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

An individual’s health depends on their personal lifestyle and living conditions, which are influenced by a host of complex physical, social, and economic determinants. The same is true of organisational and community health. This book explains the Healthy Settings Approach as a means to define population and health standards as well as a framework to promote and evaluate health in daily living activities. The determinants affecting public health go beyond the availability and quality of healthcare, and a concerted effort from all sectors of the community is required to bring about sustained improvements.
Using the Healthy Settings Approach to facilitate the “right to health”, this book argues that promoting health in multiple and varied settings concurrently will ensure healthy living throughout the community and, ultimately, the world. The author uses real life experiences from different countries, with a focus on Hong Kong, and discusses many initiatives that have been enacted (although not widely reported in some cases). Each chapter draws on this evidence and translates the healthy settings framework into daily practice, thus providing guidance in synergising actions across different contexts and offering essential insight for educators, researchers, and professionals across countless disciplines.


The Healthy Settings Approach in Hong Kong: Sustainable Development for Population Health is the second book in the Healthy Settings Series, which focuses on the upstream, midstream, and downstream approaches for improving population health and reducing health inequity in various settings and contexts.

Series Editor-in-Chief

Albert Lee

Clinical Professor of Public Health and Primary Care and Founding Director of the Centre for Health Education and Health Promotion, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong; Fellow and Associate Dean of General Education of Wu Yee Sun College, The Chinese University of Hong Kong 

Series Editors

Robin M. B. Cheung

Adjunct Associate Professor at the Centre for Health Education and Health Promotion and Honorary Professional Consultant to the Department of Educational Administration and Policy, School of Education, The Chinese University of Hong Kong; Former Masters Course Instructor in the Department of Education Policy and Leadership, Education University of Hong Kong

Amelia S. C. Lo

Health Promotion Officer in charge of the Centre for Health Education and Health Promotion, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong

Vera M. W. Keung

Health Promotion Officer at the Centre for Health Education and Health Promotion, Jockey Club School of Public Healthy and Primary Care, Faculty of Medicine,
The Chinese University of Hong Kong

Amy C. M. Kwong

Registered Physiotherapist at the Centre for Health Education and Health Promotion, Jockey Club School of Public Health and Primary Care, Faculty of Medicine,
The Chinese University of Hong Kong

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.

Chapter 1 The Settings Approach for Health Promotion: How Does It Work?

Chapter 2 The Healthy City Concept and Evaluation Framework

Chapter 3 SPIRIT Framework and City Health Profile: Concepts and Case Studies

Chapter 4 Using a City’s Health Profile to Conduct a Post-modern Analysis of Health and Urbanisation: A Tale of Two Hong Kong Districts in Different Phases of Urban Development

Chapter 5 Health-promoting Schools: Key Elements and the Framework for Monitoring and Evaluation

Chapter 6 The Significance of Student Health and Health-promoting School Effectiveness in Hong Kong

Chapter 7 Health-promoting Workplaces: Concept, Evaluation, and Monitoring

Chapter 8 Health-promoting Healthcare Organisations: Hong Kong Case Studies

Chapter 9 How Can the Healthy Settings Approach Prevent Childhood Obesity? Views of Parents in Hong Kong and Scotland

Chapter 10 The Right to Health Promotion: Revisiting the Healthy Settings Approach

Chapter 11 Concluding Remarks and the Close of City-super’s Story