The Ottawa Charter: Discussion on The Significance of This Health Promotion Document

If people lack awareness about how their lifestyle choices affect their health in negative ways, they have little reason to go through the travail of changing habits that they enjoy. By successfully manipulating health habits, individuals will live longer, healthier lives, enlightening their health holistically. Successful health promotion is essential in enabling people to access the knowledge needed to exert control over the determinants of health. In order to produce the most effective form of health promotion, a multi-faceted, multi-sectoral approach is needed, encompassing ideas and strategies from a number of various sources striving for a single goal. This paper will initially discuss the critical period of health promotion as it was catalysed through the construction of the Ottawa Charter as well as how the Ottawa Charter has influenced the expansion of health promotion through future research and conferences such as the Bangkok Charter. Additionally, it will also discuss some of the potential apprehensions facing health promotion in the near future as the health landscape shifts due to current global problems.

Perhaps the most critical piece of research influencing the importance of health promotion is the Ottawa Charter. The Ottawa Charter was synthesised in 1986 when a group of researchers, policymakers, and public health practitioners assembled to pursue ways to provide health to all humans by the turn of the century. For the first time, health was looked at holistically, considering an individual’s physical, mental and social well-being rather than simply the presence, or lack, of a disease.

Potvin & Jones (2011) exemplify the impact of the Ottawa Charter and how it’s conception has provided a framework for public health practitioners and decision-makers to endorse health. Critically, the Ottawa Charter has enabled health promotion to permeate and transform public health systems around the globe. Potvin & Jones have identified three key trends of health promotion since its inception. Firstly, it is illustrated that health promotion is now being recognised by many dominions as a core function for public health. For example, in the UK and Canada, health promotion is explicitly treated on par with traditional functions such as prevention, protection, and surveillance. Additionally, the state of Ontario, Canada has established a Ministry of Health Promotion which is independent of the Ministry of Health, and in other jurisdictions, such as Switzerland, Thailand, and Austria, mandates for health promotion have been instigated by legislation. Secondly, there is an overarching trend for states to focus on plans that propose the reduction of health inequality. This includes the stress on social factors, such as housing, access to health care facilities and sense of community, as an alternative to targeting specific diseases. Finally, it is argued that states have adopted the promotion of health in all policies as a principle of governance. This is demonstrated by Krech & Buckett (2010) where it is recognised that the government has placed an increasing emphasis on health and well-being in the development of new policies in all sectors of governance. Potvin & Jones make a strong argument for the implications of the Ottawa Charter as being the foundation piece of contemporary health promotion.

Although the Ottawa Charter significantly progressed the standing of health promotion, there are still a number of emerging health issues coming to the forefront (McMichael & Butler, 2006). Global domination of economic policies which prioritise liberalised trade and the amplification of rapid material throughput has come at the expense of social, environmental and personal well-being. Social relations and leisure time have decreased due to the increasing prominence of materialism and consumerism, especially among those in the middle class. Additionally, overpopulation offers a major threat as we collectively exceed the capability of our planet to supply, replenish and absorb. This has resulted in global issues such as the decline of accessible oil, a dangerously altering global climate due to excessive release of fossil fuels and greenhouse gases, land degradation and the depletion of fisheries and freshwater storage. Ecological footprint analysis shows that it should take 1.6 Earths to support the current population at its existing consumption levels (White, 2016). McMichael & Butler propose that a transformation of social institutional norms and public policy priorities is needed. Contemporary risks to population health are wide scale and can affect entire systems and processes in contrast to the perhaps previously localised risks on personal health and small scale environments. In a progressively consumerist society, there is little economic incentive for people to take responsibility for population health. Health promotion must continue to deal with the immediate health problems faced by individuals and communities, however, grasping these more systemic health issues requires a multi-faceted, multi-sectoral policy formation and collaboration up to an international level.

