Health promotion advocacy through co-creation: a university facilitated process in Estonia

Health promotion capacity in Estonia has grown substantially, yet national funding has decreased and municipal willingness to finance health promotion remains limited. Responsibilities are fragmented and the role of health promoters at municipal and county level is poorly defined, while communities face complex public health challenges. A bottom‑up contribution to policy development through co‑creation was needed to empower academics, practitioners and national stakeholders. In April 2026, 60 stakeholders gathered for a one‑day “Health Promotion 2.0” event at Tallinn Health University of Applied Sciences, including representatives from two ministries, national agencies, academia, municipal and county health promoters, and NGOs. The event aimed to jointly analyse the health promotion system and generate concrete, practice‑informed proposals for strengthening governance, funding and workforce structures. Eight mixed groups applied a world café‑based SWOT approach to examine what works, key barriers, opportunities and near‑term threats. Groups presented findings in plenary; the organising institution synthesised contributions. The process resulted in sixteen proposals addressing strategic leadership, funding, workforce qualifications, advocacy and visibility. These were compiled into a position paper submitted to key decision‑makers, including the Ministry of Social Affairs. The process strengthened cross‑sector dialogue between policymakers, academics and practitioners, building shared ownership and a foundation for evidence‑informed advocacy. A one‑day co‑creation format proved feasible for generating recommendations that are politically relevant and grounded in practice. The position paper will support advocacy on legislative changes, sustainable funding and workforce development. Academic institutions can play an active role in health promotion advocacy – convening stakeholders, facilitating bottom‑up policy input, and bridging practice and policy.

Key messages

• Co‑creation empowers academics, practitioners and national stakeholders to analyse fragile health promotion systems and generate practice‑informed proposals for better governance and funding.

• A one‑day, university‑facilitated co‑creation in Estonia produced sixteen health promotion policy proposals and a position paper, showing academia can play an active role in health promotion advocacy.