Community action for health and well-being

2. Building a strategy for community action

This section presents an example of a participatory process launched to develop a recommendations paper that guides thematic direction of Austria’s health promotion strategy and their multiannual work programmes. Although the process did not result in a full strategy, it demonstrates the potential of participatory approaches in identifying the needs of different communities. The evaluation of the consultation process also resulted in a set of principles for effective and inclusive planning and implementation of health promotion strategies.

2.1. Participatory strategy process Future Health Promotion – Austria

2.1.1. Context

Health promotion in Austria is planned and co-financed by the Austrian National Public Health Institute, established in 2016 (The Austrian Health Promotion Fund, 2024[7]). The institute comprises three business units, one of which is the Austrian Health Promotion Fund. This fund promotes health and supports initiatives to establish and improve knowledge, competencies, and networks by granting financial assistance and offering guidance. The fund is financed from Value Added Tax revenue, withheld before distribution to the federal government, regions, and municipalities, thus involving all three levels of territorial authorities in financing the institute’s activities. Additionally, health promotion activities are directly financed by these three levels of territorial authorities. In 2018, total public sector expenditures on health promotion exceeded EUR 100 million, and more than doubled by 2022 (OECD, 2024[8]).1

To establish health promotion more firmly and demonstrate its benefits across various societal sectors in Austria, the Austrian National Public Health Institute, under the auspices of the Federal Ministry of Social Affairs, Health, Care, and Consumer Protection, implemented the participatory strategy process Future Health Promotion (Ministry of Social Affairs, Health, Care and Consumer Protection, 2023[9]). The process was funded by the competence centre of the same name, which was established in 2022 as a part of the Agenda Health Promotion. The process spanned from July 2021 to January 2023 and engaged experts and stakeholders from multiple sectors, along with representatives from society and citizens, to prioritise health measures for the next five years. These measures aim to ensure a high quality of life, many healthy years, and equal health opportunities for all residents of Austria. Participatory methods were employed to define long-term goals and establish short- to medium-term priorities. Insights, ideas, and concerns gathered during this process were evaluated in the final phase. The outcome of this participatory process, the Future Health Promotion roadmap, outlines a set of recommendations guiding policymakers in the area of health promotion.

2.1.2. Description

To mark the 10th anniversary of the Austrian Health Targets, a broad participation process was implemented to comprehensively address the perspectives, needs and wishes of people living in Austria in the development of targeted future measures and in the further implementation of existing measures. The initial phase of the participation process featured an online population survey conducted in July 2021. The survey gathered insights on daily life health concerns during the COVID-19 pandemic, and personal health resources as well as ideas for the promotion of health and equity in Austria. More than 2 100 people representing a wide range of population groups participated in the survey. To complement the survey, focus group discussions were conducted with members of traditionally disadvantaged social groups, considered hard to reach through an online survey, namely seniors, adolescents and young adults, and people with migration experience. All focus groups included people affected by poverty or in a financially precarious situation. The design of the strategy process was informed by the results of this participation process.

The strategy process Future Health Promotion started with three events in 2021 that were organised by the Austrian Public Health Institute and the Ministry of Health: a kick-off, a scenarios forum, and a vision forum. The events involved 150 experts and stakeholders from diverse fields including politics, public administration, research, health promotion practice, civil society, business and education. Participants collectively shaped a vision for Health Promotion 2050, aimed at integrating health promotion sustainably across various societal sectors by 2050.

Subsequently, an online consultation involving 176 experts was organised, spanning two months from May to June 2022. It aimed at identifying immediate starting points and specific measures across societal sectors. The experts, drawing on their previous experiences and existing processes and strategies, participated in shaping the new roadmap for health promotion. Based on the conclusions from this consultation round, a first draft of the roadmap was prepared.

Following the online consultation with experts, a three‑month online dialogue with citizens was launched in July 2022. Participants were encouraged to express their health-related needs. The primary objective of this consultation was to make health-promoting measures more precise and to ensure they are applied most effectively in the areas with the greatest need. However, participants of the online dialogue did not fully represent the entire public, as some social groups faced barriers to participate in online events, excluding them from the discussions. To ensure the involvement of traditionally disadvantaged social groups – such as people living in poverty, people with a migration or refugee background, older individuals, and people with health issues – four focus groups and one round table discussion were initiated. The discussions were held in parallel with the online dialogue, serving to enhance and complement its findings.

