Ottawa Charter for Health Promotion

These were watershed concepts, and what the Ottawa Charter did for us, it also started to validate new ways of working. In particular, it validated the idea of public health practitioners, health promotion practitioners, as advocates. That we had as part of our role the requirement, in fact, the obligation to advocate for those who were not able to advocate for their own health. It also gave us a mandate to mediate. What that meant is that was requiring of us to intervene when there were health inequities existing in a community. It suggested that health was actually not just the responsibility of the health promotion area, but a concern for all government departments.

All areas of the society and all economic sectors, and that both non-government and voluntary organizations, all had a role to play in the development of a health and a healthful environment. So the mediation process sometimes asked us to challenge the status quo. If there were factors in the environment that were creating an unhealthy scenario or situation, perhaps it was the advertising of tobacco or some other unhealthy product, then the Ottawa Charter encouraged us to mediate and to advocate against that situation. And finally, the third way of working was enabling. And what this was was a process of empowerment.

Again, what it recognized was that the ownership for health actually resided with the participants of the healthcare process, and that our job was to enable them to make decisions to have the skills to make healthy decisions. And so enabling and capacity building became core elements of health promotion. The Ottawa Charter is probably best known for the five areas, so the five action areas. But in actual fact, these, while essentially important, an actual factor is part of the first considerations of working within a full system underpinned by the lesser known ways, three ways of working. I want to now turn to consideration around an ecological model.

Now it’s really interesting that when you look at this model, it’s worth considering that it was printed nearly thirty years ago. But if anything, it’s actually become even more relevant. Especially when you consider the impact of climate change and how the the impact that that is now having upon health. The diagram recognized that the overarching aspect of socioeconomic, cultural, and social and environmental conditions were actually crucial and had a large impact upon the health and well-being of communities and individuals. Our conditions of living and working were also seen as critical to health and the health of those around us. And the provision of healthy food, clean water, and education to all impacted upon the health of both communities and individuals.

This same story has been represented in various different ways. And I chose this particular image because it shows some of the issues that we have to consider. And one of those is reducing his gradient of inequity. This particular man, who’s pushing up a large ball up a hill. Has this job made even more difficult if they’re experiencing poverty? Or perhaps housing pressure, or unemployment, or they lack education? But traditionally what we had done is we had focused our approaches on telling that person that they had to change their behavior without any recognition at all of the impact of the living and working conditions that they were under.