Health Promotion Framework
Building a Global Framework for Health Promotion: Strategies, Successes, and the Path Forward
Lessen Childhood Obesity
Health Promotion Efforts in Lessen Childhood Obesity
Nearly one fifth of the world’s children are overweight or obese.
In Brief
Let’s take a look on the information gathered from Queensland, Tonga, Western Australia.
There are 3 approaches to empower communities in lessen childhood obesity :-
- Community-based interventions, which encourage active living and healthy eating
- School interventions, by offering healthier meals and more opportunities for physical activities.
- Church interventions, which is, in some areas, an ideal platform to promote healthier lifestyles.
Focusing on
Most of the approaches commonly focus on
- Healthy diets, including education on healthy eating
- Physical activities such as movement and exercise
Inclusive of adults, adolescents, young children, and Indigenous peoples.
Contents
Overall
The health, social, and financial costs of unhealthy diets and being overweight cost nearly 3% of the global economy, similar to the impact of smoking or war.
Statistics
- Large amount of children are obese : Nearly one fifth of the world’s children are overweight or obese. This includes 39 million children under five years old and 340 million children aged 5-19 years. 1
- Costs of unhealthy diets : The health, social, and financial costs of unhealthy diets and being overweight are significant, costing nearly 3% of the global economy, similar to the impact of smoking or war.
- Causes : Many low- and middle-income countries are struggling with undernutrition, lack of essential nutrients, and rising child obesity. 2
- Worsened : This problem has worsened due to challenges like the COVID-19 pandemic, climate change, and economic recession, leading to higher prices for fresh foods and more marketing of unhealthy, processed foods.
The drivers
The drivers of overweight in children are significantly influenced by their environment, rather than individual choices. 4
Along with decreased opportunities for outdoor activities and increased screen time should be highlighted.
The drivers of overweight in children are significantly influenced by their environment, rather than individual choices. Various environmental risk factors such as the increased availability, affordability, and marketing of ultra-processed foods, along with decreased opportunities for outdoor activities and increased screen time should be highlighted.
Ultra-processed foods
Ultra-processed foods are low in nutrients and high in calories, such as snacks and ready meals. Some countries have successfully implemented food policies to reduce the consumption of these foods.
Effective measures
Effective measures include limiting children’s exposure to marketing of unhealthy foods, taxing snack foods and sugary drinks, requiring clear front-of-package warning labels, and improving school food environments. The World Health Organization (WHO) recommends these measures to combat overweight and obesity. 3
Comprehensive approach
The focus shifts from blaming individuals to examining the broader environmental and systemic causes of overweight and obesity. It also helps to avoid stigmatizing children who suffer from these issues, as they often face lifelong health consequences and social discrimination.5 Educational efforts to change behavior may be ineffective if these external factors are not addressed. Instead, a comprehensive approach involving food, social protection, education, water and sanitation, and health systems is necessary, including regulating the food and beverage industry.
Community-Based Interventions
HWQld, Queensland is committed to empowering communities to create solutions that increase opportunities for healthy eating and physical activity, including children, young people, and Aboriginal and Torres Strait Islander peoples. through
- Making Healthy Happen 2032 Strategy
- A Better Choice : Making it easier to choose healthier and more affordable food and drink when eating out.
- Gather + Grow 2023 – 2032 : To improve health outcomes in Aboriginal and Torres Strait Islanders communities.
- Deadly Choices : To empower Aboriginal and Torres Strait Islander peoples to make healthy choices for themselves and their families
Tonga Health implements programs that engage communities in healthy living practices.
- Nutrition and water intake
- Physical activities, including informal ones
- Ensuring a collaborative approach
HWQld, Queensland, Australia
Encouragement
To increase opportunities for healthy eating and physical activity, including children, young people, and Aboriginal and Torres Strait Islander peoples.
Health and Wellbeing Queensland is committed to empowering communities to create solutions that increase opportunities for healthy eating and physical activity, by engaging with Queensland communities and priority groups, including children, young people, and Aboriginal and Torres Strait Islander peoples.
Causes and Affects
Many children in Queensland consume too many unhealthy foods and not enough fruits and vegetables, leading to one in four children living with overweight or obesity.
