The contribution of health promotion to meeting health targets: questions of measurement, attribution and responsibility

Target-setting for health is now an accepted part of health policy and has been embodied in the recent health policy documents of many nations. All include a major role for health promotion. However, if health targets are to be reached, except by good fortune, progress towards them needs to be monitored ('measurement'), the reasons for movement towards and away from them need to be understood ('attribution') and action taken by those responsible if monitoring implies they are likely to be missed ('responsibility'). This paper asks whether these important conditions hold for target-setting in relation to health promotion. Health promotion monitoring frameworks certainly exist, but do we know enough about attribution or reponsibility to take any necessary corrective action? Do we have the information and tools needed to reach the plethora of health targets set out in various World Health Organization (WHO) documents and their national counterparts? This paper concludes 'no, not at the present time'. However, there Is cause for optimism-in our view, the attribution problem in health promotion at the macro-level can certainly be tackled. A significant proportion of this paper if therefore devoted to discussing-with examples-some of the computer modelling and statistical techniques that, although relatively unexplored to date, offer great potential for attributing the contribution of health promotion to health targets. The paper focuses on the UK experience to illustrate the general points raised in these debates. Assigning responsibility for meeting health promotion and health targets is, however, likely to remain problematical.