1. A life-course perspective

The Framework organises health promotion around the life course, recognising that the conditions supporting health differ across stages of life and that opportunities to strengthen health exist well beyond early childhood.

This perspective allows health to be understood developmentally rather than episodically. It recognises that earlier conditions shape later trajectories, while also affirming that it is never too late to strengthen the conditions that support health and well-being.

2. Developmental transitions (the When)

The life course is structured through a series of developmental transitions during which individuals must adapt to increasingly complex social roles, environments, relationships, and expectations.

These transitions are not arbitrary stages. They reflect the developmental reality that people move through successive periods of adaptation, from early dependence and attachment, through school, adolescence, adulthood, work roles, parenting, ageing, and eventually the end of life.

These transitions provide the Framework with its organising logic. They create a shared structure through which governments and institutions can align policy attention around the conditions required for people to move through life in healthy ways.

The Framework identifies seven key developmental transitions across the lifespan, from birth and early childhood through older adulthood and the end of life.

3. Positive health outcomes (the Why)

At the centre of the Framework is a focus on positive health outcomes.
These are not simply supplementary indicators, nor are they defined only by the absence of illness. They are the measurable indicators that define whether an individual is successfully navigating a developmental transition and moving into the next stage of life in healthy ways.

The outcomes function in two ways at once. They are the strategic targets toward which action is directed, and they are the measurement anchors through which progress can be assessed. This is one of the Framework’s defining features.

In that sense, the positive outcomes do not merely describe health after the fact. They actually define what health looks like at each developmental transition. Where those outcomes are being achieved, the individual can be understood as moving through that stage of life healthy.

4. Influencing factors (the What)

For each positive health outcome, the Framework identifies a defined set of influencing factors most likely to support or impede its achievement.

These are not an exhaustive list of everything that might matter. They are the priority conditions that research and expert knowledge have repeatedly identified as having the strongest influence on whether individuals are able to achieve a positive outcome.

These factors are the practical points of intervention within the Framework. They identify the conditions that must be strengthened if positive outcomes are to be achieved and sustained, and they provide the key bridge between strategic goals and actionable priorities to be carried out by different stakeholders or “contributors” of population health.

The Framework therefore treats influencing factors not as vague contextual variables, but as defined intervention points within a planning architecture. This allows jurisdictions to focus effort where it is most likely to matter and to organise action around conditions that have a demonstrable relationship to positive outcomes.

5. Contributor domains across society (the Who)

Health is shaped by more than individual choice and more than medical systems. The Framework therefore adopts a socio-ecological understanding of how health is produced.

It recognises nine contributor domains across society: individuals, families, schools, workplaces, communities, civil society, the private sector, medical systems, and governments.

These domains do not carry equal roles in every circumstance, nor do they act in the same way. But all have the potential to influence the conditions that shape health outcomes.

This is critical to the Framework’s logic. It prevents health from being reduced to personal responsibility and behaviours alone, while also avoiding the assumption that governments bear sole responsibility for population health outcomes or that medical systems can produce health on their own. By identifying contributor domains explicitly, the Framework creates the bridge between strategic modelling and operational work planning. It clarifies where action sits, who has influence, and how different actors can contribute to shared outcomes from within their own mandates.

6. Evidence-based strategies (the How)

For each influencing factor, the Framework supports the identification and use of evidence-based strategies and best practices capable of strengthening the conditions linked to positive outcomes.

These strategies may take the form of policy instruments, programmes, institutional practices, communications approaches, environmental changes, service models, or other interventions demonstrated to influence the factor in question.

Their role is not merely to create an abstract connection between activities and outcomes. Their role is to ensure that behaviours, policies, programmes, interventions, and other actions are selected because there is credible evidence that they can improve the relevant influencing factors and, through them, improve the likelihood of positive outcomes being reached across the life course.

Alignment is the central organising principle of the Framework.

In many jurisdictions, efforts that influence health already exist across multiple sectors. The problem is not simply absence of effort. It is fragmentation. Actions occur in parallel, often without a shared structure linking them to common outcomes, common influencing factors, or coordinated roles.

The Framework addresses that problem by providing a common architecture through which different contributor domains can act in ways that reinforce one another.

Alignment does not mean collapsing sectors into a single system. It does not mean subordinating all action to government, nor does it imply that medical service delivery becomes less important. Clinical care and other important public health and policy responses remain essential. Existing programmes, services, advocacy efforts, and institutional mandates also remain important. The role of the Framework is not to displace them, but to situate them within a structure that allows them to contribute more coherently to shared positive health outcomes.

In this sense, alignment is both strategic and operational. It provides the logic through which different actors can orient action toward the same ends while retaining distinct responsibilities.

The Framework distinguishes between fixed structural elements and flexible implementation elements.

The fixed elements are what give the Framework coherence across jurisdictions. They include the life-course structure, the developmental transitions, the positive health outcomes, the influencing factors, and the contributor-domain architecture through which societal action is understood and organised.

These elements are not intended to be redefined from one jurisdiction to another. Their consistency is what allows the Framework to function as a shared governance architecture rather than a loose planning template.

Flexibility exists in implementation. Jurisdictions may differ in which influencing factors they prioritise first, which evidence-based strategies and best practices they adopt, how they sequence action, what governance arrangements they establish, how they communicate the work publicly, and what policy or institutional mechanisms they use to support coordination and measurement.

This balance is fundamental. It allows the Framework to be used across different governance contexts without compromising its strategic logic.
This is particularly relevant in countries with devolved regions, autonomous communities, or territorial governments that hold significant health-related responsibilities, as the Framework supports alignment around a common architecture while preserving room for jurisdictional prioritisation and implementation autonomy.

The Health Promotion Alignment Framework provides the structure through which jurisdictions can organise coordinated action.

Applied in practice, it allows governments and public institutions to work from a defined set of positive outcomes and influencing factors, identify where stronger action is needed, clarify which contributor domains have influence, and organise evidence-based strategies accordingly.

The Implementation page explains how jurisdictions can apply the Framework in practice while preserving its underlying structure.

The full architecture of the Framework is illustrated in the following diagram, which illustrates the developmental transitions over the lifecourse, positive health outcomes, influencing factors, contributor domains, and evidence-based strategies within a single alignment model.

The Resources page also provides access to reference tables, which list each of the outcomes and all of their primary influencing factors in full detail.