Workplace Health Promotion

By Dr. Bob Karch

The concepts of Health Promotion and with that, the desire to have all people obtain and maintain an optimal level of health, is truly a noble universal goal. Progress toward that goal, while never fast enough for those of us who are actively engaged and deeply committed to developing such programs, none the less, has been steady and promising. And perhaps nowhere has this been more evident than in the workplace.

Much of the history of health promotion programs offered in and through the work environment has been linked to programs in North America. However, as you will read in this issue of "Global Perspectives", there are many very fine examples of well developed workplace health promotion (WHP) programs that have been and continue to be operating in many countries throughout the world.

Investing in Human Beings

Alfred Marshall, Cambridge’s great economist at the turn of the century, was once quoted as saying, "The most valuable of all capital is that invested in human beings." I believe that the allocation of capital that is specifically committed to the development, implementation and ongoing operation of high quality WHP is not only "the most valuable of all capital" but is "imperative capital" if a company, or for that matter a country, wants to be competitive in local, regional, or global marketplaces. Companies, first and foremost, accomplish their goals through people - their employees. Thus, strategies and programs that call for building, recruiting and maintaining healthy and vital employees can be unequivocally linked to high performance.

As important as it is, the impetus for WHP is not tied exclusively to performance. Concurrent with the need to be competitive in the marketplace, companies throughout the world, to varying degrees, are faced with soaring health care costs, nationalization and privatization of health insurance plans and an aging workforce. Given these factors, companies around the globe are confronted with a critical strategic choice: invest additional capital to get and keep all employees (young and old) as healthy as possible or expect and plan to expend significant capital to pay for the associated medical and lost production costs incurred as a result of the poor health of their workers.

Healthy Workplace and Workforce

Fortunately, many insightful companies have already made the choice to be proactive in developing and promoting programs that are not only focused on issues of controlling health care costs and increasing productivity, but also on organizational issues such as the development of social, environmental, and educational policies. These programs are key elements to building and maintaining a truly healthy workplace and workforce. Outstanding examples of this very point are presented by Cathrin Frisemo. From her European Union project, "Success Factors and Quality for Workplace Health Promotion," she selected and presents several Swedish models of good practice of WHP for your review. I am confident that you will also find Dr. Michael Cashmore’s discussion on the history and current status of WHP in Singapore quite informative. As a lecturer at the School of Business Management of Nanyang Polytechnic, Michael provides us with a sound economic and managerial rationale for WHP.

Few health promotion professionals have ever heard of the outstanding program developed and operated at Taiwan Power Company. Dr. Clark Jwo, a Physical Education professor at National Taiwan Normal University, provides us with a great overview of the program’s history and success. And from the same region of the world you will read about the latest developments in South Korea. Dr. Kim, Il Soon and our own Dr. Michael O’Donnell team up to provide exciting news about new public health promotion laws and educational programs that have been established in South Korea.

Further, I know you will be very impressed with the WHP overviews provided by Anda Bruinsma, Manager of Worklife Employee Well-being of Nortel, and Mark Landgreen, Director of Health Management for the Coca-Cola Company. These two outstanding professionals share a global vision of WHP for their respective multinational companies that speaks directly to the issue of developing and maintaining a healthy and productive workforce in order to be very competitive in the global marketplace.

And finally, please note the global initiatives and IIHP newsflashes so as to stay informed of events around the world. Enjoy!

Workplace Health Promotion in Sweden: A Tradition

By Cathrin Frisemo

Sweden has a long tradition of improving working conditions for employees. The Occupational Health Services (70 percent of Swedish organizations belong to the OHS) and the unions have played a significant role in workplace health promotion (WHP). Legislation is plentiful regarding the work environment with the responsibility for employees’ health being placed on the employers. Recent legislation includes "internal control" which requires the employer to audit once a year and improve the work environment; a rehabilitation law that requires the employer to offer a rehabilitation plan and pay for rehabilitation; and a regulation that the employer has to pay for the first two weeks of sick leave. Sweden has an extensive social insurance system, but, as in many European countries, costs are increasing rapidly and major cutbacks have been undertaken. This has resulted in an increase in the provision of private health insurance, and this in turn has evoked the interest in keeping healthy. In Sweden, all parties in the workplace are involved in decisions with regard to the work environment. WHP programs address the psycho-social environment and the impact of management and organization on the health of employees, with a focus on stress reduction considering both the organizational and the individual perspective.