Good nutrition during childhood is essential for healthy growth, development, and the formation of lifelong healthy habits. However, many children in Queensland consume too many unhealthy foods and not enough fruits and vegetables, leading to one in four children living with overweight or obesity, which negatively impacts their physical and mental health.
Projects and Campaigns
Making Healthy Happen 2032 Strategy
Aiming to create a healthier Queensland over the next decade by preventing, reducing, and treating obesity.
Making Healthy Happen 2032 Strategy, released in May 2024, is the Queensland Government’s response to the National Obesity Strategy and aims to create a healthier Queensland over the next decade by preventing, reducing, and treating obesity.
Developed by Health and Wellbeing Queensland, in consultation with people with lived experience of obesity, and key stakeholders including local and state government, non-government, health, community, and academic agencies, the strategy focuses on three Ambitions: creating supportive, sustainable, and healthy environments; empowering people to stay healthy; and enabling access to prevention, early intervention supportive healthcare. These Ambitions are supported by seven focus areas, including fostering local and community-led solutions.
The strategy focuses on three Ambitions:
- Creating supportive, sustainable, and healthy environments.
- Empowering people to stay healthy.
- Enabling access to prevention, early intervention supportive healthcare.
Addressing the Underlying Drivers of Obesity
The strategy will be delivered through a series of three Action plans designed to address the underlying drivers of obesity, shift the dial on barriers, and change the systems that hold obesity in place.
The first Action Plan outlines 40 actions, led or supported by 11 Government agencies and supported by a wide range of government and non-government stakeholders. It seeks to establish a strong foundation for change through collective leadership and shared actions that leverage and enhance investment, infrastructure, and initiatives currently in progress or scheduled for implementation.
A Better Choice
One key action of the Making Healthy Happen 2032 Strategy is to make it easier for Queenslanders to choose healthier and more affordable food and drink when eating out of home through the A Better Choice initiative.
One key action of the Making Healthy Happen 2032 Strategy is to make it easier for Queenslanders to choose healthier and more affordable food and drink when eating out of home through the A Better Choice initiative. This is a suite of healthy food and drink strategies that initially target healthcare and sports and recreation facilities.
Over half of Queenslanders eat out at least once a week.
With over half of Queenslanders eating out at least once a week, A Better Choice addresses the challenge of unhealthy food and drink flooding food and retail settings like canteens, vending machines, cafés, and restaurants.
Appealing Healthier Options
When healthier options are available and appealing, customers are more likely to choose them.
So that they become the easiest and most obvious choice.
Research shows that when healthier options are available and appealing, customers are more likely to choose them. A Better Choice ensures that healthier products are easily accessible, strategically placed, promoted, and competitively priced so that they become the easiest and most obvious choice.
Reduce less healthy food and drinks
Set an example for children and young people on how best to fuel their bodies for growth and development.
It also reduces the availability of less healthy food and drinks while placing limitations on their promotion. For example, sports and recreation facilities; a crucial environment for promoting physical activity and social connection, set an example for children and young people on how best to fuel their bodies for growth and development.
Guiding sporting venues and clubs
How to offer and promote healthy options while remaining financially competitive, with practical tips and examples from successful implementation.
Launched in May 2023, A Better Choice for Sport and Recreation was developed in partnership with the Department of Tourism and Sport to guide sporting venues and clubs on how to offer and promote healthy options while remaining financially competitive, with practical tips and examples from successful implementation.
Gather + Grow 2023 – 2032
Aiming to improve health outcomes in Aboriginal and Torres Strait Islanders communities
The Gather + Grow 2023 – 2032 strategy6 is the Queensland Government’s long-term plan to improve food security in remote Aboriginal and Torres Strait Islander communities. Led by Health and Wellbeing Queensland in partnership with Aboriginal and Torres Strait Islander communities and with 17 government agencies across local, state, and federal levels, this initiative aligns with the government’s commitment to the National Agreement on Closing the Gap. Initially focusing on the Far North and Lower Gulf regions of Queensland, Gather + Grow aims to improve health outcomes in Aboriginal and Torres Strait Islanders communities.
Four key areas
The strategy addresses four key areas identified by the communities:
- Optimizing logistics : Optimizing logistics and supply chain performance and resilience to ensure quality, affordable, healthy food is consistently available year-round.
