The Red Lotus Health Promotion Model: a new model for ...

Articles

The Red Lotus Health Promotion Model: a new model for
holistic, ecological, salutogenic health promotion practice

Jane Gregg and Lily O’Hara

Introduction ways to practice health promotion, the authors could find no
evidence of existing health promotion models that explicitly
Health promotion models commonly used in modern health use values and principles in a systematic way. Many of the values
promotion practice provide guidance on the stages of health and principles purported to be central to the science of health
promotion activity from needs assessment through to promotion practice are therefore limited to rhetoric. A key
evaluation.1-4 Although many health promotion models used challenge is the overt use and subsequent realisation of values
to design, implement and evaluate health promotion programs and principles across the phases of a health promotion process.
place an emphasis on principles such as empowerment and
participation, they do not overtly focus on ways to put the values In this paper we describe a new holistic, ecological, salutogenic
and principles into action. There is little guidance within these model of health promotion. It is called the Red Lotus Health
models that would assist the practitioner to put the broad Promotion Model. The key feature of the Red Lotus Health
principles into practice. For example, well-used models such as Promotion Model is the explicit application of a values and
the Hawe, Degeling and Hall Needs Assessment and Planning principles system to all aspects of modern health promotion
Model,1 PRECEDE/PROCEED,2 and the Program Management including determining the health paradigm, needs assessment,
Guidelines from New South Wales Health3 are more technical planning, implementation and evaluation.
in orientation and include useful descriptions of what to actually
do, rather than the values and principles that underpin action. Research process

Despite the plethora of literature that describes the range of Grounded theory methodology was used to guide this
principles thought to underpin health promotion4-12 and various interpretive research.13-15 Document analysis was the method

Abstract

Issue addressed: There is a need for a system of values and principles consistent with modern health promotion
that enables practitioners to use these values and principles to understand health and in their needs assessment,
planning, implementation and evaluation practice.

Method: Grounded theory, document analysis and the authors’ own practice experience were used to
systematically collect and analyse data from key health promotion literature and to develop the Red Lotus Health
Promotion Model.

Results: The Red Lotus Health Promotion Model is a new model for holistic, ecological, salutogenic health
promotion practice. It is distinct from other health promotion models in that it incorporates a system of values
and principles that is applied across the phases of health promotion, including determining the health paradigm,
needs assessment, planning, implementation and evaluation.

Conclusion: The Red Lotus Health Promotion Model enables practitioners to proactively and purposefully put into
action a connected system of values and principles across the phases of a health promotion process.

Key words: Red Lotus Health Promotion Model, health promotion models, values and principles, holistic,
ecological, salutogenic.

Health Promotion Journal of Australia 2007;18:12-19

So what?

The Red Lotus Health Promotion Model fills a gap in the suite of health promotion models available to
practitioners. It supports practitioners in their efforts to enhance the quality of modern health promotion practice.

12 Health Promotion Journal of Australia 2007 : 18 (1)

Article The Red Lotus Health Promotion Model

used to systematically collect and analyse data from key health reductionist or positivist science where understanding the whole
promotion literature.5,16 This involved undertaking a four-stage is derived from understanding each individual part.18
process: identification of relevant documents; collection of data; Salutogenic health promotion refers to the creation of health
data analysis; and interpretation of findings.16 A five-step data for a sustainable future and places emphasis on factors that
analysis process involved: familiarisation with the data; create and support good health, well-being, happiness and
identification of a thematic framework; application of the meaning in life through the processes of needs assessment,
thematic framework to the data via thematic referencing; planning, implementation and evaluation.18,21,22 This is distinct
rearranging data from the original context to the appropriate from conventional health promotion, which focuses on disease
thematic reference; and reviewing themes for connection and prevention and the behavioural risk factors for disease.5,18 The
patterns and seeking explanations for these.5 In this research next section of the paper describes the qualities of the Red
process, the authors also drew on their own extensive experience Lotus plant, followed by a description of their structural
as health promotion practitioners and academics. representation in the Red Lotus Health Promotion Model.

