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Health Promoting Universities Activities

  The International Development of Health Promoting Universities
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The International Development of Health Promoting Universities

Networks of Health Promoting Universities – a Chronological Overview

The Organization for Economic Co-operation and Development (OECD) began its “Regional Health University” initiative in 1977 with the goal of having universities become responsible for the health of their regions. This led to the creation of the “Universities for Health” program, which was directed at the levels of education and professionalization. Its focal points were the advancement of university education and the professionalization of careers in the health sector. Additional activities were the democratization of health knowledge and the strengthening of primary health care. Not only were these regional Universities for Health considered to have responsibilities in the areas of education and research, they were also intended to actively contribute to health-related information and education for the public as well as to coordinate and deliver health services.

The World Health Organization (WHO) draws inspiration from the “Ottawa Charter for Health Promotion” to guide its “Healthy Settings” projects, including “Healthy Schools” and “Healthy Cities.” Settings-based health promotion is holistic and multi-disciplinary, viewing the university as a social system with all its various members being potential target groups. Its objective is the comprehensive and multi-sectoral integration of health promotion and prevention in the university via the key action areas as outlined by the Ottawa Charter, including the empowerment of all members in the university’s community, the creation of structural opportunities for health, and advocacy. The holistic nature of settings-based health promotion in the university encompasses its functions as an educational institute, a business operation, and a site for social innovation. Consequently, curricular design, teaching and learning conditions, work environments, and advocacy for the region are all features characterizing a Health Promoting University. Another special feature is the alignment towards a salutogenic perspective, which emphasizes resources for health at the university. These all serve to generate and develop starting points for the strategic development of a Health Promoting University.

The initial Health Promoting University to be designated as a settings project was in 1995: the University of Central Lancashire in Great Britain was exemplary in the implementation of its comprehensive approach. Close collaboration with the WHO Regional Office for Europe led to the First International Conference on Health Promoting Universities, which took place a year later in Great Britain. In 1997, “Health Promoting Universities” became an official component and sub-program of the WHO's Healthy Cities project. The first WHO Round Table Meeting on the “Criteria and Strategies for a European Network of Health Promoting Universities” occurred in Lancaster, Great Britain, the same year. The German Working Group of Health Promoting Universities was also in attendance.

The earliest networking structure for Health Promoting Universities began in Hannover, Germany in 1995. Today, the German Working Group of Health Promoting Universities continues to be coordinated by the National Association of Public Health of Lower Saxony. Over 80 universities, institutions, and organizations, which also include several from Austria and Switzerland, now belong to the network. Consequently, this Working Group has become the most far-reaching network for settings-based health promotion in universities throughout all of Europe.  Drawing from both the Ottawa Charter and a resource-oriented perspective, it employs a holistic and socio-ecological approach. Health is viewed as a cross-cutting issue, impacting all activities, members, and components of a university. To ensure the quality of Health Promoting Universities, the first such criteria were formulated. The quality criteria are rooted in the settings approach and the concept of salutogenesis, which is guided by resource-oriented action. Practical implementation requires careful planning and evaluation of health promotion initiatives in addition to the application of occupational health management strategies. These approaches allow for behavioural and structural health promotion measures to be adopted in a participatory manner, thereby ensuring sustainable implementation by regional networks as well.

The settings approach and the Ottawa Charter provide the foundations for other international networks. The English National Healthy Universities Network is one such example that employs the Ottawa Charter to describe the settings approach in its “Framework for Action.” Established in 2006 and coordinated by the University of Central Lancashire, the Network now includes 45 universities and 14 organizations. Outside Europe, further national initiatives are establishing Health Promoting Universities. For instance, collaboration between the University of Alberta in Canada and the Catholic University of Chile led to the First International Conference in the Pan-American Region, which occurred in Santiago de Chile in 2003. This event gave rise to the coordination of a Chilean Network of Health Promoting Universities with six affiliated universities. Guidelines for Health Promoting Universities have been developed, while the creation of a Pan-American network is also being discussed. In contrast to this tendency of developing larger networks, smaller and more regional networks of Health Promoting Universities are also in operation. The Chinese Beijing Health Promoting Universities Project, in cooperation with WHO China, has implemented and evaluated a locally run settings project that is active in six Beijing universities. Again, the Ottawa Charter served as the keystone for the universities' political and structural development, guiding the enablement of all stakeholders and students as well as the attainment of a healthy university environment (Table 1).

