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Towards the Development of Skills-Based Health Promotion Competencies: The Canadian

Experience
Brian Hyndman
Global Health Promotion published online 15 May 2009
DOI: 10.1177/1757975909104105

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 Global Health Promotion OnlineFirst, published on May 15, 2009 as doi:10.1177/1757975909104105

Commentary

Towards the development of skills-based health promotion

competencies: the Canadian experience
Brian Hyndman1

Abstract: The health promotion competencies presented in the Galway Consensus Conference
Statement build on an emerging international literature that includes a proposed set of Canadian
competencies developed for health promotion practitioners. In Canada, the creation of draft health
promotion competencies by Health Promotion Ontario (HPO) was fueled by increased concerns
about the potential marginalization of health promotion as well as a national public health renewal
process that placed increased emphasis on competency development as a means of strengthening the
public health workforce. This commentary presents the proposed Canadian competencies and pro-
vides an overview of the process utilized to develop them. Key similarities and differences between
the proposed Canadian competencies and the competencies outlined in the Consensus Statement are
also explored. The Canadian experience illustrates the way in which national health promotion com-
petencies can be shaped by cultural and political factors unique to a specific jurisdiction. (Global
Health Promotion, 2009; 16 (2): pp. 51–55)
Key words: Canada, Consensus Conference, health promotion competencies

Introduction Health promotion competencies: the

The health promotion competencies presented in
the Galway Consensus Conference Statement (1, 2)
build on an emerging international literature that
includes a proposed set of health promotion compe-
tencies developed for health promotion practition-
ers in Canada. The following commentary provides
an overview of the process utilized to develop these
competencies. The resulting competencies are pre-
sented, and key similarities and differences between
the proposed Canadian competencies and the com-
petencies outlined in the Consensus Statement are
explored.
Canadian context
The publication of A New Perspective on the
Health of Canadians (a.k.a. the Lalonde Report)
in 1974 (3) marked the introduction of health pro-
motion as a new subspecialty within the Canadian
public health sector. New bureaucratic structures
supporting the application of health promotion
strategies were introduced at both the federal and
provincial levels of government, and post-secondary
degree programs focusing on health promotion
emerged at Canadian universities. The subsequent
release of the Ottawa Charter for Health Promotion

1. MHSc, Principal Associate, The Alder Group, and Fellow, Centre for Health Promotion, University of Toronto,
Toronto, Canada. Correspondence to: c/o Centre for Health Promotion, University of Toronto, 155 College St Suite
400, Toronto, ON, Canada M5T-3M7. Tel: +1 416 693 4993. Fax: +1 416 971 1365. e-mail: b.hyndman@utoronto.ca.

