Ottawa Charter for Health Promotion

Appendix

Ottawa Charter for Health Promotion

First International Conference on Health Promotion Ottawa, 21 November 1986—WHO/HPR/HEP/95.1 ^∗

The first International Conference on Health Promotion, meeting in Ottawa this 21st day of November 1986, hereby presents this CHARTER for action to achieve Health for All by the year 2000 and beyond.

This conference was primarily a response to growing expectations for a new public health movement around the world. Discussions focused on the needs in industrialized countries, but took into account similar concerns in all other regions.

It built on the progress made through the Declaration on Primary Health Care at Alma-Ata, the World Health Organization’s Targets for Health for All document, and the recent debate at the World Health Assembly on intersectoral action for health.

Health Promotion

Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well- being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.

Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being.

Prerequisites for Health

The fundamental conditions and resources for health are:

r peace

∗

Charter adopted at an international conference on health promotion: The move towards a new public health, November 17–21, 1986, Ottawa, Ontario, Canada. Co-sponsored by the Canadian Public Health Association, Health and Welfare Canada, and the World Health Organization.

162

r shelter r education r food r income

r a stable eco-system r sustainable resources r social justice, and equity.

Improvement in health requires a secure foundation in these basic prerequi- sites.

Advocate

Good health is a major resource for social, economic and personal development and an important dimension of quality of life. Political, economic, social, cul- tural, environmental, behavioural and biological factors can all favour health or be harmful to it. Health promotion action aims at making these conditions favourable through advocacy for health.

Enable

Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences in current health status and ensuring equal oppor- tunities and resources to enable all people to achieve their fullest health poten- tial. This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices. People can- not achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women and men.

Mediate

The prerequisites and prospects for health cannot be ensured by the health sector alone. More importantly, health promotion demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and by the media. People in all walks of life are involved as individuals, families and communities. Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health.

Health promotion strategies and programmes should be adapted to the local

needs and possibilities of individual countries and regions to take into account

differing social, cultural and economic systems.

Health Promotion Action Means

Build Healthy Public Policy

Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health.

Health promotion policy combines diverse but complementary approaches in- cluding legislation, fiscal measures, taxation and organizational change. It is co- ordinated action that leads to health, income and social policies that foster greater equity. Joint action contributes to ensuring safer and healthier goods and services, healthier public services, and cleaner, more enjoyable environments.

Health promotion policy requires the identification of obstacles to the adoption of healthy public policies in non-health sectors, and ways of removing them. The aim must be to make the healthier choice the easier choice for policy makers as well.

Create Supportive Environments

Our societies are complex and interrelated. Health cannot be separated from other goals. The inextricable links between people and their environment constitutes the basis for a socioecological approach to health. The overall guiding principle for the world, nations, regions and communities alike, is the need to encourage reciprocal maintenance—to take care of each other, our communities and our natural environment. The conservation of natural resources throughout the world should be emphasized as a global responsibility.

Changing patterns of life, work and leisure have a significant impact on health.

Work and leisure should be a source of health for people. The way society organizes work should help create a healthy society. Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable.

Systematic assessment of the health impact of a rapidly changing environment—

particularly in areas of technology, work, energy production and urbanization—

is essential and must be followed by action to ensure positive benefit to the health of the public. The protection of the natural and built environments and the conservation of natural resources must be addressed in any health promotion strategy.

Strengthen Community Actions

Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities—their ownership and control of their own endeavours and destinies.

Community development draws on existing human and material resources in

the community to enhance self-help and social support, and to develop flexible

systems for strengthening public participation in and direction of health matters.

This requires full and continuous access to information, learning opportunities for health, as well as funding support.

Develop Personal Skills

Health promotion supports personal and social development through providing in- formation, education for health, and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health.

Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential. This has to be facil- itated in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies, and within the insti- tutions themselves.

Reorient Health Services

The responsibility for health promotion in health services is shared among indi- viduals, community groups, health professionals, health service institutions and governments. They must work together towards a health care system which con- tributes to the pursuit of health.

The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services.

Health services need to embrace an expanded mandate which is sensitive and respects cultural needs. This mandate should support the needs of individuals and communities for a healthier life, and open channels between the health sector and broader social, political, economic and physical environmental components.

Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization of health services which refocuses on the total needs of the individual as a whole person.

Moving into the Future

Health is created and lived by people within the settings of their everyday life;

where they learn, work, play and love. Health is created by caring for oneself and others, by being able to take decisions and have control over one’s life circum- stances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members.

Caring, holism and ecology are essential issues in developing strategies for

health promotion. Therefore, those involved should take as a guiding principle

that, in each phase of planning, implementation and evaluation of health promotion

activities, women and men should become equal partners.