Research output Red Lotus plant

The document analysis process produced a model of health The Red Lotus plant holds great significance for many societies
promotion that is holistic, ecological and salutogenic, which is and is found in Russia, the Middle East, Asia, India, Sri Lanka,
represented graphically by the Red Lotus plant (Nelumbo and northern Australia.23-27 The perennial aquatic herb is highly
nucifera).17 The Red Lotus Health Promotion Model builds on regarded for its culinary, medicinal and spiritual dimensions.
existing health promotion models and responds to the need for
models to help practitioners understand and respond to complex Physical qualities of the Red Lotus
health issues that have multiple interrelated determinants. It is It stands 50 centimetres to 150 centimetres above the water
distinct from other health promotion models in that it and has round, bluish-green leaves measuring between 30 and
incorporates a system of values and principles, which is applied 75 centimetres across24,25,28-30 that do not float, but rather stand
across the phases of health promotion including determining
the health paradigm, needs assessment, planning, Figure 1: Red Lotus Health Promotion Model.
implementation and evaluation.

The Red Lotus plant was chosen as the symbol for this health
promotion model because its qualities and structure are
characteristic of modern health promotion. The plant system
graphically represents the key components of the Red Lotus
Health Promotion Model.

The holistic health paradigm recognises that health includes
the interrelated dimensions of spiritual, mental, social and
physical health and well-being, and that health and ill-health
are not mutually exclusive and do co-exist. This is distinct from
the biomedical and behavioural health paradigms, in which
health is regarded as the absence of disease or ‘unhealthy’
behaviours.7,18

The science of ecology recognises that people live, work and
play in multiple nested ecosystems, from the individual level,
to the family, group, community and population level.7,19,20
Health and well-being are determined by complex interactions
between multiple determinants, including the biological and
behavioural characteristics of people, their social, economic
and political environments, and the natural and built physical
environments.19 All parts of an ecosystem have an impact on
each other, and the whole of the ecosystem is greater than the
sum of the parts.19 Ecological science also incorporates the
quantum physics tenets of connectedness, complementarity,
uncertainty and non-locality.18 Ecological science is distinct from

Health Promotion Journal of Australia 2007 : 18 (1) 13

Gregg and O’Hara Article

erect and cupped above the water.23,25,29,30 This feature Culinary qualities of the Red Lotus
distinguishes the Red Lotus from a water lily, for which it is
often mistaken. The root tubers and seeds of the Red Lotus are edible. They are
consumed raw, steamed, roasted, sliced and fried as chips, used
The Red Lotus flowers from spring to mid-autumn and remains in soups, sweet and sour dishes, salads, stir fries, dipped in
dormant throughout winter.23-26,29-31 The fragrant flowers are batter or tempura and fried, made into pickles or other
15 to 25 centimetres in diameter with deep pink, white or yellow condiments, ground into flour for bread, or made into a cooling
petals attached to a yellow centre, in which the fruit of the drink.23,28,29 The seeds of the Red Lotus are eaten raw, dried or
plant develop. After the petals die and fall off, the centre of the sugared, crushed to a paste, popped like popcorn, ground into
flower changes colour from yellow to dark grey and becomes a flour for bread, or roasted for use as a hot drink.24-26,28,31 Young
cone-like woody pod bearing nut-like, single-seeded fruit about leaves and leaf stems are used fresh in salads, steamed or as
two centimetres long. The fruit rest in up to 12 cavities on the wraps for parcels of food.25 Older leaves are used as disposable
surface of the receptacle.29 As the fruit mature, the flower stalk cups and plates.32 Red Lotus flower petals are used fresh or
dries, shrivels and weakens, turning the pod downwards, dried in many dishes or as a garnish.25 The stamens are used to
allowing the fruit to fall into the water for the seeds to flavour tea.25,31
germinate.25
Medicinal qualities of the Red Lotus
The seeds of the Red Lotus are extremely long-lived. One plant
grown from seed found in ancient tombs in Manchuria, China, The Red Lotus is highly valued for its many medicinal qualities.
has been radiocarbon dated at 1,288±271 years old.27 The It provides vitamins A, B and C and the minerals calcium, iron,
plant begins growth in the muddy, black clay shallows on the phosphorous and postassium.25 The essence of the Red Lotus
edge of ponds, lagoons, swamps, marshes, billabongs or flooded flower is used as a detoxifier, tonic, calmative, astringent, diuretic,
fields.23,24,29 It grows vigorously and has a spreading rhizome, anti-spasmodic, anti-inflammatory and a tonic for the major
developing an extensive root system that allows the plant to organs.24-26,28,31 Stamens of the flowers are used to strengthen
spread out into deeper water.25,31 the kidneys.25 The flower stalk is used to treat gastric ulcers,
excessive menstruation, and post-partum haemorrhage.31 The
Red Lotus pod is taken for anxiety and nervous conditions,