Successful Programs

As part of the European Union (EU) project, "Success Factors and Quality for Workplace Health Promotion," I have identified Swedish Models of Good Practice of WHP. A publication of four models of good practice from 18 European countries will be published during the spring of 1999. Some of the organizations that have extensively integrated WHP are ASTRA (pharmaceutical company), Länsförsäkringar Wasa (insurance company), and the Malmö Fire Brigade. They have all created a healthy work place, physically, psychologically and socially, with different solutions.

The WHP program at ASTRA includes developing and implementing policies (e.g., alcohol and drug policy, maternity policy), personnel care projects for groups at risk (holistic analysis of work situation, including hours, health profiles, attitude surveys, ergonomics); and a selection of health promotion activities, including excellent exercise facilities, culture room, education and massage.

The WHP strategy at Länsförsäkringar Wasa, is also based on a holistic view of health. Health and work profiles are compiled as a base for the program design with a commitment from the management to undertake necessary changes that are revealed in the profiles. All program components feature a yearly follow-up and evaluation.

At the Malmö Fire Brigade, the Fire Chief is leading the development of a healthy organization, which was initiated by an alcohol and drug program nine years ago. The program has now expanded to include a work environment policy, rehabilitation policy and a leadership policy with the slogan "We care". Suggestions for improvement of the work environment are often implemented, and if not approved, employees always hear the reason. An open and straight-forward dialogue between all parties is a trademark of the organization.

Investment for the Future

I am convinced that an increasing number of managers will recognize the need for health promotion programs for their organization in order to succeed with their business in the future. A Swedish survey undertaken in 1998 showed that Swedish middle-sized information technology (IT) companies invest in the health of their personnel. The emphasis is on leadership and organizational development and extensive health promotion activities programs (e.g. 90 percent offer exercise activities).

Cathrin Frisemo (BMed.Sc Public Health ) works with the National Institute for Working Life in Solna and can be reached at 46-8-7652003, 46-708-391769 (both phone), 46-8-6531750 (fax) or Cathrin.Frisemo@stud.ki.se (e-mail).

Health Fitness Promotion at Taiwan Power Company

By Dr. Clark Jwo

The first formal workplace health promotion (WHP) program in Taiwan was initiated in 1990 by Taiwan Power Company (TPC), Taiwan's largest national enterprise. The program was originally an experimental study conducted by a research group from the Department of Physical Education and the Department of Public Health of National Taiwan University and funded through a research grant from the Health Department of the Central Government. The director and the senior assistant of the occupational health department of TPC were very supportive of the ground-breaking project and convinced their highest authority, the general manager, of the benefits to be gained from an effective health promotion program. The support from the top ensured financial backing and available time for the employees to use office hours to participate in the intervention.

First Scientific WHP Study

Two hundred fifty of the 3000 employees at TPC Headquarters took part in the health fitness intervention. Half of the participants joined the experimental group, the other half the control group. The entire program was based on the PRECEDE Model for educational diagnosis. The 20-hour fitness workshop included basic knowledge of health-related physical fitness, exercise practice, exercise behavior change strategies, and goal setting. After the workshop, the following intervention activities were offered for 12 weeks:

1. Stretching exercise sessions during morning and afternoon breaks led by "opinion leaders" within their own department ;
2. Courses teaching self-monitoring skills;
3. Structured exercise groups such as jogging and aerobic dancing.

A scientific study on WHP to this degree (including process and outcome evaluation) had never before been conducted in Taiwan.

Study Results

The study found that the intervention improved cardiorespiratory endurance, muscular fitness, and flexibility, but not body fat percentage of the participants. Most participants were satisfied with the fitness workshop and it significantly improved their self-image. The number of participants who changed their lifestyle from an inactive to an active one significantly increased in the experimental group. Ninety-seven percent of the participants suggested that this program should be continued in order to benefit other colleagues. Based on the results at TPC, we found that WHP programs can be successful within the Taiwanese culture and can help employees improve their fitness and lead a more active lifestyle.

Model For Other Companies

Since 1990, TPC has been the model company for physical activity and fitness promotion at the workplace in Taiwan. The Taiwanese Health Department praised TPC as an excellent example for other companies to learn from. In addition, TPC has offered annual one-week fitness workshops through the Physical Education Department to educate their occupational health personnel from other sites on the Island ("train the trainer" concept). More and more companies are becoming aware of the importance of physical activity and fitness, in particular with the rise in "lifestyle" diseases in Taiwan. However, in my mind, still too few are implementing well-planned programs.

