The Ottawa Charter for Health Promotion First International Conference on Health Promotion, Ottawa, 21 November 1986
Health Promotion Action Means: 1-Build Healthy Public Policy Most health determinants lie outside medical/illness sector (e.g. income, housing, environmental protection, work, agriculture). These sectors must begin to take conscious accounting of the health impact of their policies. “Putting health on the agenda of all policy makers” -Does health (however defined) become the superordinate goal (“health imperialism”) of all public policy? -How can one prevent the biomedical definition of health from dominating health concepts utilized in other policy sectors? -How does healthy public policy take account of conflict or social movement struggles? 2-Create Supportive Environments Ensure physical and social environments support people’s abilities to live healthy lives. “Make healthy choices the easy choices” -How would we enable people to make healthy choices? -What do we mean by “healthy choices”? -How do we understand the relationship between environment and economy (sustainable development) and the impact of this relationship on health? -If and how the concept of “healthy life” is related to a “being productive” lifestyle? 3-Strengthen Community Actions Support activities that increase the ability of community groups to organize around and act upon those things in their physical and social environments that affect their health. -What is “community”? Which community should be supported? -Which community resources should be valued? -How do we engage with community? -Can we avoid the “new behaviorism”, the extension of the control professionals and institution once had over individuals to whole populations and their environments? Is this “community control” or “control of communities”? 4-Develop Personal Skills Enable people to “learn throughout life” and “prepare themselves for all its stages”. Skill areas may encompass personal/familial or group dynamics, organizing, political actions, social analysis.
-Do health professionals acknowledge the primacy of economic and physical environmental determinants on health, but still see their role as encouraging healthy lifestyle? -Does this notion of developing personal skills construct individuals and groups in a passive voice, that is, they are being “done to” and never “doing”? -How could personal skills be considered and practiced as resources in health services? 5-Reorient Health Services Ensure that the health care system has health has its output, and not merely the absence of disease. Emphasize services located in, and relevant to, particular needs of localities, i.e., “communitybased” rather than “institutional” service delivery organizations. Shift to “health promotion” rather than “service delivery” philosophy. -How a “community-based” health care system could be structured? -Which are the differences between a “community-based” and “institutional” service delivery organization? -How do we do a health needs assessment?
You will divide in five groups. Each group will discuss one action area. We just wrote a summary of what is actually written in the Ottawa Charter because we wanted you to make up your own ideas, and to discuss some critical issues which are present in the Charter. You will have 45 minutes to discuss. And then we would like each group to present to the others. Each group can decide to add new questions and new critical issues or to reframe the description of the action area in a different way. This is because we prefer to have each group raising the critical issues and reflecting on the application of health strategies and practices more than focusing on an analytical report.