Table 1: Values and principles in the philosophical domain.

Value Principle Explanation

Organic worldview18 The existence of an organic universe Seeing the world as a living, breathing, dynamic, whole.

Constructionist The construction of knowledge Acknowledging that all people are connected and that collectively they construct knowledge
epistemology13 through interactions within and and understanding about their worlds.
between health promotion
Ecological science7,19,20 practitioners and communities Using the science of ecology, which recognises that people exist in multiple ecosystems, from
the individual level, to the family, group, community and population level. Health is
The science underpinning health determined by complex interactions between people (including their biological status, such as
promotion is ecological age, gender and genetics, state of health and well-being, socio-economic status, attitudes,
values, beliefs and behaviours) and their social, economic, political, built and natural
environments. All parts within the whole system affect each other, and the whole is
greater than the sum of the parts. Ecological science incorporates the tenets of connectedness,
complementarity, uncertainty and non-locality.

Holistic health The concept of health includes Understanding that health is a complex concept that includes aspects of well-being that relate
paradigm7,18 interrelated dimensions of spiritual, to the whole person or communities of people.
mental, social and physical health
Salutogenic focus21,22 and well-being Emphasising factors that create and support health, well-being, happiness and meaning in life.
Health is purposeful18 Recognising that health provides a sense of purpose and enables greater enjoyment of life and
Focusing on the creation of health is not an end in itself.

The motivation for health is as a
resource for living

Assumption of positive Assume that people have a natural Assuming that when left to their own devices, people will do the best they can, given their
intentions18 desire to do the best for themselves, circumstances and available resources.
their families and their communities

Empowering health Participatory processes that enable Using participatory processes that enable and empower people to connect with their inner
wisdom, and gain control over their lives and the determinants of their health.
promotion strategies5,7,9,18 and empower people

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Article The Red Lotus Health Promotion Model

hypertension, pain in the eyes, blurred vision, and insomnia.25,27 grace and the aura of transcendence”17 is symbolic of the Red
Lotus Health Promotion Model. This section describes how
The juice from the Red Lotus leaf stem is used to treat diarrhoea, the structural components of the Red Lotus plant are
sunstroke, fever, irritability, excessive sweating, to strengthen the represented in the Red Lotus Health Promotion Model (see
liver, spleen and heart, and for haemorrhoids and leprosy.24-29,31 Figure 1).
Arrowroot flour made from the rhizomes of the Red Lotus is
applied as a paste to treat ringworm and other skin ailments and Stem and roots: Values and principles system
taken internally to treat nosebleeds.26,31 Lotus roots are also used
to aid blood circulation, remove toxins, boost energy and increase The stem of the Red Lotus plant represents three domains of
longevity.25 health promotion principles in the values and principles system
of the Red Lotus Health Promotion Model. A system is a set of
Spiritual qualities of the Red Lotus connected and interdependent material or immaterial parts
that are collectively organised into a whole dynamic entity.34
The Red Lotus has spiritual significance in many cultures around A value is an idea or concept that is regarded as worthy,
the world. The flower is a strong symbol of purity and inspiration: desirable or useful.34 For each value there is a principle that
it rises from the mud, yet is undefiled, symbolising the raising of describes the code of conduct for enacting that value.34 The
spiritual consciousness.23,26,28 values and principles system is organised into three categories:
philosophical, ethical and technical domains. The values and
Indian mythology is rich with references to the Red Lotus. The principles in the three domains are interdependent parts that
symbol of eternity, plenty and good fortune, the lotus has appeared are connected to and collectively make up the whole dynamic
in art and architecture throughout India’s history.27,33 Other values and principles system.
cultures also appreciate the beauty and spirituality inherent in
the Red Lotus. Carvings from ancient Egypt depict the Red The stem of the Red Lotus Health Promotion Model houses
Lotus26,28 and when Pharaoh Tutankhamen’s tomb was opened, the philosophical, ethical and technical principles, holds them
foremost among the contents were artefacts celebrating the lotus collectively as one supporting structure and acts as a conduit
motif.27 Chinese scholars have written extensively about the for enacting the values. Each domain includes a bundle of
spiritual significance of the Red Lotus.28 related principles. The roots of the Red Lotus Health Promotion
Model represent the values in the values and principles system.
Red Lotus Health Promotion Model Each principle in the stem is connected to a value in the roots.

