Public Health Ottawa Charter
by
Evelyne de Leeuw
  • LAST REVIEWED: 15 June 2015
  • LAST MODIFIED: 31 March 2016
  • DOI: 10.1093/obo/9780199756797-0070

Introduction

The Ottawa Charter for Health Promotion (see Introductory Works) is widely regarded as the visionary gospel for the international health promotion movement. Agreed upon and published at the First International Conference on Health Promotion (Ottawa, 17–21 November 1986), it codified and amalgamated a number of changes in health perspectives that started to emerge in the 1960s and 1970s. It called for a broader social model of health to complement, not replace, the disease-oriented and often-individual behaviorist clinical perspective.

Introductory Works

Although many believe that the Ottawa Charter launched the notion of “health promotion,” this concept had existed in English-speaking nations since the late 1970s. The European office of the World Health Organization (WHO) took the lead in adding consistency to the concept. This development aligned with the ambition of WHO and its member states to accomplish “Health for All by the Year 2000.” In the European region, work toward this goal started in earnest in the early 1980s with the development of sets of targets (World Health Organization Regional Office for Europe 1984a and World Health Organization Regional Office for Europe 1984b). These evolved from a large set of quantitative disease-oriented parameters to a smaller set of requirements, as discussed in de Leeuw 1985. The Ottawa Charter reflects this health orientation and determinants approach (Kickbusch 2003).

  • de Leeuw, E. 1985. “2000—A health odyssey: An inquiry into the planning and design of a regional strategy for health for all by the year 2000 in the European Region of the World Health Organization.” PhD diss., University of Limburg, Maastricht, The Netherlands.

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    Describes the shift in processes and priorities: focus turned from epidemiological measures to social and political measures for European WHO policy in the late 1970s and early 1980s.

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    • Kickbusch, I. 2003. The contribution of the World Health Organization to a new public health and health promotion. American Journal of Public Health 93.3: 383–388.

      DOI: 10.2105/AJPH.93.3.383Save Citation »Export Citation »E-mail Citation »

      A historical analysis, with a realist reflection on the role of WHO as a change agent in global disease prevention and health promotion.

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      • World Health Organization, Health and Welfare Canada, and Canadian Public Health Association. 1986. Ottawa Charter for Health Promotion: An international conference on health promotion—the move towards a new public health, Nov. 17–21, Ottawa. Geneva, Switzerland: World Health Organization.

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        Very brief (three pages) but highly influential conference statement calling for (1) advocacy for health; enabling people to take control; and mediation across sectors and groups for health; (2) Healthy Public Policies, which must be established to ensure comprehensive policy approaches in all sectors toward health; (3) supportive social and physical environments for health, to make intersectoral health development possible in a socio-ecological health approach; (4) community action and development, which is at the core of public control over defining health determinants, and the development of personal skills to enable individuals to make healthier choices; and (5) reorientation of health services toward active pursuit of community health rather than a focus on the cure of individual diseases.

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        • World Health Organization Regional Office for Europe. 1984a. Regional targets in support of the regional strategy for health for all. Document EUR/RC34/7, 14 July 1984. Copenhagen: World Health Organization Regional Office for Europe.

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          Landmark WHO Europe publication, explicitly acknowledging for the first time the importance of addressing social and political determinants of health.

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          • World Health Organization Regional Office for Europe. 1984b. Health promotion: A discussion document on the concept and principles. ICP/HSR 602. Copenhagen: World Health Organization Regional Office for Europe.

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            The conceptual groundwork for the Ottawa Charter for Health Promotion. Broad discussion of social and environmental trends, and shifts in (popular/lay) views of health and medicine. Reprinted in Health Promotion 1.1 (1986): 73–76 and Public Health Review 14.3–4 (1986): 245–254.

