Health Promotion International: four decades of impact

From the first issue in May 1986, Health Promotion International (HPI) (Health Promotion until 1990) pursued an agenda of advocacy and action for healthy public policy and health equity. At the time of the journal’s launch, public health had become oriented toward medicalized and behavioural approaches, with individualized health education the dominant intervention. In HPI’s first editorial, then Director General of the World Health Organization Dr Halfdan Mahler argued that this approach created significant barriers to achieving ‘Health for All’: Public health needs to move into positive and active advocacy for health. It needs to enable individuals and communities to develop their health potential. (Mahler 1986,1) Embracing the concepts and principles of health promotion developed in the early 1980s (World Health Organization 1986a) and later articulated in the Ottawa Charter (World Health Organization 1986b), HPI set out to challenge these dominant narrow approaches to public health. The journal located health promotion at the intersection of politics, society, and public health practice and highlighted the role that environments, structures, and systems played in shaping health and equity (Kickbusch 1986). HPI positioned itself as part of the ‘new public health’ (Baum 1988) which emphasized that a primary focus on individual and behavioural interventions would not create significant change (Mahler 1986, Kickbusch 2003, Catford 2011). Landmark contributions to the journal established the conceptual foundations of health promotion and informed a more comprehensive, systems-oriented approach to health and well-being (Antonovsky 1996, Nutbeam 1998). Early publications addressed the value of the settings where people lived, worked, and played (Catford 2004), including healthy cities (Kickbusch 1989), workplaces (Chu et al. 2000), and schools (Nutbeam 1992). There was also a clear focus on equitable health outcomes (Macdonald 1994), healthy public policies (Milio 1987), evidence-based public communication strategies (Lefebvre 1993), and health literacy (Kickbusch 1997, Nutbeam 2000). Importantly, the journal committed to publishing ‘the true stories, not just the myths of success’ (Kickbusch 1986,4). From its earliest years, HPI also aimed to provide a home for courageous approaches to health promotion that questioned dominant models and ideologies and demanded public accountability for decisions by those in power (Kickbusch 1986). This included recognizing that health outcomes are influenced by powerful commercial and political forces (now commonly known as the commercial and political determinants of health): In the mid-1980s we understood health promotion to be a political and social movement—yet we totally underestimated globalized corporate power combined with its global marketing onslaught and its transnational influence on political decision-making. (Kickbusch 2012,428) Over four decades, the journal’s editorial teams have advanced a political vision of health promotion. This has included encouraging bold and brave scholarship which is ‘not afraid of challenges and controversies’ (Catford and Kickbusch 1990,1). Editorials have not only played a role in setting agendas and shaping debates but have also encouraged action (Thomas et al. 2024). Examples have included confronting the ‘human vandalism’ causing the degradation of planetary health (Catford 1991,239); creating a norm of separation between harmful industries and public health to safeguard research in the interest of the public good rather than commercial entities (Catford 2012, Thomas et al. 2024, Thomas et al. 2025); ensuring that health promotion embeds Indigenous epistemologies, Indigenous Data Sovereignty, and intergenerational leadership (Maddox et al. 2025b); and fostering healthier information environments to ensure that the ‘digital age expands rather than erodes opportunities for equitable and thriving communities’ (Purnat et al. 2025,2). There has been a sustained effort to amplify voices and methodologies often excluded from mainstream public health research and debate. HPI has welcomed diverse qualitative (Scarinci et al. 2007, Jamieson et al. 2008, Arnot et al. 2024, Braun and Clarke 2024, Ferdinands et al. 2025); participatory (Wang et al. 1998, Minkler et al. 2006, Flicker and Nixon 2015, Ward et al. 2016, Madsen et al. 2025, Mathews et al. 2025); and critical approaches (Gabrielsen 1993, Kersey et al. 2023, Van Schalkwyk et al. 2024). It has championed scholarship from Early Career Researchers (Daube 2023, Thomas and Daube 2023) and created space for community perspectives that might otherwise remain unheard (Soraghan et al. 2023, Arnot et al. 2024, Guerra et al. 2024, Mccarthy et al. 2024, Frazer et al. 2025). The growing presence of HPI articles by First Nations (Reweti 2023, Maddox et al. 2025a, 2025b, Mashford-Pringle et al. 2025, McBeath et al. 2025, Henry et al. 2026) and low- and middle-income country authors (Adhikari et al. 2024, Bandara et al. 2024, Ferretti et al. 2024, Njiro et al. 2024, Dableh et al. 2025, Schuele et al. 2025) is encouraging. We will continue to support critical debate and discussion which recognizes that health promotion challenges are inseparable from the colonial legacies that perpetuate health inequity (Porto 2019, Maddox et al. 2025a, Udenigwe et al. 2026), including the ‘dominance of certain powerful actors and vested interests over the overall complex of global health structures, systems, policies and practices’ (Kumar et al. 2024,1). Digital environments have been described as a ‘high stakes balancing act’ for public health (Okan and Marchandise 2025). They