Futures study of health promotion governance in Iranin health

Abstract

After more than three decades of releasing the Ottawa Charter for Health Promotion, the Health promotion paradigm (HPP) has not yet been properly interpreted and applied in many developing countries. This issue may be due to several reasons like superficial understanding of the health promotion concepts, dominance of biomedical paradigm in the health systems, lack of evidence-based measures, inadequate infrastructures, and limited capacity in health promotion. In this regard, Iranian health system also faces with several challenges. In the present study, we aimed to perform a futures study on health promotion governance in the Iranian health system to depict believable futures in the system and to design a desirable future based on the current trends in the health promotion governance indices in the country. Methods and materials This study was conducted in three phases: (1) identifying and selecting health promotion governance indices/indicators originated from Ottawa Charter through applying a literature review and an expert panel, (2) extrapolating the core indices/indicators identified in the previous phase, and perfroming, if needed, a community survey on the status of the indices/indicators with no available data, and (3) ranking the effective drivers of the core indices/indicators based on their importance and uncertainty, and providing scenario frameworks for the drivers aiming to obtain a range of different situations for the future of health promotion indices/indicators through panel of experts and scenario writing. Results In the current study, the core indices of the health promotion governance in the health system were identified, including: per capita public health expenditure, health literacy, health equity, social capital, urban health, positive health and the number of policies can be changeable throgh advocacy.We developed a comprehensive ecological model of health promotion as a broader concept than health and well-being beyond physical and mental health through identifying the drivers of health promotion governance indices/indicators in the health system in political, economic, cultural, technological, social and environmental dimensions. The scenarios obtained in the present study revealed the future of the health promotion governance in the Iranian's health system and revealed possible and compatible alternative futures as a reasonable and reliable basis for designing any strategy and policy in this field Conclusion Description and narrative of three favorable, unfavorable and static images of the future of the health promotion governance in the health system, by presenting its alternative paths, can be guide to the policy makers in the health system in their path towards the future of the health system