American Health & Medical Research Association
Evidence review

Health promotion’s biggest wins changed the rules, not just the habits

The WHO's 1986 Ottawa Charter defined health promotion as helping people gain control over their health. Tobacco laws and food rules show what that looks like, and fluoride shows how it gets contested.

By the Health Research USA editorial team

Published Last updated October 2026

Written from the sources listed below; links checked October 2026. It touches on medicines, doses or health conditions and has not yet been reviewed by a licensed clinician, so use it to prepare for a conversation with yours. How we research and review

Sources15, listed below Reading time15 minutes

Where the evidence stands

  • Strong evidence Tobacco price increasesSmoke-free lawsSugary drink taxes lower salesFluoridation cut children's tooth decay in older studies
  • Promising but early Local trans fat restrictions cut heart attacks and strokesFluoridation adds a large benefit now that fluoride toothpaste is commonWorkplace checkups with feedback plus education
  • Not enough evidence Sugary drink taxes improve weight or healthFluoridation at U.S. levels harms children's IQ

Each use is rated separately, from the scorecard in this guide. Safety cautions are spelled out in the guide itself. How we grade

On this page
  1. A 1986 charter made health promotion about control, not compliance
  2. Tobacco shows what prices and places can do
  3. Sugary drink taxes cut sales. Health effects are still unproven
  4. Trans fat: a rule that removed a hidden ingredient
  5. Fluoride: a decades-old measure, now contested
  6. At work and in town, the evidence is uneven
  7. Where you fit: skills, choices and a voice
  8. Health promotion at five levels
  9. What the evidence says
  10. Questions readers ask
  11. The bottom line

Key takeaways

  • The World Health Organization’s 1986 Ottawa Charter described health promotion as helping people gain control over their health, through policy, surroundings and communities as well as personal skills.
  • A national task force review of 116 studies estimated that a 20% rise in tobacco prices cuts the number of young people who start using tobacco by 8.6%, with bigger drops among lower-income users.
  • Smoke-free laws were linked to a median 20.1% drop in asthma hospital admissions and no harm to restaurant or bar business.
  • Sugary drink taxes cut sales by about 15% across studies, but whether they change body weight or health is still unproven.
  • Utah and Florida banned community water fluoridation in 2025; as of October 2026, the CDC still recommended it while an EPA safety review continued.

In 2005, about 1 in 5 U.S. adults smoked cigarettes. By 2021, it was closer to 1 in 9: the rate fell from 20.9% to 11.5%, according to the Centers for Disease Control and Prevention (CDC)3.

No single doctor’s lecture did that. Public health agencies leaned on tools such as higher tobacco prices, smoke-free laws, ad campaigns and quitlines3. The CDC estimates that one campaign, Tips From Former Smokers, helped about 1 million people quit from 2012 to 20183.

Public health has a name for this kind of work: health promotion. In 1986, the World Health Organization (WHO) defined it as helping people gain more control over their health, and improve it1.

That idea sits close to natural-health values: self-reliance, community and prevention. It also reaches well past advice to individuals. Typical workplace wellness programs, which mostly hand out advice and screenings, have disappointed in careful trials, as our article on the wellness movement explains.

A 1986 charter made health promotion about control, not compliance

The Ottawa Charter was adopted on November 21, 1986, at the first International Conference on Health Promotion, in Ottawa, Canada1. It listed the basics health depends on: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity1.

It named three strategies: advocate for better conditions, enable people to reach their full health potential, and mediate among governments, businesses and communities1. Its stated aim was to make “the healthier choice the easier choice,” for policymakers as well as everyone else1.

Its five action areas still frame the field. The examples column is ours.

Action area What it means1 Example in this article
Build healthy public policy Put health on the agenda in every sector Tobacco and sugary drink taxes
Create supportive environments Make home, work and play safe and satisfying Smoke-free workplaces
Strengthen community action Let communities set their own health priorities Local votes on fluoridation
Develop personal skills Information, education and life skills Health literacy
Reorient health services Move care beyond treatment toward prevention Community health workers

The U.S. version today is Healthy People 2030. Its goals include eliminating health disparities, building health literacy, creating environments that support health, and engaging leaders across sectors to shape policy2.

Its 23 leading health indicators show how wide the lens is. Alongside adult smoking and blood pressure control, they track fourth-grade reading skills, employment among working-age adults and exposure to unhealthy air2. Our article on whole-person health covers the social conditions behind that list.

Tobacco shows what prices and places can do

The Community Preventive Services Task Force reviews community health programs and posts its findings in The Community Guide. In 2012, it reviewed 116 studies of tobacco price increases and rated the evidence strong; its page was last reviewed in January 20264.

