs E, Andersen L, Martin B. Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Br J Sports Med. 2011;45(11):923-930.

Laliberté M, Perreault S, Damestoy N, Lalonde L. Ideal and actual involvement of community pharmacists in health promotion and prevention: a cross-sectional study in Quebec, Canada. BMS Public health 2012; 12 (192).

Langford R, Bonell C, Jones H, Campbel R. Obesity prevention and the health promoting schools framework: essential components and barriers to success. Int J Behav Nutr Phys Act. 2015; 12(15).

Langford R, Bonell C, Jones H, Pouliou T, Murphy S, Waters E. et al. The WHO Health promoting school framework for improving the health and well-being of students and their academic achievement. 2014.Cochrane Library

Latha K, Meena K, Pravitha M, Dasgupta M, Chaturvedi S. Effective use of social media platforms for promotion of mental health awareness. J Edu Health Promot. 2020; 9:124. DOI: 10.4103/jehp.jehp_90_20

Lawrence J, Colin F. Healthy Cities in a global and regional context Health Prom Int. 2009; 24 (1) :11–18

Lee A., Ho M., Keung V., Kwong A. Childhood obesity management shifting from health care system to school system: intervention study of school-based weight management programme. BMC Public health, 2014; 14 (1128)

Lee A, Wong M, Keung V, Yuen H, Cheng F, Mok J. Can the concept of Health Promoting Schools help to improve student`s health knowledge and practices to combat the challenge of communicable diseases: Case study in Hong Kong. BMC Public Health 2008; 8(42)

Leeuw E. Evidence for Healthy Cities: reflections on practice, method and theory. Health Promot Int. 2009; 24(1): 19-36

Levac J, O’Sullivan T. Social media and its use in health promotion. Interdisciplinary journal of health sciences. 2010; 1(1):47-53.

Lister-Sharp D, Chapman S, Stewart-Brown S, Sowden A. Health promoting schools and health promotion in schools: two systematic reviews. 1999. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available in:

Loss J, Lindacher V, Curbach J. Online social networking sites-a novel setting for health promotion? Health Place. 2014; 26: 161-70. doi: 10.1016/j.healthplace.2013.12.012.PMID: 24457613.

Lupton D. Health promotion in the digital era: a critical commentary. Health Promot Int. 2015; 30 (1):174-83

Marino C, Gini G, Vieno A, Spada M. The associations between problematic Facebook use, psychological distress and well-being among adolescents and young adults: A systematic review and meta-analysis. Journal of Affective Disorders. 2018; (226):274–281.

Mclsaas J, Hernandez K, Kirk S, Curran J. Interventions to support system-level implementation of health promoting schools: a scoping review. Int J Environ Res Public health. 2016; 13 (2):200

Mistry K, Minkovitz C, Riley A, Johnson S, Grason H, Dubay L, et al. A new framework for childhood health promotion: the role of policies and programs in building capacity and foundations of early childhood health. Am J Public Health. 2012;102(9):1688-1696.

Møller L, Stöver H, Jürgens R, Gatherer A. Health in Prisons. A WHO Guide to the Essentials in Prison Health. Copenhagen: WHO Regional Office for Europe. 2007. Available in:

Mũkoma W, Flisher A. Evaluations of health promoting schools: a review of nine studies. Health Promot Int. 2004; 19 (3): 357-368

Newman L, Javanparast S, Baum F, Hutchinson C. Evidence review: Settings for addressing the social determinants of health inequities. VicHealth; 2015: 33.

Okanagan charter: An international charter for health promoting universities & colleges. University of British Columbia Library. 2015 doi:

Pelikan J, Krajic K, Dietscher C. The health promoting hospital: concept and development. Patient Educ Couns. 2001;45(4);239-243

Ramanadhan S, Mendez S, Rao M, Viswanath K. Social media use by community-based organizations conducting health promotion: a content analysis. BMC Public Health. 2013; 13

Rosas S. Systems thinking and complexity: considerations for health promoting schools. Health Promot Int. 2017;32 (2):301-311.

Sacchetti R, Ceciliani A, Garulli A, Dallolio L, Beltrami P, Leoni E. Effects of a 2-year school-based intervention of enhanced physical education in the primary school. J Sch Health. 2013; 83(9):639-46.

Scholtens S, Meddelbeek L, Rutz S, Buijs G, Bemelmans W. Differences in school environment school policy and actions regarding overweight prevention between Dutch schools. A nationwide survey. BMC Public Health 2010; 10 (42)

SHE. Schools for health in Europe.

