Health promotion and health protection is an Australia's health topic

A fundamental aim of any health system is to prevent disease, intervene early, and reduce ill health so that people remain as healthy as possible for as long as possible. Health promotion is a broad term that has as its foundation the process of enabling people to have control over and improve their health (WHO 1986). Health promotion activities seek to enhance the social, educational, environmental, political and economic conditions needed to promote health, while recognising the wider determinants of health, for example social, environmental, commercial and systemic (see What are determinants of health?). Achieving equity in health is a key aspect of health promotion, that is, reducing the differences in health status and ensuring equal opportunities and resources to all people to ensure optimal health (WHO 1986).

Health promotion activities such as education, social marketing, legislation and regulation, are an important part of early intervention and disease prevention and can be used to help build social and physical environments that support healthy behaviours.

Health protection refers to a subset of health promotion and is concerned with protecting individuals, groups and populations through preventing and controlling health threats related to infectious diseases, the environment, and natural and ‘human-made disasters’ (Department of Health and Aged Care 2023a; NSW Ministry of Health 2021). Health protection examples include monitoring and enforcing compliance with state and territory food acts to ensure the safe sale of food, and statements on preparing for the winter influenza season.

Priority populations

There are a number of different groups across society who experience social inequalities and disadvantage resulting in health inequity – the unfair and avoidable differences in health status (WHO 2018). An important part of health promotion and health protection is to assess the needs of these groups and tailor programs, activities and policies accordingly to address these differences in health risk factors.

The National Preventive Health Strategy 2021–2030 refers to these groups of people, as ‘priority populations’ which include, but are not limited to:

What is the role of government?

All levels of government play an important role in overseeing health promotion and health protection, which can vary depending on the strategy or situation. For example, in health promotion, the Australian Government can impose fiscal measures such as taxes on items like tobacco, e-cigarettes and alcohol to deter people from buying them – as part of a broader strategy (see Tobacco and e-cigarette control). Launched in late 2021, the National Preventive Health Strategy 2021–2030, provides the long-term approach to prevention in Australia. 

States and territories have their own public health legislation, which aim to protect, promote and improve the health and wellbeing of the public in that jurisdiction. State and territory governments are also responsible for delivering preventive health services such as breast cancer screening, school-based immunisation programs and implementing settings-based measures for example, smoke-free laws.

Local governments have responsibility for a range of local public health and environmental issues including community services and waste disposal. Being closely connected to their community, local governments implement policies and programs that serve to improve health and reduce health inequities, but may respond differently depending on resources and local needs (Schultz et al. 2023). They are also responsible for planning, building and designing new suburbs in their local area, which can harness urban design principles to promote opportunities for physical and mental wellbeing, such as through the provision of bike paths, or publicly available green space. For more information, see Built environment and health.

What role do non-government organisations play?

Health promotion activities are also undertaken outside of the government sector. Cancer Council Australia, for example, plays a key role in preventing cancer through their health promotion activities, particularly around sun safety and anti-smoking campaigns. Nutrition Australia is a non-government organisation that promotes healthy eating through their information and education services.

Health promotion practitioners may work on a range of activities including health education, community development and community engagement processes, advocacy and lobbying strategies, and social marketing. The Australian Health Promotion Association is Australia’s professional association specifically for people interested or involved in the practice, policy, research and study of health promotion. 

Current health promotion and health protection activities

There are key health promotion activities undertaken in Australia to address some of the main contributors to disease burden: tobacco smoking and e-cigarette use and overweight and obesity. Disease burden is the quantified impact of living with and dying prematurely from a disease or injury. For more information, see Burden of disease.

Health promotion and protection activities targeting the reduction of disease burden are at varying stages of development. Notable successes include the reduction in tobacco smoking over recent decades, while a range of strategies and activities are in progress to tackle the increasing rates in overweight and obesity, and e-cigarette use.

Health literacy (see glossary) relates to how people access, understand and use health information in ways that benefit their health. Health literacy is an important factor associated with other determinants of health (see What are determinants of health?) and is key to disease prevention and control, as people with low health literacy are at higher risk of worse health outcomes and poorer health behaviours (AIHW 2024c; Coughlin et al. 2020).

Tobacco and e-cigarette control

Tobacco use is the leading risk factor contributing to fatal disease burden and deaths in Australia, with almost 20,500 attributable deaths (13% of all deaths) in 2018 (AIHW 2021). Smoking remains a major risk factor in contributing to health inequalities experienced by certain population groups. A study estimating the smoking attributable mortality for First Nations people found that smoking causes half of deaths in older First Nations populations (Thurber et al. 2021). For more information, see First Nations people’s use of alcohol, tobacco, e-cigarettes and other drugs.