Table 1. International Conferences on Health Promoting Universities





United Kingdom

First International Conference Health Promoting Universities
University of Central Lancashire, WHO Regional Office for Europe, United Kingdom


United Kingdom

WHO-Round-Table Meeting:
“Criteria and Strategy for a European Network of Health Promoting Universities”


Santiago de Chile,

First International Conference Health Promoting Universities in the Pan-American Region:
“Constructing Healthy Universities”


Edmonton, Alberta, Canada
(Edmonton Charter, PDF)

Second International Conference Health Promoting Universities:
“Vitamin C for Health Promoting Universities. Community, Culture, Creativity and Change”


Cuidad Juárez, Mexico

Third International Conference Health Promoting Universities:
“Effective Training Environments”



Fourth International Conference Health Promoting Universities:
"The Social Commitment of Universities"

The 2005 “Edmonton Charter for Health Promoting Universities” states that:

“Universities and institutions of higher education exist to: educate students, create knowledge through research and contribute to the community and a civil society. As corporations and communities, they impact the health and wellbeing of individuals. (…) As research institutions they contribute to the creation of knowledge on public health and health promotion in a globalized world.” (p. 16)

These perspectives were formulated at the Second International Conference on Health Promoting Universities. They note the responsibility that universities have in contributing to social development through education and research, in addition to their significance in enhancing the worlds of work and education for staff and students by means of a socio-ecological approach.  The Charter views health in a holistic sense, having bio-psycho-social subcomponents, which is foundational for a Health Promoting University. Developing the concept of “integral health” is central to the university culture as it enables all members of the university community to lead health promoting lifestyles and creates structural opportunities for health. Thus, universities may act as catalysts for the diffusion of social innovation. They may also encourage a healthy and sustainable living environment and stimulate a regional dialogue for health by utilizing their characteristics, resources, functions, and policies.

This perspective was also adopted by the Spanish Network of Health Promoting Universities (REUS), which was established in 2006. It advocates for the social responsibility of universities in regards to knowledge and education, the implementation of health promoting strategies and activities in the socio-ecological environments of universities, and a regional orientation. Such objectives underline the importance of universities as health promoting settings, offering health promoting choices and information for all involved as well as integrating health throughout research and education. In 2009, the network also hosted the Fourth International Conference with the theme of “The Social Commitment of Universities.” Attention was given to developing international cooperation among, and forming networks of, Health Promoting Universities. The goal is to ultimately establish a comprehensive structure of health promotion at universities.

Independent, yet similar, network structures have been formed in Germany’s neighbouring countries of Switzerland and Austria beginning in 2009. These two countries have used the expanding networks as a starting point for the exchange of experiences, as models of best practice, and for the advancement of instruments and methods necessary for a Health Promoting University. Both the Network of Health Promoting Universities Austria and the Swiss Network of Health Promoting Universities are based on the Ottawa Charter and the settings approach alongside a resource orientation that is in accordance with the salutogenic concept. The Network of Health Promoting Universities Austria further emphasizes its goal of creating university settings for staff and students, which encourage health promoting ways of life and work. These are derived from the resource-oriented perspective and are combined with a behavioural and structural focus. Sub-goals include the expansion of the network, the exchange of experiences related to occupational health management, the development of evaluation methods, and the dissemination of “Models of Good Practice.” The Swiss Network, a collaboration between the Pedagogy University of Zürich (PH Zürich), the University of Zürich, and the Technical University of Zürich (ETH Zürich), aims to raise awareness among universities to formulate healthy work environments. Another related objective is highlighting the importance of workplace health promotion and occupational health management strategies to society and the economy.

The overview of the Networks below (Table 2) is neither exhaustive nor the result of a systematic review. Inclusion criteria were the mention of the settings-based approach, the Ottawa Charter, and the salutogenesis concept. These examples serve to illustrate the key aspects under study.