Commitment to Health Promotion

The participants in this Conference pledge:

r to move into the arena of healthy public policy, and to advocate a clear political commitment to health and equity in all sectors;

r to counteract the pressures towards harmful products, resource depletion, un- healthy living conditions and environments, and bad nutrition; and to focus at- tention on public health issues such as pollution, occupational hazards, housing and settlements;

r to respond to the health gap within and between societies, and to tackle the inequities in health produced by the rules and practices of these societies;

r to acknowledge people as the main health resource; to support and enable them to keep themselves, their families and friends healthy through financial and other means; and to accept the community as the essential voice in matters of its health, living conditions and well-being;

r to reorient health services and their resources towards the promotion of health;

and to share power with other sectors, other disciplines and, most importantly, with people themselves;

r to recognize health and its maintenance as a major social investment and chal- lenge; and to address the overall ecological issue of our ways of living.

The Conference urges all concerned to join them in their commitment to a strong public health alliance.

Call for International Action

The Conference calls on the World Health Organization and other international organizations to advocate the promotion of health in all appropriate forums and to support countries in setting up strategies and programmes for health promotion.

The Conference is firmly convinced that if people in all walks of life, nongovern-

mental and voluntary organizations, governments, the World Health Organization

and all other bodies concerned join forces in introducing strategies for health

promotion, in line with the moral and social values that form the basis of this

CHARTER, Health For All by the year 2000 will become a reality.

Index

Abel, T., 43–71

actors network theory, 103, 112–123 alienation, 33

Alma Ata Declaration of 1978, 14 American Public Health Association, 15 Antonovsky, A., 44, 77

astronomy, 25 autopoiesis, 75

Balbo, L., 6–11, 129–141 Bateson, M. C., 134

idea of knowledge transfer, 6 Be MedWise campaign, 136–137 Beck, U., 130

binary code, for public health, 92

bottom-up public health programs, 108–110 Bourdieu’s cultural capital theory, 45–46 Breslow, L., 16, 18, 130

Brown, S., 78 Bruhin, E., 58 Bruner, J., 133

bureaucratic regulatory system, 17

Callon, M., see actors network theory capital resources

role of interplay of social structures and beliefs, 49–51

types of, 47–49 chaos, concept of, 132

chronic disease revolutions, 17–18 clinical medicine, 93, 95–96 Code of Research Ethics, 121 COMMIT trial, 109

community mobilisation program, 9 complexity notion, in health promotion,

33–36 consciousness, 82

contemporaneous introductory textbooks, 12 contextualism, notion of, 28, 32

critical health literacy, 58

cultural capital, 44, 51–57

applications in health promotion, 57–65 incorporated state, 52–53

institutionalized state, 54, 68–71 interdependence of different states, 54–55 objectivized state, 53

deep professionalisation movement, 18 deprived social conditions, 44 desertification, 33

developing countries, 8

Diagnose Related Groups (DRGs), 96

economic capital, 44 economic field, 68 educational inequality, 53 e-health, 136

empowerment, 26

Encyclopedie of 1776, 146, 148 environment degradation, 33 epidemics, 17

European Foundation of Quality Management-model, 77 Evidence Based Medicine (EBM), 96 Evidence Based Nursing (EBN), 96 evidence rules, 36

fields, 45

Fondation Lucie et Andr´e Chagnon’s community mobilisation program, 9 Food and Agriculture Organisation of the

United Nations (FAO), 99 Foucault, M., 146, 148 Fournier, P., 112 function systems, 87

globalization, 86, 94–95

for physical, mental and ill health, 97–98 role relationships in, 92

urbanization, 86, 94–95 functional differentiation, 86, 94

167

functional health literacy, 58 funding institutions, 30

generalizability, notion of, 32 Gidden, A., 130, 133, 137 Global Health Reports, 99 global pollution, 104 globalization, 33

of function systems, 86, 94–95

habitus, 49 health

defined, 74–75 dimensions of, 156–159 education, 7, 15 education campaigns, 151 enlightenments, 146–147

expansion of life and health expectancy, 150–152

expansion of reflexivity of, 152–154 governance of, 147–150

inequalities, 7, 19 information, 137–139 in late modernity, 94–100 of living systems, 75–85 and modernity, 144–145 in modernity, 85–94 production of, 6, 18 professionals, 18 protection functions, 10 as a resource for living, 130 society, 146

threats, 10

Health Belief Model, 22–23 health care professionals, 69–70 health care services, 46 health information, 58 health lifestyle

and health promotion, 61–62 and social inequality, 63–65 as a socio-cultural resource for health,

62–63

Weberian tradition, 61–62 health literacy, 26

and health promotion, 58–59 and social inequality in health, 59–61 as a socio-cultural resource for health, 59 Health Maintenance Organisations (HMOs), 96 health promotion theory, see also health

promotion authors, 8–9 background, 7–8

challenges to, 24–26, 31–33

complexity and, 33–36 grand vs small, 29 history, 28–29

and identification of diseases, 26–27 issues and practices in different contexts,