The National Preventive Health Strategy 2021–2030 sets out targets to achieve a national daily smoking prevalence from 11% to less than 10% by 2025 and 5% or less for adults (aged 18 years and over) by 2030. There is also a target to reduce the daily smoking rate among First Nations people aged 15 and over to 27% or less by 2030. Progress against the National Preventive Health Strategy is measured using data from the National Health Survey and the National Aboriginal and Torres Strait Islander Health Survey; the latter found the daily smoking rate among First Nations people aged 15 and over is declining from 41% in 2012–13 to 37% in 2018–19 (ABS 2019).

The tobacco control measures of all Australian governments and public health organisations have been key to Australia’s success in tobacco control. The latest data from the National Health Survey 2022 estimates that 11% of Australians aged 18 and over are daily smokers, which represents a steady decline since 1995 where 24% of adults were daily smokers (ABS 2023c). For more information on Australia’s smoking and e-cigarette use rates, see Tobacco and e-cigarettes.

Reducing the use of tobacco and e-cigarettes is a key priority of the Australian Government with the 2023–24 Federal Budget including $737 million to fund measures to protect Australians against the harm caused by tobacco and e-cigarette products (Department of Health and Aged Care 2023d). In recent decades, Australia has progressively implemented a suite of tobacco control measures including (Figure 1):

  • staged tobacco excise increases
  • smoke-free laws and policies
  • social marketing campaigns
  • measures to minimise the illicit tobacco trade
  • plain packaging of tobacco products
  • labelling tobacco products with graphic health warnings
  • prohibiting tobacco advertising, promotion and sponsorship
  • providing support for people who smoke to quit (Department of Health and Aged Care 2024).

Figure 1: Daily smokers aged 14 and over and key tobacco control measures in Australia, 1990 to 2022–2023 (per cent)

Figure 1: This figure shows the daily smoking proportion for people aged 14 and over and key national tobacco policy implementation points (such as tobacco tax increases and health campaigns) over time. The green and blue shaded regions represent the respective legislation introduced at different time points across Australian states and territories within that period. The proportion of people who smoke daily declined from 24% in 1991 to 8% in 2022–23.

Visualisation not available for printing

These measures also form part of Australia’s National Tobacco Strategy 2023–2030, which provides a national framework for all Australian governments and non-government organisations to work together to improve the health of Australians by reducing tobacco use and its associated harms. These types of tobacco control measures can also be considered as health protection.

Despite Australia’s success in reducing the prevalence of tobacco use, significant challenges remain. Of particular concern is the continued and increased investment by the tobacco industry in e-cigarettes and a range of novel and emerging products (Mathers et al. 2019). Normalisation of e-cigarette marketing and use is undermining population health and has the potential to disrupt the significant achievements Australia has made in tobacco control to date (Department of Health and Aged Care 2023b).

Novel and emerging products, such as e-cigarettes (also known as vapes), present new challenges to prevent and reduce nicotine addictions (Department of Health 2021).

The liquids used in e-cigarettes may contain a range of toxic chemicals including those that add flavour, and sometimes contain nicotine even if labelled ‘nicotine free’. Hazardous substances have been found in e-cigarette liquids and in the aerosol produced by e-cigarettes, including known cancer-causing agents. While the long-term effects are currently unknown, the short-term effects can include inhalation toxicity (including seizures), nicotine dependence, increased heart rate and blood pressure, e-cigarette associated lung injury, cough, throat irritation and nausea (Banks et al. 2023). For more information on Australia’s smoking and e-cigarette use rates, see Tobacco and e-cigarettes.

Rates of e-cigarette use have increased rapidly in recent years, particularly among children and young people. The 2022–2023 National Drug Strategy Household Survey (NDSHS) shows that lifetime use of e-cigarettes among people aged 14 and over, increased significantly from 8.8% in 2016 to 19.8% in 2022–2023, with over half (54%) reporting that the last e-cigarette they used contained nicotine (AIHW 2024b).

Between 2016 and 2022–2023, there was a significant increase in the proportion of non-smokers who had tried e-cigarettes in their lifetime (from 4.9% to 16.4%) (AIHW 2024b).

In 2022–23, use of e-cigarettes was even higher among young people:

  • Around half (49%) of people aged 18 to 24 had used an e-cigarette in their life, up from 26% in 2019.
  • For people aged 14 to 17, lifetime use of e-cigarettes nearly tripled to 28%, up from 9.6% in 2019 (AIHW 2024b).

The trends for current use of e-cigarettes were similar; people aged 18 to 24 were the most likely to currently use e-cigarettes in 2022–2023 (21%), up from 5.3% in 2019 (AIHW 2024b).

In partnership with the states and territories, the Commonwealth Government is taking action to reduce smoking and vaping rates through stronger legislation, enforcement, education and support. From 1 January 2024, a ban on the importation of disposable single use vapes commenced. From 1 March 2024, the following regulations commenced:

  • cessation of the personal importation of vapes 
  • a ban on the importation of non-therapeutic vapes 
  • a requirement for therapeutic vape importers and manufacturers to notify the Therapeutic Goods Administration (TGA) of their product’s compliance with the relevant product standards 
  • a requirement for importers to obtain a licence and permit from the Government’s Office of Drug Control before the products are imported (Department of Health and Aged Care 2023c).