Sheppard A, Broughton M. Promoting wellbeing and health through active participation in music and dance: a systematic review. International Journal of Qualitative Studies on Health and Well-being. 2020; 15:1.

Sixsmith J, McSwiggan L, Fang M. Healthy Universities for Healthy Communities: Bridging the Divide. Dundee: University of Dundee.2019

Stellefson M, Paige S, Chaney B, Chaney D. Social media and health promotion. Int. J. Environ. Res. Public Health 2020; 17(3323).

Suarez-Lledo V, Alvarez-Galvez J. Prevalence of health misinformation on social media: systematic review. J Med Internet Res. 2021;23(1):e17187

Suarez-Reyes M, Van den Broucke S. Implementing the health promoting university approach in culturally different context: a systematic review. Global health promotion.2016; 23: 46-56

Szychowska A, Ruszkowska J, Drygas W. Healthy stadia programme: innovative approach to health promotion. Pol J Public Health. 2019; 129(1):5-8

Thompson S, Watson M, Tilford S. The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education. 2018; 56:73-84.

The Edmonton charter for health promotion universities and institutions of higher education. 2006. Available in:

Tsouros A. City leadership for health and well-being: back to the future. J Urban Health. 2013; (1): 4-13

Tsouros A, Dowding G, Dooris M. Strategic framework for the health promoting university project. In: Tsouros A, Dowding G, Tompson J, Dooris M. (eds) Health promoting universities. Concept, experience and framework for action. Copenhagen: WHO/Euro. 1998:121-136

Tsouros A, Dowding G, Tompson J, Dooris M. (eds) Health promoting universities. Concept, experience and framework for action. WHO/Euro. Copenhagen: (1998) p. 174

Tsouros A. Twenty-seven years of the WHO European Healthy Cities movement: a sustainable movement for change and innovation at the local level. Health Promot Int. 2015; 30 (1):3–7

Turunen H, Sormunen M, Jourdan D, von Seelen J, Buijs G. Health promoting school - a complex approach and major means to health improvement. Health Promot Int.2017; 1:32(2): 177-184

UCLAN. Healthy university (Internet) Available in:

Ventola C. Social media and health care professionals: benefits, risks, and best practices. P T. 2014;39(7):491-520.

Vilaça T, Darlington E, Rosàrio R, Bessems K, Velasco M, Velasco V. SHE mapping report. Lessons learnt from policies and practices of SHE member countries. 2019 Schools for health in Europe network foundation (SHE) Haderslev. Denmark (Internet) Available in:

Waters E, Gibbs L, Tadic M, Ukoumunne O, Magarey A, Okely A, et al. Cluster randomised trial of a school-community child health promotion and obesity prevention intervention: findings from the evaluation of fun ‘n healthy in Moreland! BMC Public Health. 2018; 92 (18)

Weare K, Nind M. Mental health promotion and problem prevention in schools: what does the evidence say? Health Promot Int; Oxford Academic.2011; 26 (1): 26-69.

Whitelaw S, Coburn J, Lacey M, McKee M, Hill C. Libraries as ‘everyday’ settings: the Glasgow MCISS project. Health Promot Int. 2017;32(5):891–900.

WHO/Euro. The International Network of Health Promoting Hospitals and Health Services: Integrating health promotion into hospitals and health services. Concept, framework and organization. 2007. (Internet) Available from:

WHO/Euro. The Ottawa charter for health promotion 1986. Available in:

WHO. Health promoting prisons. 2021. Available in:

WHO. Health promoting schools. (Internet) Available in:

WHO. Healthy cities 2021. Available in:

WHO. Healthy homes. 2021. Available in:

WHO. Healthy markets. 2021. Available in:

WHO. Healthy villages. 2021. Available in:

WHO. Shanghai declaration on promoting health in the 2030 agenda for sustainable development. 2016. (Internet) Available in:

WHO. The WHO health promotion glossary 1998. (Internet) Available in:

WHO.WHO publishes public health research agenda for managing infodemics. 2 February 2021. (Internet) Available from:

Woodall J. A critical examination of the health promoting prison two decades on, Critical Public Health.2016;26(5):615-626

Woodall J, Dixey R, South J. Control and choice in English prisons: developing health-promoting prisons, Health Promot Int. 2014;29 (3):474- 482.

Woodall J, Freeman C. Where have we been and where are we going? The state of contemporary health promotion. HEJ. 2020;1-12



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