The legendary journey of the Ottawa Charter

legendary journey of the ottawa charter

Above are logos of the global health promotion conferences held in different cities in the world since 1986. Thirty years have passed since its inception in 1986. As its name implies, the first one was launched in Ottawa, Canada.

This post sails through to peer back into the Charter’s legendary 30-year-long journey; from Ottawa in 1986 to Shanghai in 2016.

The Ottawa Charter’s birth

The Ottawa Charter was built on the 1978 Declaration on Primary Health Care at Alma-Ata, Russia. The Charter considers health promotion as a process of empowering us to gain control over health.

What is health?

The word, “health”, refers to a complete physical, mental, and social wellbeing, not merely the absence of disease or infirmity as articulated in 1948.

Writing an editorial to the Health Promotion International on behalf of the “Shanghai stop” held in 2016 – 30 years after the Ottawa Charter – Ilona Kickbusch and Don Nutbeam say, “the Ottawa Charter brought a paradigm shift in thinking about how to improve public health”.

The Ottawa Charter brought a paradigm shift to public health discourse”.

Iliona Kickbusch and Don Nutbeam

According to Kickbusch and Nutbeam, the Ottawa Charter has made “significant strides forward”. For example, in 2015, the health promotion became a Sustainable Developmental Goal (SDG) – SDG 3 aims to, ” Ensure healthy lives and promote well-being for all at all ages”.

The Ottawa Charter’s Concept

Let us sail through the logo; That is the best way to grasp its concept.

The logo consists of a red circle and three wings – the action areas.

Ottawa charter logo

The Ottawa Charter’s Red Circle

The red circle refers to Building healthy public policy. It holds other elements in place. It also symbolizes the need to build policies while working on the three wings.

The Ottawa Charter’s Three Wings

Inside the red circle, we can see three wings. These three wings represent three action areas;

  • Reorient health services,
  • Create supportive environments,
  • Strengthen community action together with developing personal skills.
    • The community action breaks through the red circle of the healthy public policy. This break through symbolizes
      • The ever-changing needs of societies,
      • and the need of having responsive healthy public policies.

The Ottawa Charter’s Small inner circle

This small circle represents three strategies that need to use in all five action areas. Those are;

  • Enable,
  • Mediate,
  • Advocate

In 1998, the Health Promotion Glossary defined every word and term. The glossary became public after the 1997 Jakarta Declaration.

The Ottawa Charter’s eight pre-requisites

To keep rolling, the Ottawa Charter requires to fulfil eight pre-requisites. These are also called the Social Determinants of Health.

  1. peace
  2. shelter
  3. food
  4. income
  5. education
  6. a stable eco-system
  7. sustainable resources
  8. social justice and equity

link; https://link.springer.com/article/10.1007/s10389-019-01108-x

The Charter has undergone many transformations throughout its long journey; each stop has added significant additions to the original. However, as Bosse Patterson wrote to the Health Promotion International in 2011, the advancements from these stops have been heavily underutilized. 

The Ottawa Charter’s journey begins,

The Ottawa Charter’s First Stop: Adelaide recommendations for healthy public policy (1988)

The Adelaide stop explored the red circle; how to build a healthy public policy.

The Adelaide recommendations called for all governments to make a “political commitment to health by all sectors”.

The recommendations made clear the characteristics of a healthy public policy;

  • It should be explicit,
  • It should reflect equity in all areas in the policy,
  • It should be accountable for the health impact of the actors.

It also highlights specific subject areas beyond the health sector;

  • Agriculture,
  • Trade,
  • Education,
  • Industry,
  • Communications.

The recommendations suggest health should become an essential element when policies are formulated in the above-mentioned fields.

The participants further identified four priority areas at this stop. Those include;

  • Supporting the health of women;
  • Improving food security, safety, and nutrition;
  • Reducing tobacco and alcohol use;
  • Creating supportive environments for health.

At its time, this statement seemed well advanced. South Australia has taken the mantle and moved forward with health for all policies later.

The Ottwa Charter’s Second Stop: Sundsvall Statement on supportive environments (1991)

This third conference held in Sweden focused on creating supportive environments. The Sundsvall Statement directly addressed policy-makers and decision-makers at all levels. It called on to form broad alliances on the health platform. And, the Statement elaborated what supportive environmental dimensions refer to Social, political, economic, and inclusion of women at all levels.

The Statement detailed key strategies to be adopted in creating supportive environments.

  • Advocacy through community groups, particularly the women’s groups.
  • Education and empowerment
  • Building alliances
  • Mediation to ensure equitable access to supportive environments

In the following year, 1992, the subject of health took a prominent role in the UN’s RIO Declaration on Sustainable Development.