“In the beginning were the waters. Matter readied itself. The sun For example, the ‘holistic health paradigm’ is included as a
glowed. And a lotus slowly opened, holding the universe on its value in the system as it describes a way of viewing health that
golden pericarp.”17 The Indian myth of creation and the “birth is regarded as the most useful health paradigm for modern
of her most majestic flower abounding in supreme beauty, sublime

Table 2: Values and principles in the ethical domain.

Value Principle Explanation

Equity-based priority Prioritise action with the most Prioritising work with communities that are most marginalised, vulnerable, disadvantaged and
communities5,6,35 vulnerable or disadvantaged often regarded as ‘hard to reach’ based on considerations of equity.
communities.
Equitable distribution Facilitating participatory and egalitarian processes that assist with the redistribution of power.
of power5,7,9 Power is distributed equitably
Ethical change between stakeholders. Ensuring that the people most affected by an issue are an integral part of all components of a
processes18,36 health promotion change process that addresses the issue, as distinct from being targeted as
Change processes enable active recipients of decisions made external to them.
participation of people affected Ensuring that all relevant parties consent to health promotion change processes and
by the issue. acknowledging and respecting that not all people will choose the same actions.
Actively considering what the benefits of any health promotion change process may be and
Processes do not impinge on who may be the beneficiaries.
people’s personal autonomy. Actively considering what the potential harms of any health promotion change process may
be, who may be harmed by the change processes and in what way. Taking steps to minimise or
Beneficence is a priority avoid this harm. Communicating risks involved in a truthful and open manner.
consideration. Ensuring that needs assessment processes incorporate the perspectives of all stakeholders, and
that health promotion practice is based on sound evidence of need, evidence of effectiveness,
Non-maleficence is a priority and appropriate theoretical foundations.
consideration.

Evidence-based Practice is based on evidence of need
practice1-3 and effectiveness, and sound
theoretical foundations.

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Gregg and O’Hara Article

health promotion to work in. The principle that enacts the value from each domain – are provided to demonstrate the application
of ‘holistic health paradigm’ is that health encompasses of the values and principles system in the Red Lotus Health
interrelated dimensions of spiritual, mental, social and physical Promotion Model to various components of health promotion
health and well-being. practice.