By the panel’s estimates, a 20% price increase cuts overall tobacco consumption by 10.4%, the share of adults who use tobacco by 3.6% and the number of young people who start by 8.6%4. Those are relative drops. By our arithmetic, if 12 in 100 adults use tobacco, a 3.6% relative drop means about 4 fewer users per 1,000 adults.

Lower-income users cut back more than higher-income users, so price increases may narrow health gaps4. The panel flagged trade-offs, too: people may switch to cheaper products, smuggling can rise, and some states block cities from setting their own tobacco rules4.

Smoke-free laws have an equally strong rating4. Across studies, they cut secondhand smoke exposure by about half and lowered tobacco use by a median 2.7 percentage points4. Hospital admissions for heart and blood vessel problems fell a median 5.1%, and asthma admissions fell 20.1%4.

A common fear didn’t come true. The reviewers found no harm to restaurants, bars or other hospitality businesses4. As of the CDC’s 2024 update, 62.7% of Americans were covered by comprehensive state or local smoke-free laws3.

If you smoke and want help quitting, the free national quitline is 1-800-QUIT-NOW3. A later article in this series covers quitting in depth.

Sugary drink taxes cut sales, but health effects are still unproven

Sugary drink taxes are newer, smaller and more contested than tobacco taxes. This is what each side can point to.

Philadelphia began taxing sugar-sweetened and artificially sweetened drinks at 1.5 cents per ounce on January 1, 20175. In the first year, a JAMA study found, sales of taxed drinks at large chain stores fell 51%5. But sales in nearby Pennsylvania zip codes rose 43%, offsetting about a quarter of the drop5. The study covered only chain stores, about a quarter of taxed ounces sold5.

A 2024 study of five taxed cities (Boulder, Oakland, Philadelphia, San Francisco and Seattle) found prices up about 33% and sales down about 33%, according to Fox Business6. It found no evidence of shoppers crossing city lines, a different result from Philadelphia’s first year6.

The broadest look is a 2022 review in JAMA Network Open, funded by the WHO, that pooled 62 studies from cities and countries7. On average, stores passed 82% of the tax on to shoppers, and sales fell about 15%7. People didn’t switch to untaxed drinks in significant numbers7. In Mexico, lower-income households cut purchases the most, and national studies found no loss of manufacturing jobs7.

The gaps are real, too. The drop in what people drank wasn’t statistically significant, partly because those data were weak7. Studies of body weight covered only older sales taxes, and the long-term health effects remain unknown7. Side effects, such as shopping across city lines and lost sales for local stores, turned up only with U.S. city taxes7.

Critics argue the taxes cost shoppers money without improving health. The beverage industry, including its trade group, the American Beverage Association, calls them discriminatory, and the association’s website says “taxes won’t make people healthier, just poorer”6. Our reading: every shopper faces the higher price, but in Mexico the lower-income households who cut back most also ended up paying less of the tax7. Voters weigh those points differently.

Trans fat: a rule that removed a hidden ingredient

Some promotion works without anyone changing a habit. New York City and several other New York counties restricted artificial trans fat in restaurant food8.

A team led by Eric Brandt of Yale compared those counties with similar ones without restrictions, using hospital data from 2002 to 20138. Three or more years after the rules began, hospital stays for heart attacks and strokes in the restricted counties fell 6.2% more than in comparable counties without them8. That design is a careful comparison, not a randomized trial.

A nationwide Food and Drug Administration (FDA) ban on partially hydrogenated oils, the main source of artificial trans fat, was set to take effect in 20188. Our article on healthy fats covers how that rule rolled out.

Fluoride: a decades-old measure, now contested

Community water fluoridation adds a small amount of fluoride to public water to prevent tooth decay. In 2022, 72% of Americans served by community water systems, more than 209 million people, received fluoridated water10.

The case supporters make. The Task Force rated fluoridation recommended, with strong evidence, in 20139. Across 12 studies, tooth decay in children fell a median 15.2 percentage points after fluoridation began, and new decay increased where it stopped9. Benefits reached every income group9. For each dollar spent, estimated benefits ranged from about $1 to $135, highest in large communities9. The American Dental Association says fluoridation cuts decay by at least 25%10.

The case skeptics make. A 2024 Cochrane review, from an independent network that weighs medical evidence, found a clear benefit in studies from 1975 or earlier but a smaller one since fluoride toothpaste became common11. In newer studies, fluoridation may have meant about a quarter fewer decayed baby teeth per child and about 3 more cavity-free children per 100, and the authors couldn’t rule out no benefit at all11. No adult studies met the review’s standards11.

In 2024, the National Toxicology Program linked fluoride above 1.5 milligrams per liter, about twice the U.S. fluoridation level of 0.7, to lower IQ in children10. In September 2024, a federal judge ordered the Environmental Protection Agency (EPA) to take further steps to regulate fluoride10. The Task Force itself lists non-dental harms and benefits for adults as evidence gaps9.

