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Skip to 0 minutes and 13 seconds Movement towards health. Now that you have explored the definitions of health promotion, let us take a look at how health promotion can be implemented in practice. The international agreement on health promotion was signed in 1986 and is known as the Ottawa Charter for health promotion. In order to move people towards health, the Ottawa Charter identified that health promotion needs to be operationalised through five levels of action. Building healthy public policy, creating supportive environments, developing personal skills, strengthening community action including networks and reorientation of health services. These levels of action are underpinned by concepts of advocacy enabling and mediation and link to the World Health Organisation definition of health promotion.

Skip to 1 minute and 12 seconds So, let us take a look at how this can work in practice using tobacco as an example. Tobacco is a unique product as it is legally available but kills half of its users. The health impacts of tobacco are well documented, including cancers, heart disease and respiratory illness. So, tobacco is a leading cause of preventable deaths on a global basis. It is also a major issue in relation to inequality with those most deprived, homeless and with mental ill health disproportionately smoking. Using the five elements of the Ottawa Charter in building healthy public policy the World Health Organisation developed the first international health treaty known as the framework convention on tobacco control which came into force in 2005.

Skip to 2 minutes and 9 seconds This policy has subsequently been translated into national policies around the world. This framework has created a supportive environment for countries to tackle tobacco use and works to eliminate illicit trade in tobacco and to support economically viable alternatives for tobacco growers. At a population level the policy has worked by introducing taxation to support price rises, smoke free public places and the strict regulation of tobacco advertising. Developing personal skills in tobacco is evidence based. Helping to support people to quit this addiction. The implementation of smoking cessation services provides support to smokers to help them quit by behavioural change and pharmacotherapy has been demonstrated to be effective in reducing smoking.

Skip to 3 minutes and 9 seconds Living in disadvantaged communities has been shown to be associated with smoking and the development of illicit places selling tobacco. Therefore, there is a need to strengthen community action including networks. One of the most effective campaigns that uses this approach is the Youth Smoking Prevention Truth Campaign in America. The final strand of this Charter is the reorientation of health services and in tobacco control, healthcare can have an important role to play in ensuring hospital grounds and buildings are smoke free. Support is provided to both staff, patients and clients to quit smoking and at every opportunity patients are asked about their smoking status, advised on how to quit and referred for support.

Skip to 4 minutes and 2 seconds So, this is one example of how a coordinated approach to health promotion using the elements of the Ottawa Charter can improve health outcomes.

Movement towards health

Now that you have explored the definitions of health promotion, let us take a look at how health promotion can be implemented in practice.

Listen to Pauline talk about the Ottawa Charter for Health Promotion (1986) and its relevance today.

Ottawa Charter logo Ottawa Charter emblem (1986) reproduced with permission from WHO http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index4.html

The Ottawa Charter identifies that health promotion needs to be operationalised through five levels of action:

  • Building healthy public policy
  • Creating supportive environments
  • Developing personal skills
  • Strengthening community action including networks
  • Reorientation of health services

These levels of action are underpinned by concepts of advocacy, enabling and mediation, and are linked to the WHO definition of health promotion (First International Conference on Health Promotion 1986).

An effective campaign that uses this approach is the youth smoking prevention Truth Initiative in the USA.

Your task

Produce a spider diagram on a health promotion issue related to your area of practice. You could do this using a word processing tool such as Microsoft Word, with a presentation tool such as PowerPoint, or you could draw your diagram by hand, then take a picture of it with your phone.

First, you will need to research a health issue that you could address in your area of practice, eg smoking, drugs, alcohol, adherence to medication, breastfeeding, etc. Then create your spider diagram.

  • Place the health issue in the centre of the diagram along with detail on your area of practice.
  • This should be surrounded by five boxes, each of which contains one of the five areas of action from the Ottawa Charter:
    1. Building healthy public policy
    2. Creating supportive environments
    3. Developing personal skills
    4. Strengthening community action including networks
    5. Reorientation of health services
  • Provide an example in each box of how the health issue could be addressed in your area of practice.
  • Assess which of the five areas would be most effective and why.

Visit one of the Padlet walls below, upload your diagram and discuss the resource you have developed:

Please remember to:

  • include your name on your post – this should be the same name you use on the FutureLearn platform
  • add a title and a short description to help your peers understand what it is
  • identify one other posting which is dissimilar to yours and critically and objectively review the key points made.

Help using Padlet

Padlet is a simple tool that allows you to post your ideas and/or share media (eg images, video) with other learners.

To add your content to the wall select the + icon or double-click on the wall itself. You will then be able to either upload what you have discovered or link to a URL that is available in your browser address bar. For more information on how to post, please visit the Padlet website.

By following any of the links to Padlet you will be taken to a third party website. On this website you may be asked to submit some information about yourself. Please make sure you are familiar with the terms and conditions and privacy policy of the third party website before submitting your information.

Whether you follow the links and submit your personal information or not, your course progress will in no way be affected.

Helpful reading for the task

Hosseinpoor, A. R., Parker, L. A., Tursan d’Espaignet, E., and Chatterji, S. (2012) ‘Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries: Results from the World Health Survey’. PLoS ONE. [online] 7 (8), e42843. available from https://doi.org/10.1371/journal.pone.0042843 [19 June 2018]

Steinberg, M., Williams, J., and Yi, Y. (2015) ‘Poor Mental Health and Reduced Decline in Smoking Prevalence’. American Journal of Preventive Medicine [online] 49 (3), 362-369. available from https://dx.doi.org/10.1016%2Fj.amepre.2015.01.016 [19 June 2018]

Truth Initiative (n.d.) Who We Are and What We Do [online] available from https://truthinitiative.org/about-us [4 July 2018]

Tsai, J., and Rosenheck, R. (2012) ‘Smoking Among Chronically Homeless Adults: Prevalence and Correlates’. Psychiatric Services [online] 63 (96), 569-576. available from https://doi.org/10.1176/appi.ps.201100398 [19 June 2018]

WHO (2003) Framework Convention on Tobacco Control. Geneva: WHO. available from http://apps.who.int/iris/bitstream/handle/10665/42811/9241591013.pdf [19 June 2018]


First International Conference on Health Promotion (1986) ‘Ottawa Charter for Health Promotion’. Health Promotion International. [online] 1 (4). available from https://doi.org/10.1093/heapro/1.4.405 [19 June 2018]

WHO (1986) Ottawa Charter emblem [online] available from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index4.html [16 August 2018]

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Could You Be the Next Florence Nightingale?

Coventry University