Clark Jwo is a professor in the Department of Physical Education of National Taiwan Normal University and can be reached at tel: 886-2-29312901 ext. 23 or fax: 886-2-23634240; or Email: t08002@cc.ntnu.edu.tw. The postal address is P.O.Box 97-32, Taipei, Taiwan 116

Enhancing the Health and Well-being of Our Global Employee Population

By Anda Bruinsma

Nortel Networks (Northern Telecom) is a world leader in cutting edge network technologies and integrated network solutions based in Canada. With over 70,000 employees in more than 150 countries, addressing the health and well-being issues and meeting the needs of employees, is an ongoing challenge. Nortel provides a broad scope of traditional health and wellness initiatives to enhance the well-being of its employees around the world. The Nortel "Aralia" Wellness Program is found in nearly all North American locations and includes health promotion activities targeting high risk behavior, as well as supporting fitness centres where feasible. Similar initiatives are currently underway in Europe, Asia and the Caribbean/Latin America. Following an extensive needs assessment, the location programs are tailored to meet the needs, interests and cultural norms of the population.

Health Informatics

The explosion of health and medical information available on the world wide web and the deployment of consumer health information systems to the public, provided a unique opportunity for Nortel Networks to focus on the possibility of using its own technology to deliver health information (otherwise called health informatics) and programs to its employees. The ability to deliver information, assessments and programs in this virtual environment is assisting us in reaching a growing group of hard to reach employees. Making health and wellness information available to employees, anytime, anywhere, provides valuable support infrastructure for existing and future programs.

The web-based application recently developed by Montreal- based GlobalMedic Inc. integrates personal health risk assessments with focused lifestyle interventions and health information. The program allows individual access to extensive health and wellness information. A personalized health file allows their expert system to integrate the health data entered by each user. Health risk appraisals provide personalized wellness profiles with readiness to change components and action planning modules. The system also provides aggregate data collection on utilization.

Nortel Networks recognizes, supports and values location, linguistic and cultural diversity. The ability to customize the system to meet location requirements and the availability of the system in French helps to meet the needs of our global employee population.

Keys to Success

Corporate online health informatics programs are still in their infancy. Several variables are important in assuring success. The computer literacy of the employee population and the degree of direct access to computers or kiosks are obvious factors. Adequate promotion and support as well as linking the tool to existing programs and services integrates the system into the corporate health promotion strategy availing all employees of current, reliable health and wellness information. The strategies differ between manufacturing and knowledge worker environments, but visibility, promotion and support by all related functional areas (health, wellness, safety, ergonomics) is key.

Current changes in health care delivery in North America suggest strongly that health informatics is the way of the future. People will be able to access more and more information and will become much more involved in shared decision making with respect to their personal health and wellness management. Nortel encourages and supports personal responsibility for well-being. Providing employees access to a web-based personal health information and assessment tool demonstrates a leading edge initiative for Nortel in meeting the needs of employees in a changing work environment.

Anda Bruinsma, MSc., is Manager of Worklife & Employee Well-being in Resourcing & People Development Services, NORTEL and may be reached by phone: 1-613-765-5875 (ESN 395), fax: 1-613-763-8618 (ESN 393) or e-mail: abruins@nortelnetworks.com.

Workplace Health Promotion Singapore: Growth in Times of Economic Crisis

By Michael Cashmore

Let me first discuss workplace health promotion (WHP) in the general health context of Singapore. The national health expenditure in 1989 amounted to $1,672 billion (2.9 percent GDP), and latest figures show in 1997 this increased to $4 billion with estimates of it reaching 8 percent of GDP by 2030 when one in four people will be 65 and older. The average medical cost per employee per year has also been rising from $310 in 1991 to $541 in 1996, an increase of about 75 percent. There are however some more positive trends. A survey of 5000 firms by the Manpower Ministry, found that the average number of days of sick leave per employee went down from 3.2 in 1995 to 2.0 in 1997.