Global Health Promotion 1757-9759; Vol 16(2): 51–55; 104105 Copyright © The Author(s) 2009, Reprints and permissions:
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52
in 1986 (4) fueled an expansion of health promotion
as both a distinct field of practice and a viable career
option; for the first time, public health and social
service organizations in Canada created positions
with the term ‘health promotion’ embedded in the
job title.
The emergence of health promotion as a distinct
field of practice in Canada invariably gave rise to
discussions about the need for skills-based compe-
tencies defining the scope of health promotion
practice. Sporadic debates about the benefits and
risks of health promotion competencies occurred
within Canadian health promotion organizations
during the 1980s and 1990s. These discussions
were most often framed within the broader
context of ‘professionalizing’ health promotion
practice through the adoption of standardized
requirements (5). In 2000, the issue of health pro-
motion competencies was explored at a sympo-
sium organized by the Canadian Association of
Teachers in Community Health (6). While partic-
ipants at this session concluded that health pro-
motion competencies could be useful as broadly
defined ‘guidelines’, concern was expressed that
the rigid interpretation of competencies as profes-
sional standards of practice could prove detrimen-
tal to a field that was still evolving.
However, subsequent developments sparked a
renewed interest in health promotion competencies.
Increased support for the development of skills-
based health promotion competencies was attribut-
able to two key factors.
First, a series of consultations with health promo-
tion practitioners in Ontario, the largest Canadian
province (7–9), revealed growing concerns about
the potential marginalization of health promotion
within the broader public health sector. Second,
a national public health renewal process, which
included the creation of the Public Health Agency of
Canada (PHAC) in 2004, launched a competency-
based approach to public health workforce develop-
ment (10). This culminated in the creation of core
competencies for the public health workforce in
Canada (11), as well as support for the development
of competencies for key public health professions,
including health promotion. Health promoters
working in the field of public health risked further
marginalization if they failed to play a lead role in
developing a set of competencies that incorporated
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B. Hyndman
the key concepts, values and principles underlying
health promotion practice.
Towards the development of
Canadian health promotion
competencies: initiating the process
In the spring of 2006, Health Promotion Ontario
(HPO), a provincial network representing the inter-
ests of Ontario-based health promoters, undertook a
review of existing health promotion competencies.
Several examples were considered, including compe-
tencies developed for health promoters in Australia
and New Zealand (12, 13) and an academic set of
competencies developed by the MHSc degree
program in health promotion at the University of
Toronto (14). In addition, over 60 job descriptions
for health promotion positions were assessed to
identify common knowledge and skill requirements.
The information garnered from this review
guided the development of the following set of pro-
posed health promotion competencies, which were
released by HPO in April 2007 (15). Specifically,
these competencies state that all health promoters
should be able to:
1. Demonstrate knowledge necessary for conduct-
ing health promotion that includes:
1.1 applying determinants of health frame-
work to the analysis of health issues
1.2 applying theory to health promotion plan-
ning and implementation
1.3 applying health promotion principles in the
context of the roles and responsibilities of
public health organizations
1.4 describing the range of interventions avail-
able to address public health issues.
2. Conduct a community needs/situational assess-
ment for a specific issue that includes:
2.1 identifying behavioral, social, environmen-
tal and organizational factors that promote
or compromise health
2.2 identifying relevant and appropriate data
and information sources
2.3 identifying community assets and resources
2.4 partnering with communities to validate
collected quantitative and qualitative data
 Commentary
2.5 integrating information from available
sources to identify priorities for action.
3. Plan appropriate health promotion programs
that include:
3.1 identifying, retrieving and critically
appraising the relevant literature
3.2 conducting an environmental scan of best
practices
3.3 developing a component plan to implement
programs including goals, objectives and
implementation steps
3.4 developing a program budget
3.5 monitoring and evaluating implementation
of interventions.
4. Contribute to policy development that includes:
4.1 describing the health, economic, adminis-
trative, legal, social and political implica-
tions of policy options
4.2 providing strategic policy advice on health
promotion issues
4.3 writing clear and concise policy statements
for complex issues.
5. Facilitate community mobilization and build
community capacity around shared health prior-
ities that include:
5.1 engaging in a dialogue with communities
based on trust and mutual respect
5.2 identifying and strengthening local commu-
nity capacities to take action on health
issues
5.3 advocating for and with individuals and
