Does reported health promotion activity neglect people with ill-health?

Considering health as an alternative to ill-health ignores the multidimensi onality of both concepts and invites neglect of health promotion as a multi dimensional activity in persons with known ill-health. Drawing on the Ottaw a Charter and Maori perspectives of health, we interpret (ill) health accor ding to people's ability to function in their environment by developing phy sical, psychological, social and spiritual resources for living. We use thi s framework to test empirically our hypothesis that although the concept of health promotion has always included people with ill-health, the practice of health promotion has continued to neglect them. Our exploratory review o f articles published during 1989-99and indexed on three electronic database s suggests widespread omission of people with ill-health from research on i nterventions for health promotion. Of 881 citations approximately three-qua rters included people without ill-health in any dimension. This finding cou ld reflect a failure to include these people in health promotion, to descri be activity to improve their health as health promotion, or both. Supportin g the latter interpretation is uncertainty over the meaning of health, and the targeting of health promotion at groups at high risk of ill-health and 'all' persons We need therefore to enable health promotion activity to incl ude ill people explicitly.