Table 2. Overview of the Network of Health Promoting Universities (as of 01/2010)

Year of Establishment




German Working Group on Health Promoting Universities
(Deutscher Arbeitskreis Gesundheitsfördernde Hochschulen)

72 universities and other organizations


Beijing Health Promoting Universities Project

6 universities in Beijing and surroundings


American Network of Health Promoting Universities

72 universities

Around 2003

Chilean Network for Health Promoting Universities
(Universidades Saludables Chile)

6 universities


English National Healthy Universities Network

45 universities and 14 organizations


Spanish Network for Health Promoting Universities
(Red Española de Universidades Saludables [REUS])

18 universities and organizations


Network for Health Promoting Universities Austria
(Netzwerk Gesundheitsfördernde Hochschulen Österreich)

14 universities


Swiss Network for Health Promoting Universities
(Schweizer Netzwerk Gesundheitsfördernder Hochschulen)

4 universities

Current trends in the development of the networks

Although the Health Promoting Universities project has been a subproject of the WHO’s Healthy Cities program since 1997, no global or international platform is in operation to coordinate the generated information or experiential exchange. As a result, national network projects act in a more sector-like manner on the international stage. However, the German Working Group and the Spanish Network are engaged in the process of establishing an international network. This prospective collaboration was planned in 2009 at the Fourth International Conference for Health Promoting Universities in Pamplona. In addition, the formation of a European Network is being promoted by German Working Group.

Ensuring suitable conditions for learning and study are central activities for a Health Promoting University; nonetheless, large gaps have become evident when implementing these concepts. The Bologna Process has fundamentally shifted the landscape of German and European university education, resulting in dramatic differences in the processes of examination. In contrast to the issue of sustainability, health was a neglected topic in the Bologna Process. However, this would have been a particularly relevant theme in light of the considerable impact that the Bologna Process has had on the health of both students and teachers alike. A first advisory statement was completed by the German Working Group of Health Promoting Universities to accentuate the connections between health and education. Its audience, namely the Ministers of Education who are involved in the Bologna Process throughout the European Region and represent 47 participating countries, will continue discussion of this topic at the next Ministers Conference in 2012.

Despite the considerable success of the settings-based Health Promoting Universities project, the network and universities are primarily driven by their own dedication and the support of individual organizations, including other universities as well as national accident and health insurance companies. These circumstances have allowed the project to develop and evolve in Germany over the last 15 years. Nevertheless, deficiencies in coordination and collaboration of national networks are clear. Political support is also missing as is evidenced by the absence of health as cross-cutting topic in the Bologna Process and the provision of resources, infrastructure, and continued financial investments to the project. Another concern is the lack of commitment by universities to health promotion, which affects the areas of related research and research funding. Indeed, few studies have focussed on the topic of Health Promoting Universities and their evaluation. To further the settings project among universities and networks, the analysis, evaluation, and exchange of results and experiences are essential for achieving the ultimate goal of identifying “Models of Good Practice.”


Universities can contribute significantly to the advancement of the comprehensive settings-based Health Promoting Universities project. As stakeholders with a social responsibility, combined with their broad scope of tasks and roles, universities can strengthen the cooperation within and between national and international networks. The continued international development of Health Promoting Universities demonstrates the potential of settings-based projects. Network structures provide a solid starting point for the continued development and improved implementation of this concept.


* The translation above is based on the original article of Silke Gräser “Zur internationalen Entwicklung der gesundheitsfördernden Hochschulen.”  Please see this article for further references.
Reference: Gräser S. (2010): The international development of health promoting universities. Prävention und Gesundheitsförderung; Band 5, Heft 3: S. 179-184

Health Promoting Universities Initiatives

Asian Healthy University Initiative:

Hompage of the Asian Healthy University Initiative (in English)

Health Promoting University Chile:

Hompage of the Project Health Promoting University Chile (in Spanish
Reflections on the progress and potential of healthy universities (in English) - Key note presentation, 2nd International Conference for Health-Promoting Universities by Ilta Lange of the Pontificia Universidad Catolica de Chile (PDF)

Presentation of the Project Health Promoting University Chile 2004
(in Spanish) of the Pontificia Universidad Catolica de Chile (PDF)

Informations about the Project Health Promoting University Chile 2002
(in Spanish) of the Pontificia Universidad Catolica de Chile (PDF)

University of Central Lancashire, Health Promoting University:

Hompage of the University of Central Lancashire, Health Promoting University (in English)

Here you find the printable version
last update: 20.12.2011