National Campaigns and Initiatives

Historically in Singapore, attempts at WHP began in the early 1980s and were concerned mainly with ad hoc health educational activities initiated by the then Training and Health Education Department of the Ministry of Health. However, there was greater management participation in the planning and implementation of WHP over the years, so that in 1987 the Workplace Health Education Unit (WHEU) was formally set up and subsequently provided assistance to over 370 organizations, both private and Ministries and Statutory Boards. Public sector organizations such as the Housing Development Board followed suit with a gymnasium and recreational club, and DBS Bank invested $90,000 in facilities. National campaigns such as the National Lifestyle Campaign have been introduced in the ’90s with the mission to "develop new ideas and programs which will excite and gather greater participation in healthy sports and lifestyle among all sectors of the public; in schools, the workplace, and the community at large."

The Corporate Sector as Major Investor in Health Promotion

In 1993 the Singapore Sports Council (SSC) conducted a Wellness Survey of over 500 companies in Singapore which showed that 24 companies had a structured wellness program as opposed to just offering recreational activities; the majority (21) were operated by company staff. Today, companies like Hewlett Packard (HP), Seagate Technology, Tech Semi-conductor, Maybank, American International Assurance, are big players in WHP. Private sector companies such as HP were among the first to implement a structured program with considerable investment. HP spent $3 million building a sport and recreation clubhouse for its employees, but more recently developed its own Intranet which not only gives health information and promotes programs, but allows employees to choose their canteen lunch from a variety of menus.

Interestingly, it is Motorola that has captured the most attention in the last year or two with their innovative incentive schemes for workers. At one plant some 30 percent of its 3,500 workers have joined in the fitness and healthy lifestyle program which pays the employee up to $200 in benefits for regular participation. Motorola's senior wellness officer Ms. Yap Lai Ping said, "At first we wanted to raise awareness and teach skills, so we rewarded people for taking part in activities, but the program has been so successful we are ready to put some of the responsibility back to the individual. Good companies go beyond just paying their people, they work with employees to achieve balance in their lives."

Growth in Times of Economic Crisis

As for the Asian Economic Crisis, it does not seem to have slowed down the focus on wellness where it has become ingrained in company culture. Nevertheless, effort is needed to get more organizations on board the WHP train. One such movement with the aim of promoting greater participation in WHP is the Society of Workplace Health Promotion Facilitators (SWHPF). Registered in 1994 it grew out of the work of the WHEU and, in particular, the efforts of the Head of the unit, Dr. Koh Yang Huang. Five day courses through the SWHPF trained human resource officers in program design, planning, and implementation.

I would like to conclude by saying that as Singapore moves forward on its mission to build a knowledge based economy, getting the balance right between productivity and productive capability through WHP is essential.

Michael Cashmore is a lecturer at the School of Business Management of Nanyang Polytechnic and can be reached at Michael_CASHMORE@NYP.gov.sg (e-mail), 65-5501167 (tel) or 65-5527200 (fax).

Coca-Cola’s Global Approach to Associate Employee Management

By Mark Landgreen

Global Coca-Cola finds that a global approach to health management is an effective means to increase employee satisfaction, productivity and the value of health care dollars spent. The economic value added by implementing an integrated health management strategy proved effective for us. This U.S.-based strategy combines health promotion, early detection of disease, occupational medicine, disease management, health plan design, and return to work/disability programs.

Worldwide Impact

The challenge for our company, with nearly one million employees in a worldwide system, is to transfer the learnings from integrated health management, capitalizing on our economies of scale. Coca-Cola worksites around the world have well established, effective health programs, yet we have just begun to tap the potential of sharing these learnings across complex company structures and diverse country borders. Success stories can be found from headquarters in Atlanta, where a 70 percent fitness center participation rate (active members) has been documented, to Drogheda (Ireland), Manaus (Brazil), and Cidra (Puerto Rico) where 80 percent participation rates have been tracked over nearly a decade.

"Multi-local" Approach

A unique aspect of the Coca-Cola business is our system of bottling partners, which are as diverse as the cultures they serve. These billion dollar bottling systems have major production and distribution processes supported by large numbers of employees. A strength of our business is "multi-local" execution, incorporating country by country marketing and advertising that reflects local culture. This approach creates local ownership and enables us to sell over one billion soft drinks a day. However, this same multi-local approach does present unique challenges in applying health management programs and practices.