Philosophical domain: Values and principles in the Example from the philosophical domain: When health
philosophical domain include the things that are valued and promotion practitioners consider the health paradigm for a
believed to be important to modern health promotion (see Table particular program, the philosophical domain of the Red Lotus
1). For example, the use of ‘constructionist epistemology’ is a Health Promotion Model guides the practitioner towards using
philosophical value and the principle that enacts this value is the value of ‘holistic health paradigm’ and its principle that the
the construction of knowledge through interactions within and concept of health includes interrelated dimensions of spiritual,
between health promotion practitioners and communities. mental, social and physical health and well-being. When working
with the Red Lotus Health Promotion Model, the practitioner
Ethical domain: The values and principles in the ethical domain critically reflects on the existing health paradigm and makes a
provide guidance on the humane or ethical thing to do (see determination about whether that health paradigm is highly,
Table 2). For example, using ‘evidence-based practice’ is an somewhat or not consistent with the holistic health paradigm.
ethical value that is enacted by the principle of practice being If inconsistencies between the existing health paradigm and
based on evidence of need and effectiveness, and sound the holistic health paradigm are identified, practitioners
theoretical foundations. strategically plan to advocate for, mediate or enable the
reorientation of the health paradigm.
Technical domain: Values and principles in the technical
domain provide guidance on the humane way to practice health Example from the ethical domain: When health promotion
promotion (see Table 3). This is often referred to as best practice practitioners consider where their efforts should be focused,
or good practice. For example, the value of ‘practitioner is a the ethical domain of the Red Lotus Health Promotion Model
resource’ is enacted by working with communities as an ally guides the practitioners towards the value of ‘equity-based
and being on tap as a resource for the community. priority communities’ and its principle of prioritising action with
the most vulnerable or disadvantaged communities. This means
Enacting the values and principles system prioritising work with communities that are most marginalised,
vulnerable, disadvantaged and often regarded as ‘hard to reach’
The values and principles system is proactively and purposefully based on considerations of equity. This is important because
integrated into the health paradigm and the needs assessment, health promotion has been criticised for choosing to work with
planning, implementation and evaluation stages of health the more empowered and easy-to-reach sections of the
promotion through a process of ongoing, conscious, deliberative, community and thereby contributing to widening the disparities
critical reflection on practice. Using the Red Lotus Health in health status.4,5,7 Therefore, not to use equity issues as a basis
Promotion Model, practitioners individually or collectively apply for prioritising communities is considered to be unethical or
the values and principles system as a reflective and strategic inhumane practice.8,24When working with the Red Lotus Health
tool. This involves critically reflecting on each value and its Promotion Model, the practitioner critically reflects on the
principle by assessing the degree of congruency between that existing or proposed priority communities and makes a
value and principle and the health promotion practice that is determination about whether those communities are or are not
being undertaken at that time. Based on this assessment, equity-based priorities. If the priority communities are not equity-
practitioners strategically plan to advocate for, mediate or enable based priorities, practitioners strategically plan to advocate for,
future action that is consistent with the values and principles of
the Red Lotus Health Promotion Model. Three examples – one

Table 3: Values and principles in the technical domain.

Value Principle Explanation
Using multiple strategies incorporating all action areas of the Ottawa Charter.
Comprehensive Portfolio of multiple strategies is used
actions10-12 to address complex issues. Using models of governance and decision making that facilitate active and meaningful
Democratic governance5,9 participation by all stakeholders.
Collaborative models of governance Working with communities as an ally and a resource on tap for communities.
Practitioner is a resource5,6 and decision making. Ensuring that evaluation focuses on assessing the changes in the range of factors that enable
System-level evaluation5,25 people to increase control over the determinants of their health.
Work with communities as an ally.

Evaluate sustainable changes to
systems that support people to
increase control over their health.

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Article The Red Lotus Health Promotion Model

mediate or enable the reorientation of the focus towards equity- the environmental conditions that interact with the
based priority communities. characteristics of people to determine health outcomes. There
are five petals that represent the social, economic, political,
Example from the technical domain: When health promotion built and natural environments. Related values: organic
practitioners consider the strategies that will be used in a health worldview and ecological science.
promotion program, the technical domain of the Red Lotus
Health Promotion Model guides the practitioners towards using Petal layer 2: Needs assessment
the value of ‘comprehensive actions’ and its principle that a
portfolio of multiple strategies is used to address complex issues. The three petals in layer two represent the components of the
When working with the Red Lotus Health Promotion Model needs assessment process. The first petal represents the types
the practitioner critically reflects on the existing or proposed of need that should be assessed, including people’s felt,
portfolio of strategies and assesses the mix of strategies. If the expressed, comparative and normative health needs. The second
mix of strategies does not include all of the Ottawa Charter for petal represents the data (existing and new) for needs assessment
Health Promotion action areas, practitioners strategically plan that are collected in reference to people’s characteristics and
to advocate for, mediate or enable the expansion of the strategy the environmental determinants of health. The third petal
portfolio. represents the range of processes used for needs assessment
that enable all people directly or indirectly affected by the issues
This first part of this section on the Red Lotus Health Promotion to contribute to decision making.
Model has described the values and principles system. The
remainder of this section describes the other structural Related values: constructionist epistemology; ecological science;
components of the Red Lotus plant, their representation in the holistic health paradigm; salutogenic focus; empowering health
Red Lotus Health Promotion Model, and the values from the promotion strategies; equity-based priority communities;
values and principles system that are most relevant to each equitable distribution of power; evidence-based practice;
component. democratic governance; and practitioner is a resource.

