The Healthy Settings Approach in Hong Kong: Sustainable Development for Population Health

The third Sustainable Development Goal (SDG) for 2030 established by the United Nations is to “ensure healthy lives and promote well-being for all at all ages”. This goal refers to more than just the prevention of premature death, it is also about empowering individuals and communities to achieve optimal health. Health is more than the absence of disease or infirmity; it is a state of complete physical, mental, and social well-being. To improve their health, people must increase control over the determinant factors of their health (Ottawa Charter for Health Promotion, 1986). In particular, efforts should be made to promote equity in health, as emphasised in the World Health Organisation’s “Health For All” principles. Health depends on the personal lifestyles and living conditions of individuals, as well as a host of complex physical, social, and economic determinants. These determinants go beyond healthcare; thus, a concerted effort of all sectors of the community is required to bring about sustained improvement in public health. At the time of this book’s publication, the world is still reeling and recovering from the COVID-19 pandemic. The implementation of physical measures to interrupt or reduce the spread of respiratory viruses based on sustained physical distancing, restricted social gathering, and “shut down” measures, have a strong potential to reduce the magnitude of the epidemic peak of COVID-19. Successful implementation of those measures is largely dependent on precautionary behaviour of the population. It requires society to have an understanding of the boarder dimensions of health promotion in the context of everyday life.

Notwithstanding the increasing expenditures to healthcare services, we are still observing health inequalities within communities as well as inequities between high-income (HI) and low-middle-income (LMI) countries. Investments in healthcare systems have largely ignored social structure, especially when it comes to providing services to vulnerable populations. Like developed countries in the West, developing countries also struggle with the burden of chronic diseases but at an even faster pace. Meanwhile, communicable diseases still pose a big health burden in both HI and LMI countries, and the impact of globalisation on non-communicable diseases (NCDs) and mental health in LMI countries has been minimal.
Contemporary society exposes people to more health risk factors, and failure to recognise the importance of non-health-sector contributions to health improvement places a greater burden on conventional health care providers. Subsidised or free health services for LMI countries would only solve immediate concerns and ignore the local culture and social contexts that lead to inequitable distribution of health. Such efforts treat symptoms rather than the cause and may ultimately have a negative impact on the system of governance in the future.

There is a global aspiration for all citizens to enjoy the highest attainable standard of health. However, the standard varies in different parts of the world, and there is a need for a universal standard to be established. The Healthy Settings Approach provides social structures so people can participate in healthy activities in the context of their daily lives. This approach facilitates the “right to health” as it argues for investments that address multiple determinants of health at all levels of society.