Charter Program in Mexico

It is naive to think that sharing best practices and pooling resources will happen without concerted efforts within an organization that does business in more countries than the United Nations. To meet the challenge, Coca-Cola’s corporate health management team initiated an integrated approach within the Latin American Division (210,000 employees). For "practical considerations" the team selected Mexico (80,000) as the charter country to test the concept.

We are currently:

• Identifying key resources in Mexico, including our Mexico City division office, two major bottling partners, the Mexican community and government, consulting firms and local and global health insurance carriers
• Assessing current health management best practices
• Identifying viable partnership opportunities

Our next steps include:

• Designing and implementing integrated programs/services
• Evaluating outcomes
• Sharing/leveraging knowledge
• Implementing across Latin America

When the outcomes of our Latin America charter program show added value to our business, then the concept will be delivered to Africa, Asia and Europe. With this we hope to have the world’s healthiest, most productive workforce, accomplished through a fully integrated, cost effective health management system.

Mark Landgreen is Director, Health Management, The Coca-Cola Company, Atlanta. He can be contacted at 404-676-2844 (tel), 404-676-7291 (fax) or e-mail: mlandgreen@na.ko.com.

Country Profile: The Genesis of Health Promotion in South Korea

By Dr. KIM Il Soon and Dr. Michael P. O’Donnell

In future years, 1998 will probably be recognized as the year in which the cornerstones of the health promotion foundation were laid in Korea. During 1998, a Public Health Promotion Law was implemented, the first Institute for Health Promotion was created, the first "Healthy City" Project was launched, the first graduate level courses on health promotion were taught, and plans for the first broad- based workplace health promotion program were developed.

Public Health Promotion Law # 4914

As stated in section 1 of the Public Health Promotion Law, "The purpose of this law is to enhance the health status of the population by providing accurate information. By educating people in the value of health and responsible behaviors, an appropriate environment will be created to allow people to practice healthy lifestyles by themselves."

The law requires the Minister of Health to develop a health promotion plan which will be implemented by city mayors and provincial governors and draw on the services provided by local health centers. Health campaigns will be launched to encourage people to quit smoking, drink moderately, and improve their nutrition and oral health. Limit-ations will be placed on tobacco advertisement and sales, and non-smoking areas will be designated in public places. "Healthy lifestyle societies" will be created at the city and provincial level to help people practice good health habits. The law also requires that a "Health Promotion Fund" be created to provide grants for health promotion efforts, including public education, materials development, research, health assessments, and health promotion efforts in local health centers. Funds are secured by a "tax" of 2 Korean Won per pack of cigarettes sold (about .15¢ US), allocation of 5 percent of health insurance budgets and an optional subsidy from the Ministry of Health. This law was passed in 1995, and the first grants from the fund were awarded in 1997. The various elements of the law are still being implemented.

We expect this Public Health Promotion Law to provide a stable framework for health promotion in Korea, but also recognize that grassroots health promotion efforts are equally important for the development of this new area. Fortunately, a number of pivotal efforts, described below, are occurring in education, and program development.

Health Promotion in Academia and the Workplace

For what we believe to be the first time in Korea, health promotion was introduced into academia and the workplace. Graduate level courses in health promotion were taught in the Graduate School of Health Science and Management at Yonsei University, and the Department of Preventive Medicine at Catholic University, both in Seoul, Korea. Also, the Institute for Health Promotion was created in March of 1998, within the Graduate School of Health Sciences and Management at Yonsei University. The purpose of the Institute is to refine the science of health promotion, assist in national health promotion planning, build coalitions of health promotion professionals and train health care professionals in health promotion techniques. Current research efforts include research on the relationship between health practices and medical care costs. The Institute is also coordinating the Kwachun City Healthy City Project in conjunction with the World Health Organization.

Finally, the College of Medicine at Catholic University is working with a number of large employers to develop what we believe are the first systematic broad-based health promotion programs in Korea.

Future of Health Promotion

The future of health promotion in Korea is potentially promising, but uncertain at this point. Korea is in the midst of a financial crisis which has included a 40 percent devaluation of its currency relative to the US dollar, bankruptcies of a number of major corporations, and the second highest recorded unemployment rate in Korean history. Medical care costs are not a severe problem in Korea so there is little pressure to control them. These conditions do not bode well for health promotion. However, many leaders of the medical community and the Ministry of Health are very interested in health promotion. The cause of death in Korea has shifted from infectious disease to diseases with lifestyle-related causes. Korean men lead the world in smoking rates; a growing portion of Korean people are sedentary; binge drinking is part of the culture; traditional Korean diets are low-fat but very high in sodium and people are beginning to adopt high fat Western fast foods. Health promotion could certainly improve the health and quality of life of the Korean people, and we are pushing ahead to fill out the foundation for health promotion in Korea.

