[Health promotion--as a change of social systems]

Most prevention concepts are principally based on the goal to change people's behavior, yet consider structural changes as important. Often measures concerning structural changes are planned and realized over people's heads. The concept of health promotion according to the Ottawa Charta postulates the planning and realization of structural changes with the participation of the persons affected by it. Methodical hints and concrete examples of such participative changes of social systems (communities, districts, schools, hospitals, firms etc.) are rare in literature. This article outlines how, with the model of the "Public-Health-Action Cycle", changes in social systems can be participatively planned and realized, with the aim of developing or maintaining healthy social systems. Social systems can only be changed together with the people affected (participation), if these systems are comprehensible. In this way, participative structural changes become a practicable goal in health promotion.