Health promotion is a multifactorial process operating on individuals and communities, through education, prevention, and protection measures.1 The statement of principles known as the Ottawa charter for health promotion, developed by the World Health Organisation, is internationally accepted as the guiding framework for health promotion activity. This describes five approaches; building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services.2 Health promotion methods may include activities as diverse as awareness raising campaigns, provision of health information and advice, influencing social policy, lobbying for change, professional training, and community development—often in combination in complex interventions. However, health promotion is rarely judged on its effectiveness in all these areas.