The American Dental Association counters that the IQ studies came from places with high natural fluoride levels and don’t address 0.710.

The Task Force’s fluoridation page still listed it as recommended when last reviewed in December 20259. To learn what’s in your own tap water, check your utility’s annual water quality report. If your child is at high risk of cavities, the American Academy of Pediatric Dentistry recommends some form of fluoride every day from 6 months to 16 years10. The FDA’s 2025 action targets swallowed prescription products for children under 3 and lower-risk older children13, so ask your dentist which form fits your child.

At work and in town, the evidence is uneven

Workplaces show how much the details matter. In 2007, the Task Force recommended health-risk checkups with personal feedback plus health education, based on 51 studies15. Tobacco use fell by a median 13.3% in relative terms, and systolic blood pressure dropped 2.6 points15.

That evidence has limits. The search ended in 2005, and only 20 of the 51 studies had a comparison group15. Two later randomized trials of broad workplace programs found little change in health or costs, as our article on working full time describes.

Communities have other tools. Community health workers, trusted local people trained to link neighbors with care, are one; our article on group healing reviews their track record. Sidewalks, bike lanes and nearby destinations are another, as our article on supportive surroundings explains.

Where you fit: skills, choices and a voice

Personal skills remain one of the charter’s five pillars1. Healthy People 2030 makes building health literacy, the ability to find, understand and use health information, a national goal2.

Your surroundings shape your choices, too. Our article on supportive surroundings explains why moving food out of reach and setting healthy defaults have support, while some famous examples, such as the small-plate trick, rested on research later retracted.

Natural-health values fit here. The charter talks about self-help and social support, and about communities setting their own priorities1. That’s self-reliance and community, not dependence. Smoke-free laws, for example, cleared shared indoor air while leaving adults free to smoke at home.

Some readers see taxes and mandates as government overreach. That’s a values question as much as a science one. The evidence can tell you what a policy is likely to do. It can’t tell you how to weigh cost, freedom and health.

Health promotion at five levels

This tool is ours. Each row pairs a level with an action that has evidence behind it.

Level An action with evidence What’s known
You Use free quit support, such as 1-800-QUIT-NOW3 One national ad campaign helped about 1 million people quit, 2012–20183
Family Keep your home and car smoke-free Public smoke-free policies halved exposure; ways to change smoking at home need more study4
Workplace Push for checkups with feedback plus follow-up education, not just perks Task Force recommended in 200715; newer trials of broad programs disappointed
Community Back smoke-free public spaces, and learn your water system’s fluoride level Both smoke-free policies and fluoridation carry Task Force recommendations49
Policy Weigh in on tobacco, food and water rules Strongest evidence for tobacco prices and smoke-free laws4

How to push for one change locally

  1. Pick one change. Smoke-free parks, water fountains at school or safer crossings near a clinic are good candidates.
  2. Check the evidence. The Community Guide’s findings are options for decision makers, not mandates9. Read the caveats, too.
  3. Find who decides. A city council, school board, water utility or state legislature. State law may limit what a city can do4.
  4. Bring allies. Parents, clinicians, faith groups and business owners carry weight. Say what you want in one sentence.
  5. Speak at public comment. Share a local story and one number.
  6. Ask how success will be measured. A change worth making is worth evaluating.

What the evidence says

Policy or program Evidence level What it rests on
Tobacco price increases Strong evidence Task Force review of 116 studies4
Smoke-free laws Strong evidence Task Force review; fewer heart and asthma admissions4
Sugary drink taxes lower sales Strong evidence 62 studies, all observational; sizes varied7
Sugary drink taxes improve weight or health Not enough evidence Few studies, mostly of older sales taxes7
Local trans fat restrictions cut heart attacks and strokes Promising but early One careful county comparison8
Fluoridation cut children’s tooth decay in older studies Strong evidence Task Force review, 2013; Cochrane’s pre-1975 studies911
Fluoridation adds a large benefit now that fluoride toothpaste is common Promising but early Cochrane 2024: small, uncertain benefit in newer studies; Task Force still recommends it911
Fluoridation at U.S. levels harms children’s IQ Not enough evidence Harm linked to higher levels; EPA review under way1012
Workplace checkups with feedback plus education Promising but early Mostly older before-and-after studies15; newer trials of broad programs found little

Questions readers ask

Isn’t taxing tobacco or soda just the government telling me what to do?

It’s a fair question, and people weigh it differently. A tax doesn’t ban anything; it changes the price. The evidence shows prices change behavior, especially for young people and lower-income buyers47. Whether that’s worth the cost to your wallet and freedom is your call as a voter.

Should I worry about fluoride in my water?

