Setting a foundation: underlying values and structures of health promotion in primary health care settings

Abstract

Jurisdictions around the world have articulated a need for development of an integrated health care system with increased emphasis on primary health care and incorporation of the principles and practices of health promotion. To date, the medical model has been the default model of care. Yet, treatment alone is unlikely to have marked effects on health inequities or health status. This article presents and discusses two foundational dimensions (values, structures) of a health promotion philosophy and approach in primary health care settings. We propose a strategy and framework to support practical and attainable action. Our article (the first of a series of two) is based on a literature review, validation by key experts and a national survey of Canadian primary health care settings. We argue that fundamental philosophical values provide a foundation for health promotion in primary health care. These values should be reflected in the structures that create a supportive environment for health promotion. Our remaining three domains (strategies, processes, outcomes) are presented in a second following article. Based on values and structures, we conclude that subsequent strategies (interventions), processes (client- and community-centred care), and desired health promotion outcomes (intended or unintended) may be achieved.