- Improving the accessibility : Improving the accessibility and availability of healthy food by creating supportive settings for sustainable local food production.
- Empowering healthy communities : Empowering healthy communities by building awareness, capability, and environments for good nutrition.
- Supporting healthy homes : Supporting healthy homes that enable the utilization of healthy food with reliable and functional health hardware (for example, food cooking and storage facilities).
Gather + Grow seeks to overcome barriers and leverage community strengths, engaging with communities and sectors to implement lasting, impactful solutions for food security.
Through local and systemic actions, Gather + Grow seeks to overcome barriers and leverage community strengths, engaging with communities and sectors to implement lasting, impactful solutions for food security.
Challenge in choosing healthy food options
Many remote communities rely on a single store for their food supply, making stores vital in promoting healthy food options.
Choosing healthy food options can be challenging, even more so in remote communities where healthier food items can be limited and often expensive. Many remote communities rely on a single store for their food supply, making stores vital in promoting healthy food options.
Healthier food environments created
25 out of CEQ’s 27 stores have developed a Gather + Grow Store Action Plan to create healthier food environments that support healthier food and drink purchasing behaviors.
Health and Wellbeing Queensland funds Community Enterprise Queensland (CEQ), to deliver the Healthy Stores project which aims to create healthier food environments to empower Aboriginal and Torres Strait Islander communities to make healthy choices. Since 2021, 25 out of CEQ’s 27 stores have developed a Gather + Grow Store Action Plan to create healthier food environments that support healthier food and drink purchasing behaviors.
This has included the placement and promotion of healthier options, such as fruits, vegetables, and water over less healthy options, such as sugary beverages, and stocking a range of healthier food choices such as lower-fat yogurts and cheeses.
Collaboration
The Healthy Stores research project is guided by a collaboration with Monash University, The University of Queensland, and Menzies School of Health Research.
Health and Wellbeing Queensland has invested over $1.5 million in partnerships with Apunipima Cape York Health Council, Torres Strait Island Regional Council, Gidgee Healing, and Mura Kosker to work with communities in the Torres Strait, Cape York, and Lower Gulf Regions to identify opportunities to improve local food security.
Increase physical activity and healthy eating.
In addition to this, Health and Wellbeing Queensland is supporting the delivery of more than $1.4 million to 19 Queensland Aboriginal and Torres Strait Islander discrete communities to increase physical activity and healthy eating.
The Healthy Eating and Physical Activity Infrastructure Planning Funding Program, delivered in partnership with the Department of Tourism and Sport, allows local councils to take up planning, design, or consultation for projects such as playgrounds, sporting facilities, community kitchens, and food storage.
Prevention
A suite of evidence-based, high-quality chronic disease prevention programs that are free of charge to Queenslanders no matter where they live.
Health and Wellbeing Queensland currently partners with a range of Queensland’s peak preventive health organizations to fund the delivery of a suite of evidence-based, high-quality chronic disease prevention programs that are free of charge to Queenslanders no matter where they live. Since 2021, the program suite has achieved broad reach, promoting health and wellbeing and collectively supporting almost 160,000 Queenslanders to improve and maintain better health.
For example, Health and Wellbeing Queensland funds the Deadly Choices programs7, delivered by the Institute for Urban Indigenous Health (IUIH), which aims to empower Aboriginal and Torres Strait Islander people to make healthy choices for themselves, their families, and their communities.
Deadly Choices
Deadly Choices aims to empower Aboriginal and Torres Strait Islander peoples to make healthy choices for themselves and their families
- To stop smoking
- To eat good food
- To exercise daily.
A Deadly Choice is a healthy choice.
“We aim to empower Aboriginal and Torres Strait Islander peoples to make healthy choices for themselves and their families – to stop smoking, to eat good food and exercise daily. Deadly Choices also encourages our people to access their local Community Controlled Health Service and complete an annual ‘Health Check’.”
In Aboriginal slang, if something is ‘deadly’ it is great. As such a Deadly Choice is a good choice, and we encourage community to make such choices each day.