The Ottwa Charter’s Third Stop: Jakarta Declaration, 1997

At this stop, the Emblem has evolved further from its original one; the outer circle of healthy public policy and the inner small spot in the original logo had merged to form a large blue spot. The three wings originate from the blue spot. And, the wing’s color has become brick-red. According to the designers, this represents the evolution of the original Ottawa Charter to be more open to embracing new players.

The Jakarta stop was the fourth conference as well as the first held in a developing country with the active involvement of the private sector.

This Declaration focused its attention on the determinants of health of the original Ottawa Charter: peace, shelter, food, income, trade, industry, social justice, women empowerment, stable eco-system, sustainable resource use, respect for human rights, and equity. Above all, they recognized poverty as the greatest threat.

Further, it emphasized the clear need to break through traditional barriers within the government sectors, between the government and non-government sectors, and the involvement of the private sector.

The Declaration finally recommended all countries develop appropriate political, legal, economic, educational, social environments supportive of health promotion.

Key messages of the Jakarta Declaration:

  • Applying all five action areas together is the most effective than single-track ones.
  • Choosing settings – schools, markets, mega-cities, the workplace, healthcare facilities – make implementation all five action areas feasible.
  • People should be at the center of decision-making and implementation.

The Ottawa Charter’s Fourth Stop: Mexico Ministerial Statement, 2000

This statement stated health promotion should be a fundamental component of all public policies and programs in all countries. With the involvement of politicians, the subject of health promotion was brought up in the political arena. Another major development from this stop was the birth of a broad Framework for Countrywide Plans of Action for Health Promotion.

The Ottawa Charter’s Fifth Stop: Bangkok Charter, 2005

In Bangkok, the focus was on the determinants of health. The document acknowledged the UN’s recognition of health as a fundamental right. Moreover, it highlighted major progress that placing health measures at the center in the Millenium Development Goals (MDGs).

The Bangkok statement was named the Bangkok Charter that identified the implementation gap at the regional and country levels and called for member states to follow through. Among the recommended strategies included

  • Building capacity for policy development, leadership, health promotion practice, knowledge transfer and research, and health literacy.
  • Partner and build alliances
  • Invest in sustainable policies

In 2010, The Eastern Mediterranean region published a capacity mapping tool for health promotion; it was an excellent development after this stop.

The Ottawa Charter’s Sixth Stop: Nairobi, 2009

The Ottawa charter’s Nairobi stop focused on the implementation gap in health promotion; it went further in contrast to the previous ones outlining 59 evidence-based interventions.

A notable follow-up development was the Rio Declaration in 2011. It was a political declaration.

Rio Political Declaration on Social Determinants of Health, 2011

Through this Declaration, political leaders agreed to implement the Social Determinants of Health approach to reduce inequity.

The Seventh Stop: Helsinki, 2013

This stop again reiterated the importance of the “Health -in – all – policies” (HiAP) approach. With this, the participants affirmed their commitment to improving equity in health, considering health as a fundamental right without any discrimination. The Declaration called on the governments to,

  • Commit health and health equity as a political priority
  • Ensure effective structures, resources, and processes to enable health in all policies across all levels
  • Strengthen the capacity of the ministry of health to engage other sectors
  • build capacity to provide evidence on social determinants of health, inequity, and effective responses
  • Adopt transparent audit and accountability mechanisms for health and equity impacts
  • Establish conflict of interest measures
  • Include communities

This link provides access to conference presentations; https://extranet.who.int/kobe_centre/en/news/8GCHP_WKC_20130610

As a follow-up development in 2017 a global network for health-in-all policies was launched; https://actionsdg.ctb.ku.edu/.

The Eighth Stop: Shanghai Declaration, 2016

This stop was held 30 years after the inaugural Ottawa Charter in 1986. And, one year after the UN Sustainable Developmental Goal (SDG) held in 2015. The Declaration aimed at the 2030 agenda of the Sustainable Developmental Goal (SDG). It focused on four themes;

The Declaration called to action,

  • To recognize health as a political choice
  • To counteract interests detrimental to health and remove barriers to empowerment – especially for girls and women
  • To accelerate the implementation of the SDGs through political commitment and financial investment in health promotion

In parallel to the Declaration, the city mayors who attended the conference gave birth to another revolutionary document: Consensus on healthy cities.

The Ottawa charter marches on…

Author: Prasantha De Silva

A specialist in Community Medicine board-certified in Sri Lanka and a research analyst in Canada

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