The three basic strategies for health promotion are advocate, enable, and mediate. These were established in the 1986 Ottawa Charter for Health Promotion, a foundational document created by the World Health Organization that still shapes public health practice worldwide. Each strategy targets a different layer of what it takes to improve health at a population level: making the case for change, giving people the tools to act, and coordinating across sectors that don’t naturally work together.
Advocacy: Making Health a Priority
Advocacy is the strategy aimed at shaping the conditions that affect health, particularly through political, economic, and social channels. The core idea is straightforward: health doesn’t improve just because individuals make better choices. It improves when policies, funding, and public attention create environments where healthier choices are realistic in the first place. Advocacy pushes health onto the agenda of decision-makers who control those levers.
In practice, advocacy takes several forms. One of the most effective is translating health data into economic arguments, since policymakers often respond more readily to cost projections than to disease statistics. Advocates also use coalition-building, bringing together government officials, civil society organizations, and community groups to amplify their message. Strategic framing matters too. For example, campaigns to improve access to medicines have gained traction by framing the issue as a human right rather than a budget line item.
Legal strategies play an important role as well. Embedding the right to health in domestic law, or using existing legal frameworks to challenge harmful trade policies, gives advocates enforceable tools rather than just persuasive ones. Successful advocates also practice what researchers call “shifting forums,” moving their efforts from one institutional setting to another when progress stalls. If a trade negotiation isn’t receptive, advocates might take their case to a public health body or a legislative committee instead. The common thread across all these tactics is that advocacy treats health as something that must be actively fought for in arenas where it competes with other priorities.
Enabling: Building Capacity for Health
The enabling strategy focuses on equity. Its goal is to reduce gaps in health outcomes by ensuring that all people have access to the information, skills, and resources they need to achieve their fullest health potential. Where advocacy targets systems and policies, enabling targets people and communities directly.
This goes well beyond handing out pamphlets. Enabling means building what public health professionals call “community capacity,” the ability of community members to identify problems, organize responses, and sustain change over time. That includes practical skill-building: communication strategies, planning, grant writing, and leadership development so that community members can effectively represent their own interests and shape the health interventions that affect them.
Community organizing is a central piece of this strategy. Local outreach brings together people with shared concerns and gives voice to those who are typically excluded from decision-making. This serves two purposes. It increases the power of marginalized groups, and it gives health planners direct insight into which interventions actually matter to the people they’re designed to help. A program designed without community input might target the wrong problem entirely, while one shaped by the community is more likely to address real barriers like transportation, language, or cultural norms.
The Ottawa Charter is explicit that enabling requires a “secure foundation in a supportive environment.” That means access to clean water, safe housing, and adequate nutrition aren’t just nice additions to a health program. They’re prerequisites. Without them, individual skill-building has limited reach.
Mediation: Coordinating Across Sectors
Mediation recognizes that health cannot be ensured by the health sector alone. Improving population health requires coordinated action among governments, industries, nongovernmental organizations, local authorities, media, and community groups. These sectors often have different priorities, different languages, and different timelines. Mediation is the strategy that brings them to the same table.
A real-world example illustrates how this works. In southern France, a program called the Open Arena was designed to improve community health through collaborative partnerships among local government, academic institutions, hospitals, civil society organizations, and community representatives. When addressing childhood obesity in disadvantaged neighborhoods, the program brought together the city government, regional health agencies, the education ministry, university researchers, and local organizations. Each contributed something different: researchers brought data and expertise, community representatives provided feedback on the social and cultural context, and municipal policymakers discussed financing alongside competing priorities. The result was a comprehensive neighborhood-level approach to healthy lifestyles that no single sector could have designed or delivered alone.
The same model was applied to elderly care, where the complexity of aging requires integrated health and social services. By coordinating across health networks, government departments, hospitals, and civil society groups, the program created a dedicated center combining health and social support to help older adults remain in their homes. In another case involving potential cancer risks near a waste incinerator, the collaboration included the regional health agency, a university hospital, local government, and neighborhood representatives working together on surveillance and data collection.
What makes mediation distinct from simple cooperation is that it actively breaks down administrative barriers between institutions and fosters collaboration among professionals who aren’t used to working together. The diversity of stakeholders leads to richer knowledge sharing and solutions that no single sector would have reached independently.
How the Three Strategies Work Together
These three strategies are not separate programs you choose between. They’re designed to operate simultaneously, each reinforcing the others. Advocacy creates the political will and funding for health initiatives. Enabling ensures communities have the capacity to participate in and benefit from those initiatives. Mediation coordinates the many sectors whose cooperation is necessary for any large-scale health improvement.
Consider a campaign to reduce smoking rates. Advocacy pushes for tobacco taxes, advertising restrictions, and smoke-free laws. Enabling provides cessation programs, educational resources, and support groups, with particular attention to communities where smoking rates are highest. Mediation brings together health departments, schools, employers, media outlets, and community organizations to create a consistent environment that supports quitting.
One honest caveat: measuring the combined impact of all three strategies remains difficult. A review of workplace health promotion programs found that only about 30% of studies used rigorous evaluation methods, and very few assessed structure, process, and outcomes together. The strategies are well-established in theory and widely applied in practice, but comprehensive evidence linking their combined use to specific percentage improvements in health outcomes is still limited. That doesn’t mean they don’t work. It means health promotion operates across so many variables that isolating the contribution of any single strategy is inherently complex.
The Ottawa Charter also outlines five action areas where these strategies are applied: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services. The three strategies of advocate, enable, and mediate are the “how” that drives action across all five of those areas.