Deadly Choices Programs
Deadly Choices healthy lifestyle programs include the Deadly Choices healthy lifestyle school education programs, Good Quick Tukka, and DC Fit which encourage Aboriginal and Torres Strait Islander people to eat good food, exercise daily, and stop smoking.
Good Quick Tukka
Good Quick Tukka is a cooking education program, which believes that anyone can learn how to cook something – they just have to give it a try.
One of the fundamental principles of positive health relates to a person’s selection, preparation and consumption of wholesome, nutritious foods.
DC Fit
At Deadly Choices we understand that every individual’s health journey is different.
Our DC FIT program embodies inclusivity across all fitness levels.
Participation
Between 1 July 2021 and 31 December 2023, Deadly Choices programs supported over 16,550 Aboriginal and Torres Strait Islander young people, their families, and communities to improve their health and wellbeing through participation in over 2,100 programs and community events across Queensland.
Health Check
This health check is essential for managing and preventing chronic diseases, such as diabetes and heart disease, which are more prevalent in these communities.
During this period, almost 5,000 program and community event participants completed a 715 Medicare health check that helps identify if a person is at risk of illness or chronic conditions. This health check is essential for managing and preventing chronic diseases, such as diabetes and heart disease, which are more prevalent in these communities.
To incentivize participation, health services offer clients a free Deadly Choices shirt upon completing a health check. These shirts, updated annually, along with other merchandise, serve as reminders for follow-up appointments, vaccinations, and allied health visits.
Tonga Health
Engage communities in healthy living practices. For example, they
- Promote physical activities
- Provide education on healthy eating.
Tonga Health implements programs that engage communities in healthy living practices. For example, they promote physical activities and provide education on healthy eating. The Ma’alahi Youth Project (MYP)8 was conducted in Tonga from 2005-2008 to enhance the capacity of the community—including schools, churches, parents, and adolescents—to promote healthy eating and regular physical activity. The project aimed to reduce the prevalence of overweight and obesity among youth and their families by addressing unhealthy eating habits and low physical activity levels, the two main modifiable risk factors for obesity.
The two main modifiable risk factors for obesity are
- Unhealthy eating habits
- Low physical activity levels,
Ma’alahi Youth Project (MYP)
The primary goal of MYP was to empower youth and their families to adopt and value healthy lifestyles. A comprehensive 10-point action plan guided the program’s development and activities. This plan included three standard objectives on capacity building, social marketing, and evaluation.
Nutrition objectives
It also focused on four nutrition objectives:
- Promoting healthy breakfasts
- School lunches
- Fruit and vegetable consumption
- Water intake
Physical activity objectives
Additionally, it included two physical activity objectives:
- Increasing organized sports
- Informal physical activities
Lastly, the plan emphasized the importance of championing key individuals as role models.
Effective engagement
The action plan provided a structured framework for effective engagement between communities, schools, and both government and non-government organizations, ensuring a collaborative approach to promoting health and well-being among Tonga’s youth.
School Intervention
Tonga Health and Healthway, Western Australia, focus on offering healthier meals and more opportunities for physical activities.
While HWQld, Queensland, focus on boosting students to learn more about and consume more vegetables and fruits, and they began as a pilot.
Tonga Health
Providing healthier school meals and increase opportunities for exercise.
Tonga Health collaborates with schools to ensure children receive proper nutrition and engage in regular physical activity. This includes initiatives to provide healthier school meals and increase opportunities for exercise. Additionally, Tonga Health promotes health within schools by awarding those that meet specific health criteria. By targeting younger populations, the program aims to prevent future obesity and non-communicable diseases (NCDs), encouraging healthy habits early in life.
Healthway, Western Australia
Aiming at improving nutrition and physical activity in schools.
- Offering healthier food options
- More opportunities for physical activity
- Teaching the Australian Dietary Guidelines (ADG) in the classroom
Healthway funds initiatives aimed at improving nutrition and physical activity in schools. This includes providing grants for programs that offer healthier food options and more opportunities for physical activity. Healthway promotes practical approaches to teaching the Australian Dietary Guidelines (ADG) in the classroom, emphasizing which foods and drinks should be consumed most frequently and which should be avoided. For older children who can understand more complex health messages, the importance of maintaining healthy body weight as a protective factor for overall health and well-being, in line with the ADG, should be taught in a supportive classroom environment.