Once the necessary information regarding health promotion needs was gathered, the public was actively involved in drafting proposals for action. To facilitate this process, three citizens’ councils were organised in the major cities of Salzburg, Vienna, and Graz between September and October 2022. To ensure the representativeness of the assembly participants, invitations were sent to 6 000 people randomly selected from the Central Population Register. Those who showed interest were asked to provide demographic information, including age, gender, level of education, and region of residence. This data was used to draw the final group of participants and helped to ensure the heterogeneity of the Austrian population was reflected in the councils. Ultimately, 43 people participated in these councils, contributing to the drafting of recommendations for health promotion actions.

The consultation process concluded with the Forum for Future Health Promotion, held in October 2022. A highlight of the forum was the presentation of the citizen councils’ results to the Minister of Health by the participants. The forum used a hybrid format, accommodating both in-person and remote participation. Prior to the forum, the action proposals were revised to incorporate key findings from the online consultation. During the forum, the proposals were critically assessed in thematic workshops using the following criteria: addressing special needs, acceptance by the public and stakeholders, visibility and resource efficiency, alignment with existing capacities and concepts, relevance to non-health sectors, and adherence to fundamental health promotion principles. Based on the evaluations, forum participants defined the next steps of the future health promotion. They pinpointed critical areas and formulated effective measures for implementation, organising them into ten groups. The recommended measures, along with a detailed description of the consultation process, were later published in a recommendation paper.

The recommendation paper was structured as a roadmap, outlining a series of measures designed to strengthen health promotion across Austria and demonstrate its value across various sectors. This roadmap is intersectoral, relying on collaboration among stakeholders from diverse sectors (i.e., social affairs, sport, education, environment, and agriculture) for its implementation. It serves as a tool for forming alliances aimed at implementing specific measures within different priority areas. Each group of measures was structured according to three categories in order to systematically enhance the effectiveness and reach of health promotion initiatives: (i) policy and partnership, (ii) resources and implementation, and (iii) knowledge and competencies.

Finally, the consultation process was evaluated using the CLEAR model, a tool developed by the Council of Europe to evaluate participatory projects (Vana, Schlee and Gruber, 2023[10]). The evaluation resulted in the development of 5x5 principles for effective and inclusive planning and implementation of health promotion strategies. The principles are based on international guidelines and concrete implementation experiences, offering a roadmap for future participatory health initiatives.

The participatory consultation process, due to its length and multiple stages, was relatively resource intensive. In terms of human resources, the entire process required the equivalent of one person working full-time for 10 months. This work involved co‑ordinating with key stakeholders, promoting participation formats, conducting individual focus groups, and preparing and evaluating the results. Financially, the implementation of all participation formats and related material costs amounted to approximately EUR 200 000.

2.1.3. Relevant lessons

Even though the three‑stage consultation structure was developed for the co-creation of a health promotion policies, it offers valuable insights for other countries that seek to build a strategy for community action. Public participation can inform the development of a long-term vision for community action for health by gathering comprehensive data on population health needs. Moreover, the inclusive design of the consultation process emphasises the importance of involving all residents, especially disadvantaged groups, ensuring that diverse needs are addressed, and enhancing the overall effectiveness of health initiatives. A blend of participatory methods – foresight methodology, citizens' councils, online consultations, and focus groups – enable the inclusion of both the opinions of experts as well as perspectives from the broader public and foster socio-economic inclusion. Multi-sectoral collaboration, a key feature of the applied methodology, promotes a holistic approach to health, integrating perspectives from various sectors, which can inform comprehensive community action strategies.

However, some challenges must be addressed to adapt this approach effectively in other countries. One challenge is the potential lack of specificity, as the participatory strategy consultation may result in general recommendations rather than detailed operational lines. Such outcomes would make it difficult to assign roles clearly to the relevant actors, requiring strong stakeholder collaboration to ensure successful implementation. Additionally, the resource‑intensive nature of this approach requires substantial time and financial investments. Activities such as organising citizen assemblies and roundtables are labour-intensive and demand significant financial and human resources. To maximise the benefits of this approach, it is crucial to steer the inclusive, multi-sectoral process towards practical and well-defined actionable outcomes. Also, effective resource management needs to be tailored to each country’s unique context.

Note

← 1.  The figures for 2022 might be influenced, to some degree, by the consequences of the COVID‑19 pandemic.