Does reported health promotion activity neglect people with ill-health?

Considering health as an alternative to ill-health ignores the multidimensionality of both concepts and invites neglect of health promotion as a multidimensional activity in persons with known ill-health. Drawing on the Ottawa Charter and Mäori perspectives of health, we interpret (ill) health according to people's ability to function in their environment by developing physical, psychological, social and spiritual resources for living. We use this framework to test empirically our hypothesis that although the concept of health promotion has always included people with ill-health, the practice of health promotion has continued to neglect them. Our exploratory review of articles published during 1989-99 and indexed on three electronic databases suggests widespread omission of people with ill-health from research on interventions for health promotion. Of 881 citations, approximately three-quarters included people without ill-health in any dimension. This finding could reflect a failure to include these people in health promotion, to describe activity to improve their health as health promotion, or both. Supporting the latter interpretation is uncertainty over the meaning of health, and the targeting of health promotion at groups at high risk of ill-health and 'all' persons. We need therefore to enable health promotion activity to include ill people explicitly.