HWQld, Queensland, Australia
Pick of the Crop
For children to learn about and eat more vegetables and fruits.
Pick of the Crop9 is Health and Wellbeing Queensland’s whole-school healthy eating initiative aimed at increasing opportunities for Queensland primary school children to learn about and eat more vegetables and fruits.
Schools develop locally designed action plans, focusing on their needs and environment. These are based on five key components.
Five key components
- Food and grower connections
- Teaching and learning
- Veggies and fruit at schools
- Healthy school environments
- Family and community connections
Pick of the Crop aligns with the Queensland Department of Education strategy – Smart Choices – Healthy Food and Drink Supply Strategy for Queensland Schools and follows the latest Australian and international best practices.
Began as a Pilot
Pick of the Crop began as a pilot in 2020 with 35 state schools in Bowen, Bundaberg, and Logan. Since then, it has expanded to include more students in state schools across Queensland, covering regions such as Far North Queensland, North Queensland, North Coast, Darling Downs South West, Metropolitan South, and South East. 204 schools have participated in the initiative since 2020, reaching over 44,000 students. In 2024, 91 new schools have come on board.
Supporting schools
The initiative supports schools through regional coordinators, hosted by local organizations, who engage with and assist in the development and implementation of the local school action plans.
Church Intervention
Tonga Health
The church plays significant role in the lives of many Tongans, making it an ideal platform to promote healthier lifestyles.
Tonga’s strategy in combating obesity includes a noteworthy collaboration with the nation’s churches. The Ministry of Health Tonga and Tonga Health recognizes the significant role that the church plays in the lives of many Tongans, making it an ideal platform to promote healthier lifestyles.
“If we want to make a difference, we must work hand in hand with the church.”
Through this partnership, religious leaders actively advocate for
- Physical activity and healthy diets
- Conduct health screenings
- and Set an example by serving nutritious meals.
Ofeina Filimoehala, CEO of the Tonga Health Promotion Foundation, highlights the importance of collaborating with the church, stating, “If we want to make a difference, we must work hand in hand with the church.” This approach acknowledges the influential role of the church and aims to utilize it as a catalyst for positive health changes within the community10.
References
- 1 Obesity and overweight. Geneva: World Health Organization; 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
- 2 Headey DD, Alderman HH. The relative caloric prices of healthy and unhealthy foods differ systematically across income levels and continents. J Nutr. 2019 Nov 1;149(11):2020–33. https://doi.org/10.1093/jn/nxz158 PMID:31332436
- 3 A different scale: global action to address obesity. Geneva: World Health Organization; 2022. Available from: https://www.who.int/news-room/events/detail/2022/05/24/default-calendar/a-different-scale-global-action-to-address-obesity
- 4 A systems approach to improving children’s diets. New York: United Nations Children’s Fund; 2022. Available from: https://www.unicef.org/media/….pdf
- 5 Jackson-Morris A, Kataria I. Weight stigma among adolescents and its significance for health promotion in low- and middle-income countries. [poster]. In: International Union for Health Promotion and Education World Conference on Health Promotion; 2022 May 15–19; Montreal, Canada. Berlin: ResearchGate; 2023. https://doi.org/10.13140/RG.2.2.17306.52165
- 6 Gather + Grow 2023 – 2032, https://hw.qld.gov.au/gather-grow/
- 7 Deadly Choices, https://hw.qld.gov.au/initiatives/deadly-choices/
- 8 Fotu KF, Millar L, Mavoa H, Kremer P, Moodie M, Snowdon W, Utter J, Vivili P, Schultz JT, Malakellis M, McCabe MP, Roberts G, Swinburn BA. Outcome results for the Ma’alahi Youth Project, a Tongan community-based obesity prevention programme for adolescents. Obes Rev. 2011 Nov;12 Suppl 2:41-50. doi: 10.1111/j.1467-789X.2011.00923.x. PMID: 22008558.
- 9 Pick of the Crop https://hw.qld.gov.au/pick-of-the-crop/
- 10 Ma’alahi Youth Project (MYP), https://tongaindependent.com/health/tonga-leading-the-fight-against-obesity-and-non-communicable-diseases-in-the-pacific/
