Revitalizing the setting approach - supersettings for sustainable impact in community health promotion

Abstract

Background: The concept of health promotion rests on aspirations aiming at enabling people to increase control over and improve their health. Health promotion action is facilitated in settings such as schools, homes and work places. As a contribution to the promotion of healthy lifestyles, we have further developed the setting approach in an effort to harmonise it with contemporary realities (and complexities) of health promotion and public health action. The paper introduces a modified concept, the supersetting approach, which builds on the optimised use of diverse and valuable resources embedded in local community settings and on the strengths of social interaction and local ownership as drivers of change processes. Interventions based on a supersetting approach are first and foremost characterised by being integrated, but also participatory, empowering, context-sensitive and knowledge-based. Based on a presentation of "Health and Local Community", a supersetting initiative addressing the prevention of lifestyle diseases in a Danish municipality, the paper discusses the potentials and challenges of supporting local community interventions using the supersetting approach.

Discussion: The supersetting approach is a further development of the setting approach in which the significance of integrated and coordinated actions together with a participatory approach are emphasised and important principles are specified, all of which contribute to the attainment of synergistic effects and sustainable impact of supersetting initiatives. The supersetting approach is an ecological approach, which places the individual in a social, environmental and cultural context, and calls for a holistic perspective to change potentials and developmental processes with a starting point in the circumstances of people's everyday life. The supersetting approach argues for optimised effectiveness of health promotion action through integrated efforts and long-lasting partnerships involving a diverse range of actors in public institutions, private enterprises, non-governmental organisations and civil society.

Summary: The supersetting approach is a relevant and useful conceptual framework for developing intervention-based initiatives for sustainable impact in community health promotion. It strives to attain synergistic effects from activities that are carried out in multiple settings in a coordinated manner. The supersetting approach is based on ecological and whole-systems thinking, and stipulates important principles and values of integration, participation, empowerment, context and knowledge-based development.

Figure 1

The supersetting approach: Applying a set of principles (listed on the left hand side) and involving relevant partners (listed on the right hand side) within the supersetting (centred circle) as the basis for developing sustainable approaches to optimised health, wellbeing and life quality. The supersetting is represented as multiple settings within a local community (the outer ring). Activities within individual settings are coordinated and integrated (symbolised by the lines) with activities in other settings as the basis for achieving synergistic effects.

Figure 2

The conceptual framework of the Danish supersetting initiative “Health and Local Community” carried out in the municipality of Bornholm. Arrows represent expected cause-effect relationships. Actions are shown on the left hand-side of the figure, outputs are shown in the middle and outcomes and effects are shown on the right hand-side.

Figure 3

The organisation structure of the Danish supersetting initiative “Health and Local Community” carried out in the municipality of Bornholm.