In addition to the issues health promotion is facing in the paragraph above, the inevitable rise of globalisation also brings new matters to prominence. Global health promotion refers to the process of enabling individuals to take control over their health within a global context. Global health governance is a relatively new term that encompasses contemporary issues in health promotion, specifically the progression of globalisation. Since the twentieth century, there have been increased calls for intersectoral action on global issues such as climate change and outbreaks of disease (Lee & Kamradt-Scott, 2014). Lee (2006) looks at examples of global health promotion, identifying strengths and weaknesses of this modern strategy. The healthy cities initiative aims at developing physically and socially sustainable environments amongst urban landscapes that provide maximum opportunities for holistic wellbeing. The number of cities taking part in the program steadily increased since its inception, to a point where over 3000 cities were involved worldwide. The difficulty with this proposal, however, is that all cities are diverse and require different resources and actions to acquire the global goal.

Jackson et al. (2006) set out to examine the effectiveness and cost-effectiveness of health promotion strategies based on the Ottawa Charter by inspecting eight reviews written throughout the six years prior. Out of this, the authors concluded with a number of deductions that are essential for successful health promotion. It is noted that, as discussed earlier, the implementation of healthy public policy is key in creating effective health promotion interventions. Environments conducive to healthy living need to be realized at structural, social and individual levels. Strategies are most effective when planned and executed by multiple sectors, including government and non-government organizations, as well as key stakeholders. Furthermore, Jackson et al. state that community interventions aimed at personal skill development, such as health education, are ineffective strategies if employed independently, and must be combined with other approaches in order to produce consistently positive results. The authors cite the Canadian tobacco control strategy, whereby a number of sectors cooperate to reduce tobacco consumption, including; policies to ban tobacco advertising and sponsorship, legislation on where tobacco is sold and used, tobacco use by minors, significant taxation, anti-smoking media campaigns, school-based education on the repercussions, free access to support and counselling as well as subsidized nicotine treatment As recognized by the articles previously discussed, intersectoral collaboration is the crucial ingredient in operative health promotion.

The success of the Ottawa Charter inspired a number of global conferences including Adelaide, Jakarta, Mexico City and Sundsvall, in aiming to refine the principles and action areas defined in the original charter. The Bangkok Charter, held in 2005, built on the foundations of the Ottawa Charter, adapting its values to a more modern, global world. A number of new factors that influences health are looked at, including; inequalities between countries, commercialisation, urbanisation, patterns of consumption and forms of communication. The Bangkok Charter focused on health promotion becoming an increasingly key responsibility for all sectors of government, in all jurisdictions moving beyond the original charters emphasis on strengthening community and personal skills development. Using evidence from a number of research articles, inclusive of those investigated in this paper, the Bangkok Charter concludes that, the government, international organisations, and the private sector must feature an integrated policy approach in order to have health promotion reach its potential.

The Ottawa Charter is arguably the most important document on health promotion, providing a set of guidelines for future researchers to base their theories on. Because of this, health promotion has seen a significant rise in popularity, being recognised in many places as a core function of government, whereby it is placed as having similar importance to traditional roles such as prevention and surveillance. However, although the Ottawa Charter has provided a sufficient framework throughout the last few decades, the altering global sphere has instigated an abundance of contemporary issues that policymakers have to consider. Overpopulation has led to unmistakable global contentions such as climate change and the decline of natural resources. These new issues have sought an international reply, with jurisdictions from all around the globe collaborating to tackle these worldwide obstacles. The Bangkok Charter recognised these new developments from the advice of research and urged government and non-government sectors, at both international and national levels to cooperate to create a multi-faceted approach to enable people to take control over their health. The rise of this new approach to health promotion will be interesting for researchers although it may be too soon, due to lack of evidence, to conclusively determine that its properties are the best way to promote health to all people. Conceivably, throughout the next few decades’ health promotion will continue to advance, however, unfamiliar complications are sure to reveal themselves, again altering the challenges faced by health promoters.