Pod: People Petal layer 3: Planning

The pod of the Red Lotus plant represents people at individual, The seven petals in layer three represent the components of
family and community levels. Each seed represents an individual, health promotion planning. One petal represents the people
and each pod contains multiple individuals that exist with others identified as primary and secondary co-activists. People directly
in different types of collectives, such as families, workplaces, affected by the priority health issues have primary stakeholding
schools, or other communities. The health and well-being of in making planning decisions and are therefore identified as
people and communities includes interrelated dimensions of primary co-activists. These are the people who live with the
spiritual, mental, social and physical health and well-being. The health issue and with whom health promotion practitioners need
pod’s life cycle is symbolic of the various life stages of people, to work with (not on). People who are indirectly affected by the
including the notion of life-death-life inherent in the spiritual priority health issues are identified as secondary co-activists.
beliefs of many cultures. This could include service providers and people with resources
available to address the issues. The second petal in this layer
Related values: organic worldview; constructionist epistemology; represents the partnerships that are formed between the
ecological science; holistic health paradigm; salutogenic focus; practitioner and the primary and secondary co-activists and
and health is purposeful. other relevant stakeholders. The third petal represents the priority
health issues that are analysed by co-activists and other
Stamens: Biological status, socio-economic stakeholders to identify the range of immediate and contributing
status, behaviours determinants for each issue. The fourth petal represents the
evidence for the health issue analysis that is compiled from
The stamens represent the characteristics of people that interact existing literature and new research with people affected by
with environmental conditions to determine health outcomes, the issues. The fifth petal represents the goals and objectives
including biological status such as age, gender and genetics, that are developed by co-activists and other stakeholders from
state of health and well-being, socio-economic status, and their the health issue analysis, and that identify desired changes in
attitudes, values, beliefs and behaviours. the health issue (goals) and the immediate and contributing
determinants of the issue (objectives).
Related values: organic worldview; constructionist epistemology;
ecological science; salutogenic focus; assumption of positive The sixth petal is represented by the strategy portfolio that is
intentions; and empowering health promotion strategies. designed by co-activists and other stakeholders to achieve the
goals and objectives. The strategy portfolio includes a
Petal layer 1: Environmental determinants of health