U.S. fluoridation runs at about 0.7 milligrams per liter, below the 1.5 level linked to lower IQ in the 2024 federal report10. The EPA released its assessment plan in August 2026, and a draft is still to come12. Check your utility’s report, and talk with your dentist about your family’s needs.

Do workplace wellness programs work?

Some pieces do, such as checkups with feedback and follow-up education, though that evidence is old15. Broad programs built on screenings and small rewards have shown little effect in randomized trials, as our article on the wellness movement describes.

What’s the most useful thing one person can do?

Start with yourself and your home, then pick one local change and follow the steps above. Bring one clear request and one local story.

The bottom line

Health promotion means more than telling people to eat better. The biggest wins, from pricier cigarettes to smoke-free air and trans-fat-free food, changed the setting so that the healthy choice became the easy one. Newer measures such as sugary drink taxes cut sales, but their health payoff is still being measured, and fluoride’s long record now faces fresh safety reviews.

Natural-health values fit this work well: self-reliance at home, and community action for the things no one can fix alone. Use the evidence to choose your battles, and expect honest people to disagree on the trade-offs.

About this article

This article was researched using World Health Organization and Healthy People 2030 documents, Community Preventive Services Task Force reviews, CDC data, peer-reviewed studies and news reports on 2025–2026 policy changes, all listed below. It was reviewed in October 2026. It is general education, not medical, legal or financial advice.

Sources

  1. World Health Organization. “Ottawa Charter for Health Promotion.” First International Conference on Health Promotion, Ottawa, November 21, 1986 (WHO Regional Office for Africa copy). afro.who.int
  2. Office of Disease Prevention and Health Promotion. “Healthy People 2030 Framework” and “Leading Health Indicators.” Healthy People 2030, HHS, accessed October 2026. odphp.health.gov and odphp.health.gov
  3. Centers for Disease Control and Prevention. “Health and Economic Benefits of Tobacco Use Interventions” (updated July 12, 2024) and “Community Water Fluoridation Recommendations” (reviewed May 15, 2024; accessed October 23, 2026). CDC. cdc.gov and cdc.gov
  4. Community Preventive Services Task Force. “Tobacco Use: Interventions to Increase the Unit Price for Tobacco Products” and “Tobacco Use: Smoke-Free Policies.” The Community Guide, findings November 2012, pages reviewed January 2026. thecommunityguide.org and thecommunityguide.org
  5. Roberto CA, Lawman HG, LeVasseur MT, et al. “Association of a Beverage Tax on Sugar-Sweetened and Artificially Sweetened Beverages With Changes in Beverage Prices and Sales at Chain Retailers in a Large Urban Setting.” JAMA, 2019;321(18):1799–1810. pubmed.ncbi.nlm.nih.gov
  6. Pandolfo C. “Soda taxes made sugary drink prices rise and sales fall in cities that tried them, study finds” (on Kaplan S, et al., JAMA Health Forum, 2024). FOX Business via FOX 29, January 8, 2024. fox29.com
  7. Andreyeva T, Marple K, Marinello S, Moore TE, Powell LM. “Outcomes Following Taxation of Sugar-Sweetened Beverages: A Systematic Review and Meta-analysis.” JAMA Network Open, 2022 (copy via UConn Rudd Center). uconnruddcenter.org
  8. Yale News. “Ban on trans fats in diet may reduce heart attacks and stroke” (on Brandt EJ, et al., JAMA Cardiology, 2017). April 12, 2017. news.yale.edu
  9. Community Preventive Services Task Force. “Dental Caries (Cavities): Community Water Fluoridation.” The Community Guide, finding April 2013, page reviewed December 2025. thecommunityguide.org
  10. CNN via KVIA. “HHS, EPA to study fluoride in drinking water as RFK Jr. says he’ll tell CDC to stop recommending it.” April 7, 2025. kvia.com
  11. Iheozor-Ejiofor Z, Walsh T, Lewis SR, et al. “Water fluoridation for the prevention of dental caries.” Cochrane Database of Systematic Reviews, October 4, 2024 (plain-language summary). cochrane.org
  12. U.S. Environmental Protection Agency. “Fluoride in Drinking Water.” EPA, updated August 3, 2026. epa.gov
  13. U.S. Food and Drug Administration. “FDA Acts to Protect Children from Unapproved Fluoride Drug Products.” FDA news release, October 31, 2025. fda.gov
  14. CareQuest Institute for Oral Health. “2026 Community Water Fluoridation Policy State Legislative Activity.” September 25, 2026 (advocacy group that supports fluoridation). carequest.org
  15. Community Preventive Services Task Force. “Worksite: Assessment of Health Risks with Feedback plus Health Education.” The Community Guide, finding February 2007, page reviewed January 2026. thecommunityguide.org