Further reforms are being introduced to prohibit the import of non-prescription vapes, and to prevent domestic manufacture, advertisement, supply and commercial possession of non-therapeutic and disposable single use vapes. During 2024, a range of reforms are being implemented to strengthen the product standards for therapeutic vapes, including the limit of flavours, reducing permissible nicotine concentrations, requiring pharmaceutical-like packaging and banning single use disposable vapes. Further information on the reforms and other health promotion activities to increase e-cigarette and smoking cessation support can be found at Vaping hub | Therapeutic Goods Administration (TGA).

Overweight and obesity

Overweight and obesity continues to present a public health challenge in Australia. Excess weight, especially obesity, is a major risk factor for cardiovascular disease, type 2 diabetes, some musculoskeletal conditions and some cancers (Forouzanfar et al. 2015). In 2022, 66% of adults aged 18 and over, and 28% of children and adolescents aged 5 to 17 were living with overweight or obesity (ABS 2023b). The most recent data available (2018) show that overweight and obesity is a risk factor that contributed the most to non-fatal disease burden in both males and females (7.4%) (AIHW 2021).

The National Obesity Strategy 2022–2032 offers a framework for action to prevent, reduce, and treat, overweight and obesity in Australia. Two key aims of the strategy are:

  • creating supportive, sustainable and healthy environments
  • empowering people to stay healthy (Department of Health 2022). 

The first of these focuses on changing the systems, environments and commercial determinants that affect Australians’ opportunities to live active and healthy lives. Strategies include:

  • creating a healthier food system through funding innovation
  • making healthy food and drinks more accessible through food reformulation (see Partnership Reformulation Program)
  • improving the nutrition information provided on food products (see Health Star Rating system) 
  • reducing exposure to unhealthy food and beverage marketing and sponsorship
  • creating safe community spaces to encourage physical activity.

Also recognised is the important role of schools through the curriculum and wider school environment. 

Strategies to empower individuals include communication activities to promote healthy eating and physical activity, and supporting local communities and organisations to develop and lead their own healthy eating and physical activity initiatives.

The National Obesity Strategy 2022–2032 and the National Preventive Health Strategy 2021–2030 share two ambitious goals:

  • Halt the rise and reverse the trend in the prevalence of obesity in adults by 2030 – after adjusting for age, the proportion of adults aged 18 and over living with obesity has remained stable at 31% from 2017–18 to 2022 (ABS 2023a).
  • Reduce overweight and obesity in children and adolescents aged 2–17 years by at least 5 percentage points by 2030 – the proportions of children and adolescents living with overweight and obesity have not changed significantly from 2017–18 (25%) to 2022 (26%) (ABS 2018, 2023d; Department of Health 2021, 2022).

Current progress against these targets has shown a stable trend but further monitoring is required to determine whether Australia will meet these targets by 2030. 

For more information, see Overweight and obesity.

Health promotion and health protection success stories

Australia has a long history of health promotion. Memorable campaigns such as ‘Slip Slop Slap’, ‘Life. Be in It’ and ‘Every cigarette is doing you damage’ are examples of population-targeted health promotion (AIHW 2018). The compulsory wearing of seatbelts in motor vehicles, random breath testing and 50 km/h residential street limits have been part of a more comprehensive road safety strategy, which uses both health promotion and health protection measures. Road deaths have reduced from 30 per 100,000 population in 1970 to 4.6 per 100,000 in 2022 (BITRE 2010, 2023).

There have been other notable successes. Australia’s response to Human Immunodeficiency Virus (HIV) is also an example of effective health promotion (Smith et al. 2016). Since the 1980s, health promotion and prevention principles have been integral to Australia’s national HIV strategies, such as partnerships between government and non-government organisations, clinicians, researchers and political parties, and participation from affected communities (Smith et al. 2016). This partnership approach has helped Australia achieve a relatively low HIV prevalence by international standards (Brown et al. 2014). In 2022, the estimated prevalence of HIV in Australia remained low and stable at 0.14% since 2017 (Kirby Institute 2018, 2023).

Mandatory folic acid fortification of flour for making bread was introduced in Australia in 2009 to help prevent neural tube defects (serious birth defects). Following this initiative, the rate of neural tube defects to 2011 fell by 14.4%, from 10.2 to 8.7 per 10,000 conceptions that resulted in a birth (AIHW 2016). The decrease was largest for teenagers (54.8% reduction) and First Nations women (74.2% reduction). The reduction in neural tube defects in the First Nations population is of particular note given that previous strategies to increase folic acid intake and reduce neural tube defects in this population were limited in success (D’Antoine and Bower 2019).

Where do I go for more information?

For more information on health promotion, see: