Bridging the gap between evidence and action: Advancing collective leadership in health promotion

In my article published in Open Access Journal, April 2023, I made the case for collective leadership to bridge the gap between current evidence and actions toward a healthy society – leaving unanswered the question – if collective leadership can bridge this gap – how do we do it?

This article and others to be published over the next few months will explore insights gleaned from collective leadership underway at multiple levels, with examples drawn from the Canadian context.

In my previous article, I recommend maximising health promoters’ skills as one way to bring evidence to creating a healthy society. This article expands on the definition of health promotion, focuses on the collective leadership underway in Canadian health promotion and why leaders – government, business, community and academia – need to reach out to this group.

Health promotion: Advocate, enable, mediate

Health promotion is defined as “the process of enabling people to increase control over, and to improve their health” ⁽¹⁾ and is viewed as a universal approach for creating a healthy society.⁽²⁾ The Ottawa Charter for Health Promotion lays the foundation to achieving health through three main strategies: advocate (to boost the factors which encourage health), enable (allowing all people to achieve health equity) and mediate (through collaboration across all sectors); and five core actions: build healthy public policy, create supportive environments, strengthen community actions, develop personal skills and reorient health services.

The Charter has provided the foundation for public and population health work in Canada for decades, including public health mandates, health professional training, policy development, and academic research; and it has underpinned the development of national and global strategies.⁽³⁾

The International Union of Health Promotion & Education and the Alliance for Health Promotion are two organisations which have been advancing health promotion on an international scale. National and local organisations are managed within each respective country. Canada, once viewed as a leader in health promotion, has limited mention of health promotion in its policies and structures. However, a movement led by Health Promotion Canada aims to increase its national visibility and influence.

Health Promotion Canada (HPC) was formed in 2016 with the vision of being a vibrant, connected and effective member-based organisation to advance workforce development and action in health promotion by 2026. The goal was to ensure all health promoters are equipped to foster health equity for all by 2046 through convening, promoting education and advancement of the Pan-Canadian Health Promoter Competencies (and toolkit).⁽⁴⁾

Energy for building the organisation might have waned during the Covid-19 pandemic, when many health promoters were assigned to public health responsibilities such as protection and surveillance.

However, the HPC executive, with membership from academia, public and private sectors across Canada, met virtually to continue exploring how HPC could advance health promotion in Canada. Their urgency to strengthen HPC was based on an anticipated pressing need to rebuild and repair communities across Canada, support the vulnerable and build on lessons learned through the disruption of the pandemic. Timing was critical.

To validate their vision and gain insight into the status of health promotion in Canada, a survey was distributed to the HPC member list, a newsletter contact list (with over 1,000 contacts) and through requests to other organisations and networks. The survey opened in January 2023 and received 181 responses in English and seven in French, with an estimated completion rate of over 65%⁽⁵⁾.

While the survey system was open, discussion groups were held. Results were disseminated in a webinar organised with the National Collaborating Centre on the Determinants of Health. In summary, respondents supported the need for leadership through a national organisation, and work is underway to pursue their recommendations.

So – what next?

Health promoters are a hidden resource, whether in government positions, non-profit organisations or academia. They often do not have health promotion in their job title but they are knowledgeable of the evidence needed to address societal conditions and possess skills for action on the determinants of health at the local, as well as provincial and national, levels. The challenge for those in leadership is knowing where to find them and tap their skills. HPC is positioning itself as a leader in making those connections.

Conclusion

The story of HPC illustrates processes evidenced by many examples of collective leadership I have observed. Initially, as with HPC, a pressing issue is identified by a passionate person or small group who are inspired to invite key individuals with diverse perspectives and mandates to engage in defining operational values and elaborating on a shared vision.

This is followed by convening a wider audience to validate, contextualise and provide greater understanding of the issue; to mobilise the vision and to collaborate on defining strategy. If the process sounds familiar and resonates with steps of Collective Impact ⁽⁶⁾, it is with reference to this process that we may find the way forward.

While research projects demonstrate the success of government/community/ academic partnerships, systems of governance have not changed. Working across sectors and partnering with communities are crucial for us to navigate current and future disruption ⁽⁷⁾ and strengthen civil society. Mindful that both public endorsement and political will are required for action, collective leadership will only be effective through communication, collaboration, co-learning and innovation. Health promoters are invaluable in facilitating the process.

References

1. World Health Organization. (1986) https://www.who.int/
   teams/health-promotion/enhanced-wellbeing/first-global- conference
2. Health Promotion Canada. (2023) Health Promotion Canada Summary of Survey Results, June 2023. Unpublished report available on request
3. World Health Organization. (1986)
4. Health Promotion Canada. (2025) Pan-Canadian Health Promoter Competencies – skills to improve health, health equity and determinants of health. https://www.healthpromotioncanada.ca/resources/ hp-competencies/
5. Health Promotion Canada. (2023) Health Promotion Canada Summary of Survey Results, June 2023. Unpublished report available on request
6. Kania, J. & Kramer, M. (2011) Collective Impact, Stanford Social Innovation Review, Winter 2011
7. Weaver, L., Fulton, B and Hardin, J. (2020) Leadership for Navigating Uncertainty https://www.tamarackcommunity.ca/ library/paper-leadership-navigating-change-liz-weaver- bill-fulton-jodi-hardin-civic-canopy