communities that will improve their health
and wellbeing.
6. Engage in partnership and collaboration that
include:
6.1 establishing and maintaining linkages with
community leaders and other key health
promotion stakeholders (e.g. schools, busi-
nesses, churches, community associations,
labour unions, etc.)
6.2 utilizing leadership, team building, negotia-
tion and conflict resolution skills to build
community partnerships
6.3 building coalitions and stimulating inter-
sectoral collaboration on health issues.
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53
7. Communicate effectively with community
members and other professionals that includes:
7.1 providing health status, demographic, sta-
tistical, programmatic, and scientific infor-
mation tailored to professional and lay
audiences
7.2 applying social marketing and other com-
munication principles to the development,
implementation and evaluation of health
communication campaigns
7.3 using the media, advanced technologies,
and community networks to receive and
communicate information
7.4 interacting with and adapting policies and
programming that respond to the diversity
in population characteristics.
8. Organize, implement and manage health pro-
motion interventions that include:
8.1 training and coordinating program volunteers
8.2 describing scope of work in the context of
organizations’ mission and functions
8.3 contributing to team and organizational
learning.
An overarching feature of these competencies is
the capacity to define, analyze and take action on
health issues from a health promotion perspective.
Specifically, health promoters should be able to
assess the nature of a health issue or problem and
provide analysis and advice on how to address it
through the appropriate mix of health promotion
strategies, including community mobilization, health
education, advocacy, policy development and orga-
nizational change. This skill set constitutes the
‘value added’ that health promoters bring to the
field of public health (15).
The Galway Consensus Conference
Statement and the proposed Canadian
health promotion competencies: how do
they compare?
The domains of health promotion competency
presented in the Galway Consensus Conference
Statement and the proposed competencies for health
promoters in Canada have many common features.
These commonalities reflect a shared understanding
IUHPE – Global Health Promotion Vol. 16, No. 2 2009
54
of the parameters of health promotion practice and
the key principles and values underpinning health
promotion. At the same time, there are notable dif-
ferences between the two sets of competencies.
These differences may be attributable to differences
in the purposes and intended audiences of the
respective competencies, as well as contextual
factors shaping the nature of health promotion
practice in Canada.
Both sets of competencies embrace the definition
of health promotion embedded in the Ottawa
Charter as both the conceptual basis for, and the
desired outcome of, health promotion practice. In
addition, both competency statements acknowledge
that health promotion is guided by a core set of
values and principles that include a holistic socio-
ecologic approach to addressing health issues that
encompasses the social, economic and cultural
determinants of health (1, 15).
As was noted previously, the Consensus Statement
and the Canadian health promotion competencies
have different intended audiences. The Consensus
Statement identifies several audiences including
practitioners, researchers, academics and policy and
decision makers who have a stake in promoting the
health of the public (1). The proposed Canadian
competencies, by contrast, were developed prima-
rily for practitioners working in organizations
with a health promoting mandate, such as public
health departments, community health centers and
regional health authorities. As such, they are
intended to assist Canadian practitioners in devel-
oping competency-based job descriptions, struc-
turing the content of training and continuing
education opportunities, and increasing under-
standing of the requisite skill set for the planning,
implementation and assessment of health promo-
tion interventions (15).
Features of health promotion practice in Canada
influenced the positioning of key health promotion
skills within broader domains of practice. While the
Consensus Statement identifies advocacy as a
primary domain of health promotion practice, the
proposed Canadian competencies cite advocacy as a
key competency area within the broader practice
domain of community mobilization and capacity
building. This placement reflects a commitment to
building capacity by advocating ‘with’ communities
as well as an acknowledgment of a working reality
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B. Hyndman
limiting the extent to which health promoters can
engage in direct advocacy within their organizations.
Another distinction concerns the importance of eval-
uation and monitoring skills as a prerequisite for
health promotion practice: while the Consensus
Statement cites evaluation as a primary domain area,
the proposed Canadian competencies position eval-
uation as a subset of the practice domain related to
planning. This was done to reinforce the importance
of the ‘continuous quality improvement’ cycle
linking the effective planning of health promotion
initiatives to evidence-informed practice.
One key area of debate, both in Canada and inter-
nationally, concerns the extent to which standards
and quality assurance mechanisms are required to
