Health promotion comes of age: The Ottawa Charter 20 years later

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Health promotion comes of age The Ottawa Charter
20 years later

• Marcia Hills, RN. PhD
• VP World Conference, IUHPE
• President, Canadian Consortium For Health
  Promotion Research

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Health promotion the prodigal daughter of public
health

• In the beginning.the Ottawa Charter
• The middle years lost in the wilderness
• The return of the promise health promotion comes
  of age

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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.

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Health

• 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. .
  

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Prerequisites and determinants of health

• The fundamental conditions and resources for
  health are
• peace
• shelter
• education
• food
• income
• a stable eco-system
• sustainable resources
• social justice
• equity.
• Improvement in health requires a secure
  foundation in these basic prerequisites.

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Initial Promise 1986-1994

• The Lalonde Report (1974)
• The Epp Framework (1986)
• Health promotion grew up in Canada without
  health education grandparents
• The Creation of Centres of Excellence for
  health promotion

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Health Promotion Infrastructure

• The federal government creates a health promotion
  directorate (Irv Rootman)
• Every province creates health promotion
  departments, offices, directorates etc.
• Every province initiates work around health
  promotion settings (e.g. schools, communities,
  hospitals, workplaces, etc.)

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The Middle Years the exile of health promotion
1994-2002

• Health promotion is too elitist and exclusionary
• Epidemiologists feel left out
• Population health argues for the need to bring a
  science base to the question of determinants of
  health (CIAR)
• Health promotion values are supressed
• Population health promotion (Bhatti Hamilton,
  1996)

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The Language of Population Health

• Health Welfare Canada drops welfare and
  becomes Health Canada
• Health promotion disappears and becomes the
  population health approach
• More emphasis on early childhood development and
  other areas open to easier measurement (this lead
  to a bias towards lifestyle approaches)

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The Canadian Consortium for Health Promotion
Research

• Created in 1992, 16 academic Centres across the
  country
• Never gave up hope that health promotion would
  come back and that its core values were
  fundamental for improving the health of all
  Canadians
• The daughter laboured in the wilderness to
  sustain the development of health promotion
  despite its relative neglect at the centre of
  power

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The International Union for Health Promotion
Health Education

• Changed its name from International Union for
  Health Education..Lavada Pinder (A Canadian) was
  a key advocate for this change
• Since this move IUHPE has been the lead
  international organization that pushes the
  development of health promotion as a field
• Canadians have been at the forefront of IUHPE
  (e.g. Irv Rootman, Michel ONeill) and this has
  had an important impact on Canadian policy
  development

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The Return of the Promise

• The creation of the Public Health Agency of
  Canada and the appointment of incredible
  leadership that advocates for health promotion
  and have a deep understanding and commitment to
  health promotion values
• Linkages between CCHPR, PHAC CPHA become
  stronger
• CCHPR wins bid to hold next IUHPE World
  Conference in Vancouver, Canada in June, 2007.

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This is an exciting time as we renew our
commitment to health promotion twenty-one years
after the Ottawa Charter. "Nous vivons
présentement un temps très excitant.  Nous
renouvelons notre engagement à la promotion de la
santé vingt-et-un ans après la Charte
d'Ottawa." "Estos son tiempos muy importantes en
los que renovamos nuestro compromisocon la
promoción de la salud 21 años después de la Carta
de Ottawa". Marcia Hills,
Conference Chair David Butler Jones, Honorary
Co-Chair
WELCOME! BIENVENUE! BIENVENIDO!
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"The IUHPE Vancouver conference will be a
sensitive barometer of progress since the health
promotion movement burst onto the scene in Ottawa
in 1986. Maurice B Mittelmark President IUHPE
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The leadership of Canada in HP is recognized all
over the world due notably to the Lalonde Report,
the Ottawa Charter, the Epp document as well as
projects like Healthy Communities. (Helena
Restrepo, Colombia)
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There are several examples of the Canadian
influence on Brazilian health promotion.
(Márcia Faria Westphal Tatiana Pluciennik
Dowbor, Brazil)
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We see the Canadian Public Health system as a
dynamic policymaker, capable of promoting crucial
social and structural system changes. (Hiram
Arroyo, Puerto Rico)
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Health promotion experts advocate participatory
approaches to evaluate programmes on which Canada
has had significant influence. This Canadian way
was adopted for the programmes implemented by
Aide Médicale Internationale. (Valéry Ridde,
Suraya Dalile, Shukrrullah Wahidi., Linda
Bartlett, Afghanistan)
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Canada contributes to improving the determinants
of health by fostering basic education, promoting
womens rights, strengthening grassroots economy
in rural areas as well as stimulating
decentralization and community participation in
local decisions. (Awa Seck, Senegal, March,
2006)
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It is mainly through its donor capacity that
Canada has influenced the development of Health
Promotion, a role often underestimated and
misunderstood. (Jan Ritchie, Pacific Islands
March , 2006)
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PAHO looks towards Canada, searching for
expertise to acquire and disseminate knowledge
and experiences among developing countries.
(Helena Restrepo, Colombia)
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No olvidemos que la enfermedad de muchos
chilenos no es más que expresión de la
desigualdad social y la pobreza... Asimismo
señalamos que la forma más segura de alcanzar la
equidad en salud es evitando la enfermedad,
poniendo al alcance de todos los conocimientos e
instrumentos que permitan mantener sana a la
población. Por eso, nuestro primer compromiso es
reforzar la salud pública de modo de actuar
integralmente en la promoción de la salud y la
prevención de la enfermedad. Presidente Ricardo
Lagos Hospital Barros Luco, 2004
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Thousands of participants from every continent
and most countries will attend with eagerness,
enthusiasm and dedication to the cause of equity
in health. On that basis alone, we can declare
already that Ottawa spawned a healthy, vigorous,
effective and growing movement. How fitting that
we celebrate this success in Vancouver! Maurice
B MittelmarkPresident, IUHPE
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Professionals exchange experiences with Canadian
counterparts and Canadian professors regularly
visit and students go to Canada for graduate
studies in health promotion. (Márcia Faria
Westphal Tatiana Pluciennik Dowbor, Brazil)
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