offer opportunities to strengthen and scale health communication, but also allow for misinformation and disinformation to undermine trust in evidence, expertise, and public institutions (Wirtz et al. 2023, Denniss and Lindberg 2025, Holly et al. 2025, Purnat et al. 2026). Individuals now learn about health in places where ‘new information flows constantly, and the pace of that stream shapes what feels trustworthy’ (Purnat et al. 2026,1). Health promotion must strengthen approaches which involve communities in co-creating messages, identifying relevant channels for connection and dissemination, and enabling people to critically appraise and navigate an increasingly complex and polarized information ecosystem (Taba et al. 2023, Cornell et al. 2025, Smith et al. 2025). However, these approaches do not lessen the need to strengthen regulation of Big Tech and the commercial actors that benefit from confusion, outrage and doubt, and profit from these platforms at the expense of health (Pitt et al. 2024a, Gram et al. 2025, Hardie et al. 2025, Holly et al. 2025, Purnat et al. 2025). In 1995, the journal highlighted that ‘much remains to be done to strengthen the commitment to women's health in policy’ (Kickbusch 1995,79). Gender continues to play a role in persistant structural, health and economic inequalities (Hawkes et al. 2020), and research addressing the health and social realities of women and girls remains chronically underfunded (Womersley et al. 2025). Neoliberal policy regimes, conservative ideologies, colonialism, and racism intersect with gender (Hawkes et al. 2025), shaping and constraining health opportunities and life outcomes for women and girls (Perri et al. 2022, Kersey et al. 2023, Udenigwe et al. 2026). Subsequently, women and girls face threats to their health, social, and human rights that are political and preventable. The erosion of sexual and reproductive rights, gender-based violence, economic insecurity, and disproportionate exposure to environmental harms and commercial exploitation reflect political failures to create supportive environments and healthy public policy for women and girls (Keleher 2004, Perri et al. 2022, McCarthy et al. 2023, Lunnay and Foley 2024). HPI will continue to reaffirm that protecting and promoting the health of women and girls requires working with them to understand their lived experiences, listen to their concerns, and involve them in decision making (Haraldsson et al. 2010, Craddock 2022, Boadu et al. 2025, Ferdinands et al. 2025, McCarthy et al. 2026). We will advocate that the health and well-being of women and girls must be a priority for health promotion agencies, as well as for collective action to create structural change—transforming services and policies, enabling greater autonomy and control, creating strengths based approaches, and confronting the power structures that shape their health and well-being. The silencing of critical voices by those in power—whether through political or professional pressure, institutional constraint, or by narrowing what is considered legitimate evidence—weakens the foundations of health promotion. HPI has a responsibility to provide space for independent, critical scholarship. Protecting academic freedom, integrity, and the right to question those in positions of authority and power (including within the academic and health systems in which we work) is not ancillary to public health, but central to its purpose. This includes shining a light on silencing and intimidation tactics which can have a chilling effect on researchers and their research and standing with colleagues whose work challenges dominant narratives and power structures (Evans-Reeves et al. 2024, Pitt et al. 2024b). As current and former Editors and Chairs of the Board of HPI, we recognize that our choices shape agendas, define what counts as legitimate evidence, and determine whose knowledge and experiences are represented. This responsibility is even greater when public health is marginalized, contested, or constrained by political, commercial, or institutional interests. Health promotion is strengthened through critical inquiry which identifies how power, policy, and ideologies shape health outcomes. Through our decisions at HPI, we can either reinforce problematic paradigms and ideologies or create space for inquiry that resists silencing and contributes to social change. At the outset of the journal, access to health information was recognized as fundamental for people to ‘take control over their health’ and to enable ‘effective and concrete public participation’ (World Health Organization 1986a). This is a vital sign of quality health promotion (Catford 1993) and is being sorely tested in today’s turbulent, divisive, and threatening world. The journal’s recent move to fully open access reaffirms HPI’s foundational commitment to knowledge as a public good, enabling wider participation, scrutiny, and action in health promotion. Finally, we extend our deepest thanks to the authors, reviewers, associate editors, editorial board members, and readers who have shaped HPI over the past 40 years. As HPI enters its fifth decade, we invite you to stand with us in advancing scholarship that confronts structural injustice, shifts power, and advances health equity through collective action for human and planetary health. S.T. is Editor in Chief for HPI. J.C. is former Editor in Chief for HPI. M.D. is Chair of the Boards of HPI. I.K. is the founder and Chair Emerita of HPI. J.F. is Deputy Editor in Chief of HPI. O.O., K.D., C.W., S.K., B.L., K.F., A.H., and B.M. are Associate Editors of HPI. None declared. Not applicable. No data were used in the preparation of this manuscript.