9–10

significance of, 21–24 Western concepts, 29

health promotion, 154–156, see also health promotion theory

actions, 13

Bourdieu’s approach, 45 and health lifestyle, 61–62 and health literacy, 58–59 institutional setting for, 30 knowledge, 15

practice, 29–31, 36–37 practitioners, 7 programs, 123–124 role of capital, 46–51

and social inequality, 43–44, 65–68 as a strategy for public health, 13–17 theoretical perspective for, 38–39 third revolution of public health, 19 health standards, normative, 47 Healthy Cities, 99

healthy public policy, 16 Healthy Regions Initiatives, 99 Hochschild, R., 136

Holland, W., 153

hormone replacement therapies, 135 human longevity, 18

Hume, D., 34

ill health, 76, 79, 88 care for, 90–91, 96 immigration, 33

incorporated cultural capital, 52–53 individual attitudes, 22

individualization, 86, 106 infectious diseases eradication, 104 information society, 133

institutionalized cultural capital, 54 interdisciplinary research, 15

International Classification of Diseases (ICD), 89–90

International Obesity Task Force 2003 Report, 140

International Union for Health Promotion and

Education (IUHPE), 10, 15, 26

internet informed patient, 136

Jacobs, J., 132

Kahnawake Schools Diabetes Prevention Project (KSDPP), 121–122

Kant, I., 151

Kantian tradition, of health promotion, 34 Kickbusch, I., 1–5, 144–159

Kuhnian perspectives, on research, 30

Lalonde Report, 28, 155 life expectancy, 93

lifelong learning, 44, 130, 133 and adult women, 134–135 and experiences, 132–134 Lisbon Treaty (2000), 133 living conditions, 44 logical positivism, 24, 29 longevity, 76, 106

Luhmann, Niklas, 75, 82, 86–89, 96

McQueen, D. V., 1–5, 12–19, 21–39 medical public health, 37

medicine, in modern society, 88–91, 93 migration, 33

Minnesota Heart Health, 109 Mormons, 62

negative functioning, 76 negative health, 79

dimensions and indicators for, 84 non profit organizations (NPO’s), 77 nutrition transition, 140

O’Neill, M., 37 obesity epidemic, 107 objectivized cultural capital, 53 optimist modernist reactions, 124

Ottawa Charter for Health Promotion, 6–8, 12, 18, 28, 67, 88, 151, 155

documents of, 13

participation, 119–123 pathogenic reproduction, 77, 85 Pawtuckett Heart Health, 109 Pederson, 37

Pelikan, J. M., 74–100 Penser sociologiquement, 129

“Perspective on the Health of Canadian”

document, 14

pessimist modernist reactions, 124 physical capital, 62

pollution, 33

population health assessment, 16 positive functioning, 76 positive health, 79

dimensions and indicators for, 84 Potvin, L., 6–19, 103–125 poverty, 26

Professorships, in health promotion, 27 psychological factors, 22

psycho-social learning process, 52 psychotherapy, 137

public health, 17, 86 institutions, 10 in modern society, 91–94 officials, 13

and reflexive modernity, 103–107 revolution, 129

role of programs in, 107–112 tradition and ideology, 37–38 Public Health Act, of England, 148

quality of life, 76

Qu´ebec National Public Health Program, 16

randomized controlled clinical trial (RCT), 29, 37

real world experiences, 44 reflection, theory of, 90, 92

reflexive modernity, 103–107, 131–132, 134 reflexive social practices, 132

reflexive sociology, 33

reproduction of living systems, 77, 84 research institution, 30

R´eseau francophone des intervenants en promotion de la sant´e, 15 risk society, 131

role relationships, in function systems, 92 Rootman, I., 37

Salutogenesis paradigm, 44 salutogenic reproduction, 77, 82, 85 school-based smoking prevention program,

108

scientific journals, 15

scientific knowledge, 18, 109–110 scientific theories, 24

social actors, 132 social capital, 26, 44 social differentiation, 95

social epidemiologic research, 65–68 social fields, 50

social inclusion and exclusion, 47 social medicine, 149

social production, of health, 7

social public health, 37

Social Science Medicine, 13

social sciences, 6, 23

social status, 82–83

social stratification system, 61, 65 social technical networks, 113–114

social-cultural processes, of health production, 47

sociological systems theory, 75 autopoietic systems, 82 structures vs. processes, 76 stem-cell therapy, 91 Straus, R., 21–22

structural coupling, 75, 90–91 Suppe’s work on scientific theories, 24 Swedish Health Policy Statement, 16, 19 Swiss Foundation for Health Promotion, 9 Syme, Len, 16

taxi document, 13 Terris, M., 17

The Boston Women’s Health Collective, 155

The Enlightenment, 104

third revolution, of public health, 16–19 top-down public health programs, 108–110 translation process, 114–119

multidirectional, 119–123

U.S. National Institute of Health Report, 135 universal vaccination programs, 104 urbanization, 33

urbanization, of function systems, 86, 94–95 US Centers for Disease Control, 6 Von Bertalanffy, L., 35

Weick, K. E., 76 Western societies, 55

White Paper on Teaching and Learning (1995), 134

World Health Organization (WHO), 6, 13, 26,

67, 74, 88, 99, 146