The five petals in the first layer of the Red Lotus flower represent

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Gregg and O’Hara Article

complementary mix of health promotion strategies from across an evaluability assessment, which is based on process evaluation
the Ottawa Charter for Health Promotion.10 Strategies are data. This assessment determines if the program is ready for
designed based on evidence of effectiveness in the literature impact and outcome evaluation. The second petal represents
and existing theories and models of change, such as the implementation of the impact evaluation plan and the third
organisational change theory, policy-making models, community petal represents the implementation of the outcome evaluation
change theory, and behaviour change theory. plan. Impact and outcome data are collected and analysed.
The fourth petal represents the dissemination of evaluation
The seventh petal represents the evaluation plans (process, findings to all those with an interest in the program. Findings
impact and outcome) that are developed through active are also communicated via a range of media to those with the
engagement with the full range of stakeholders including primary capacity to respond, for example potential funders, practitioners
and secondary co-activists, funders, policy makers and and policy makers.
practitioners. Evaluation plans incorporate the range of
stakeholder perspectives regarding the evaluation questions, Related values: constructionist epistemology; empowering
evaluation criteria or indicators, evaluation research methods health promotion strategies; ethical change processes; evidence-
(data type, collection and analysis) and communication of based practice; democratic governance; practitioner is a
evaluation outcomes. Process evaluation plans are designed to resource; and system-level evaluation.
assess program implementation, co-activist involvement and
satisfaction, and program quality. Outcome and impact Leaves: Sustainability
evaluation plans are designed to assess changes in the health
issue (outcome) and the immediate and contributing The leaves of the Red Lotus plant represent the concept of
determinants (impact) of the issue. sustainability. The longevity of the plant is ensured by the
presence of healthy, vibrant leaves. Sustainability is considered
Related values: constructionist epistemology; ecological science; through assessment of the future viability of the program, based
holistic health paradigm; salutogenic focus; empowering health on evaluation outcomes in conjunction with potential for future
promotion strategies; equity-based priority communities; impact.
equitable distribution of power; ethical change processes;
evidence-based practice; comprehensive actions; democratic Related values: organic worldview; constructionist epistemology;
governance; practitioner is a resource; and system-level ecological science; evidence-based practice; democratic
evaluation. governance; practitioner is a resource; and system-level
evaluation.
Petal layer 4: Implementation
Conclusion
The four petals in layer four represent the components of health
promotion implementation. The first petal represents the None of the existing health promotion models commonly used
necessary support provided to the primary and secondary co- in modern health promotion practice explicitly incorporates
activists to implement the strategy portfolio. This support includes values and principles in a systematic way.
securing, mobilising and maintaining the necessary financial,
human and other resources, and facilitating partnerships with Values and principles are discussed in the literature at a broad
other relevant stakeholders. The second petal represents the level, but not with specific reference to their explicit and
response to the unanticipated opportunities to enhance the purposeful application across the phases of a health promotion
effectiveness of the program. The third petal represents the process. There is no evidence of a system of philosophical, ethical
collection of process evaluation data throughout the and technical values and principles being articulated, mobilised,
implementation of the strategy portfolio. The fourth petal and evaluated across the life of a health promotion program.
represents the communication to relevant stakeholders of
progress on the implementation of the strategy portfolio. A key challenge for health promotion practitioners is to
proactively and purposefully enact a connected set of values
Related values: constructionist epistemology; empowering and principles across the phases of a health promotion process:
health promotion strategies; equitable distribution of power; determining the health paradigm, needs assessment, planning,
ethical change processes; evidence-based practice; implementation and evaluation. This paper has described the
comprehensive actions; democratic governance; and Red Lotus Health Promotion Model, a new holistic, ecological,
practitioner is a resource. salutogenic health promotion model that incorporates a system
of values and principles. The key feature of the Red Lotus Health
Petal layer 5: Evaluation Promotion Model is the explicit application of the values and
principles system to all aspects of holistic, ecological, salutogenic
The four petals in layer five represent the components of health health promotion including determining the health paradigm,
promotion evaluation. The first petal represents the conduct of needs assessment, planning, implementation and evaluation.

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Article The Red Lotus Health Promotion Model

Acknowledgement from: http://www.exoticindiaart.com/article/lotus

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Authorhouse; 2004.
conducted background research on the Red Lotus plant and
19. Van Leeuwen JA, Waltner-Toews D, Abernathy T, Smit B. Evolving Models of
contributed the original graphic design of the model, and Karen Human Health Toward an Ecosystem Context. Ecosystem Health. 1999;5(3):204-
19.
Carter, who undertook the next phase of graphic design of the
20. Lowe I. Ecological health promotion: some principles. Health Promot J Aust.
model. 2002;13(1):5-9.

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Authors
Jane Gregg and Lily O’Hara, Centre for Healthy Activities, Sport and Exercise, University of the Sunshine Coast, Queensland

Correspondence
Ms Jane Gregg, Centre for Healthy Activities, Sport and Exercise, University of the Sunshine Coast, Sippy Downs, Queensland

4556. Tel: (07) 5459 4639; fax: (07) 5430 2881; e-mail: [email protected]

Health Promotion Journal of Australia 2007 : 18 (1) 19