Healthy Settings

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The Scotland Chikwawa Health Initiative (SCHI) is implementing the ‘Healthy Settings’ approach in a rural district of Malawi. Led by the University of Strathclyde and in collaboration with University of Malawi (Polytechnic), Ministry of Health (Malawi) and the Chikwawa District Health Office the project is developing model communities (n=18), and integrating these principles into the associated schools (n=3), markets (n=2) and health facility (n=1). This evidence base will be used to support and provide sustainable methods to increase the size of the project, whilst continuously taking into consideration methods to improve health and remove barriers to success so to achieve sustained and effective change in the community that can be replicated elsewhere.

Health promotion has the principal goal of empowering individuals to take control of their own health and change their behaviour in order to live a healthy life. Health is not merely the absence of disease; it encompasses the physical, mental and social well-being of an individual (WHO, 1946). Therefore to obtain a state of healthy living, one must understand and aspire to fulfil personal goals, satisfy daily needs and adapt to changing environments (WHO, 2009), with cultural, economic and social factors all playing their role (determinants of health).

 The Main Determinants of Health (Adapted from Dahlgren & Whitehead, 1991)


Ottawa Charter for Health Promotion (WHO, 1986) highlighted the importance of health promotion in improving the health of the population. Since that time, the importance of the setting in which health promotion is addressed has also been noted as a key factor in success. As such, the WHO developed the ‘Healthy Settings’ approach whereby health promotion is implemented through a setting for health such as a school, workplace, city or village. This multidisciplinary method aims to maximise disease prevention but recognises that health is not individualistic and cannot be improved on an individual level due to the diverse nature of health and its interaction with a multitude of factors. This approach identifies the need to invest into the social system in which people spend their daily lives, as well as taking into account the personal, organisational and political stakeholders who are all involved in improving the health of populations. ‘Healthy Settings’ projects spend time in the community educating individuals and empowering communities to take control of their local health issues and be involved in the decision making process to ensure equity in healthcare and information access.

As such, the SCHI has a multidisciplinary team, who are working closely with community members, traditional, religious and government leaders, non-governmental organisations and other relevant stakeholders to identify, prioritise and build capacity in these communities to address their needs and improve their determinants of health.

Healthy communities
Characteristics of a healthy community

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