Kim, Il Soon, MD, PhD is the Director, Institute for Health Promotion, Graduate School of Health Science and Management and Professor, Department of Preventive Medicine, College of Medicine of Yonsei University. Michael O' Donnell, PhD, MBA, MPH is the Editor-in-Chief of the American Journal of Health Promotion and currently a Fulbright Senior Scholar at Yonsei University and Catholic University in Seoul, Korea. For more information, contact Dr. Kim Il Soon at dpmkis@yumc.yonsei.ac.kr Michael O’Donnell at ajhealthp@AOL.com

International Institute for Health Promotion Newsflashes

Outlook for 1999

1999 will be an exciting year for the IIHP. A number of initiatives were outlined during the annual meeting in Washington DC last year:

• Expanding the IIHP network with regard to settings and regions
• Implementing a regional approach within the network
• Student representatives at American University have been identified for the regions and will facilitate dialogue and collaborative projects
• Increasing cooperation with other key international organizations, e.g., World Health Organization, World Bank
• Improving communication capabilities and information access within the network through new and existing technologies (e.g. videoconferencing / newsletter/ internet)
• Meeting education and training demands through regional mini-conferences and seminars, in particular in emerging countries
• Facilitating cooperative research or exchange projects amongst IIHP partners
• Conducting a successful annual meeting (with follow-up scientific congress) in Curitiba, Brazil, Oct. 10-13.

Participation in "Health Promotion: Global Perspectives" (HPGP)

HPGP continues to strive for better information sharing and alliance building worldwide in 1999. You are encouraged to provide feedback to the newsletter, suggest topics, and contribute as an author with articles or brief newsflashes. A more formal survey on the newsletter will be conducted at a later stage this year. Planned future topics are:

• Global communications: distance learning and health info systems
• Health care reforms and health promotion in different countries
• Health fitness testing - standardization and the establishment of a global database
• Global outlook for health promotion for the new millennium

Any input on how to improve HPGP is welcome.

IPN Proposal

The Institut für Prävention und Nachsorge (IPN) in Köln, Germany recently developed a model addressing programmatic areas that health promotion professionals worldwide could work together in. This would be coordinated by the IIHP. The goal is to form sub-committees in the following areas:

• Policy
• Programmatic operations (e.g., workplace)
• Communication
• Finance/funding/sponsorship
• Products
• Annual meeting
• Quality standards
• Database
• Training/education/curriculum development
• Information / public relations
• Internships

The committee coordinators would form a steering group. Please provide feedback on the programmatic areas and additional insight how to realize such a structure by contacting Dieter Lagerstrøm at IPN: 49-2234-9465711 (tel) or 49-2234-946576 (fax) or by contacting the IIHP Headquarters at American University.

Fourth Annual Meeting

The Fourth Annual Meeting of the IIHP will take place in the beautiful Brazilian city of Curitiba in October (10-13) of 1999. In contrast to many other large Brazilian cities, Curitiba emphasizes the concept of quality of life and therefore is void of outrageous traffic, pollution, or high crime rates. Well-planned city neighborhoods and a multitude of parks provide a great setting for the IIHP meeting. Our Brazilian readers are encouraged to participate in the planning of the event program, especially because a scientific congress with primarily a national focus and international speakers is planned to directly follow the meeting. Please contact Neiva Melamed of the ABQV- Curitiba Chapter at 55-41-3420232 (tel) or 55-41-2421920 or humana@ mps.com.br (e-mail) for more information.

About IIHP

The International Institute for Health Promotion (IIHP) is a global center for the development and advancement of health promotion policies, programs, services, and research that maximizes multiple efforts across the globe. It was established in 1994 as an addition to the National Center for Health Fitness at American University in Washington, DC, to assist in leading, facilitating, and coordinating the efforts of many international individuals and organizations. More than 50 cooperating members from 25 nations form an extensive interdisciplinary health promotion network that includes ongoing dialogue, information exchange and project participation. E-mail the IIHP at <iihpaa@american.edu>. The IIHP website is <http://www.healthy.american. edu/iihp.html>

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