assess proficiency in the domains of core health
promotion competencies. The Galway Consensus
Statement recommends that each country or region
develop or adopt quality assurance mechanisms in
accordance with prevailing political, economic or
cultural contexts (1).
To date, Canadian health promoters have taken a
cautious stance on this issue. A 2006 discussion
document prepared by the Ontario Prevention
Clearinghouse concluded that the process required
for health promotion to become a formally accred-
ited and regulated profession would be rigorous,
time-consuming and potentially divisive (5). In
acknowledgment of this viewpoint, the proposed
Canadian competencies are not being promoted as
an initial step towards the mandatory accreditation
of health promoters; rather, they are meant to
inform and stimulate dialogue towards agreement
on a requisite skill set for health promotion practice
in Canada (15).
Moving forward
At present, the Canadian health promotion com-
petencies are still a work in progress. The proposed
competencies were initially presented at the annual
HPO conference in Toronto in May 2007. They
were subsequently shared with an international
audience at the 19th Annual International Union for
Health Promotion and Education Conference in
Vancouver in June 2007. Participants at both events
provided feedback that will be used to further refine
the competencies. Additional feedback was cap-
tured through an online survey sent to health
 Commentary
promoters across Canada in the summer of 2007.
HPO hopes to finalize the competencies by the end
of 2009.
The Canadian experience with health promotion
competency development illustrates the ways in
which health promotion practice is shaped by
broader social and political contexts. As is the case
with the Galway Consensus Statement, it is hoped
that the proposed Canadian competencies will
stimulate dialogue and an open exchange of ideas
that, over time, will foster broad agreement on the
parameters of effective health promotion practice.
Editor’s Note:
This article is one of a collection of manuscripts
related to “Toward International Collaboration on
Competencies and Accreditation in Health Promotion
and Health Education: the Galway Consensus
Conference,” held June 16-18, 2008, at the National
University of Ireland, Galway. The conference spon-
sors, the International Union for Health Promotion
and Education (IUHPE) and the Society for Public
Health Education (SOPHE), are pleased to provide
open access to all of the related manuscripts, half of
which are published in IUHPE’s Global Health
Promotion and half of which are published SOPHE’s
Health Education & Behavior. To read the entire col-
lection of articles, go to http://online.sagepub.com/
and search for the journal titles.
References
1. Allegrante JP, Barry MM, Airhihenbuwa CO, Auld
ME, Collins J, Lamarre MC, et al. Domains of core
competency, standards and quality assurance for
building global capacity in health promotion: The
Galway Consensus Conference Statement. Health
Education & Behavior; 2009; 36(3): 476–82.
2. Barry MM, Allegrante JP, Lamarre MC, Auld ME,
Taub A. The Galway Consensus Conference: interna-
tional collaboration on the development of core com-
petencies for health promotion and health education.
Global Health Promotion. 2009; 16 (2) 5–11.
Downloaded from ped.sagepub.com at PENNSYLVANIA STATE UNIV on February 26, 2014
55
3. Lalonde M. A new perspective on the health of
Canadians. Ottawa: Information Canada; 1974.
4. World Health Organization. Ottawa charter for
health promotion. Geneva: WHO; 1986.
5. Ontario Prevention Clearinghouse. Ontario health
promoters: gains of organizing/risks of professional-
izing. Commentary from the Ontario Prevention
Clearinghouse. Toronto: OPC; 2006.
6. Canadian Association of Teachers in Community
Health. Final report from the Symposium for
Teachers of Health Promotion and Community
Health (CATCH), 22 October 2000. Toronto:
CATCH; 2000.
7. Rush B. Report on the 2004–2005 Ontario Health
Promotion Resource System Provincial Needs
Assessment. Toronto: OHPRS; 2005.
8. Feltracco A, Wilkerson T. Health Promotion Ontario:
fulfilling the promise. Toronto: Health Promotion
Ontario; 2005.
9. Moloughney B. Pan-Canadian Public Health
Education Initiative: summary of three regional
workshops. Ottawa: Health Canada, Centre for
Surveillance, Coordination and Health Care Policy
Directorate; 2004.
10. Moloughney B. The development of a draft set of
public health workforce core competencies. Ottawa:
Federal/Provincial/Territorial Public Health Human
Resources Joint Task Group; 2004.
11. Public Health Agency of Canada. Core competencies
for public health in Canada. Ottawa: Public Health
Agency of Canada; 2007. http://www.phac-aspc.gc.
ca/core_competencies, accessed 12 December 2008.
12. Shilton T, Howat P, James R. Review of competencies
for Australian health promotion. Australian Health
Promotion Update. Oct.–Nov. 2003; 5.
13. McCracken H, Rance H. Developing competencies
for health promotion training in Aotearoa– New
Zealand. Promotion & Education. 2000; 7 (1): 40–3.
14. MHSc Health Promotion Program objectives. Dalla
Lana School of Public Health, University of Toronto.
http://www.phs.utoronto.ca/mhsc_health_promotion
.asp#Links, accessed 12 December 2008.
15. Hyndman B. Towards the development of competencies
for health promoters in Canada: a discussion paper.
Toronto: Health Promotion Ontario; 2007. http://hpo.
squarespace.com/storage/HP%20competenciespaper%
20Apr%2007.pdf, accessed 12 December, 2008.
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