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            Textbooks and Anthologies

            There are many textbooks and anthologies that address health-promotion theory, planning, implementation, and evaluation with a growing emphasis, since the late 1990s, on evidence and program logic. Few textbooks, however, ground themselves firmly in Ottawa Charter values and perspectives. De Leeuw 1989 was the first to provide a structured review of social and theoretical advances leading to the charter’s action areas. Bunton and MacDonald 1992 more rigorously applies a critical social science perspective, with Pederson, et al. 1994 looking at the practical strengths of the charter in one country (Canada). Tones and Green 2004, more than any other text, provides a comprehensive social science review of the theoretical and empirical successes and failures of the charter and gives an excellent planning framework. Pan American Health Organization 1996 is an excellent anthology of influential foundation and follow-up papers documenting implementation of the charter.

            • Bunton, R., and G. MacDonald. 1992. Health promotion: Disciplines and diversity. New York: Routledge.

              DOI: 10.4324/9780203412848Save Citation »Export Citation »E-mail Citation »

              Sociological review of the Ottawa Charter and its premises.

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              • de Leeuw, E. 1989. The sane revolution: Health promotion—backgrounds, scope, prospects. Assen, The Netherlands: Van Gorcum.

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                Critical appraisal of the ideological foundations of the Ottawa Charter. Assessment of particular issues surrounding healthful public policy, ecological approaches to human health, and holistic health development. Argues for more theory- and evidence-based approaches toward health promotion.

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                • Pan American Health Organization, ed. 1996. Health promotion: An anthology. Washington, DC: Pan American Health Organization.

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                  A compilation of twenty-six articles published earlier on history, Ottawa Charter action areas, and health promotion for specific groups and environments. Editors chose publications by number of citations and expert assessment. Published by Pan American Health Organization (PAHO), it has a global scope, with contributions from Europe and Australia. Issues pertaining to lower- and middle-income countries are less prominent. Published in Spanish as Promoción de la salud: Una antología.

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                  • Pederson, P., M. O’Neill, and I. Rootman, eds. 1994. Health promotion in Canada: Provincial, national and international perspectives. Toronto: W. B. Saunders.

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                    A first review of the implementation and effectiveness of the Canadian health promotion framework launched at the Ottawa Conference. The authors see nominal progress and some effectiveness and optimistically look forward to further advances in health promotion in Canada.

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                    • Rootman, I., S. Dupéré, A. Pederson, and M. O’Neill, eds. Health promotion in Canada: Critical perspectives on practice. 3d ed. Toronto: Canadian Scholars, 2012.

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                      The third edition of Health Promotion in Canada adds perspectives on scholarship and reflexivity of Canadian accomplishments in a global context.

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                      • Tones, K., and J. Green. 2004. Health promotion: Planning and strategies. London: SAGE.

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                        This book contains an extensive introductory section that critically evaluates and assesses key concepts of the Ottawa Charter then proceeds to apply these to the development and evaluation of comprehensive health promotion strategies.

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                        Antecedents

                        The Ottawa Charter for Health Promotion is very much a child of the 1970s, in which great hopes for a better (health and social) future were voiced. The Alma-Ata Declaration on primary health care is a direct antecedent to the charter. In turn, both the Alma Ata Declaration and the Ottawa Charter drew on novel and often-critical analyses from disciplines relatively new to the health sciences. Syme 2005 shows how they emerged from sociology and social epidemiology in the early 1960s. In synergy, health-focused social movements (e.g., women’s health exemplified by the Boston Women’s Health Book Collective and the self-help movement [Katz 1981]) and serious critiques of the biomedical pathogenic paradigm of health (Illich 1976 and McKeown 1982) sought to explore new approaches to individual and population health development. The behaviorist and often victim-blaming approach of traditional health education was criticized and initially fully dismissed (Illich 1976, Crawford 1980) then was rebalanced in a political agenda of health. The pathogenic paradigm was complemented with a more positive alternative, the salutogenic paradigm (Antonovsky 1979). Similar shifts occurred in health policy development. Internationally, health policy innovation found inspiration in Lalonde 1974, based on conceptual health planning and policy development work by Hubert Laframboise and Henrik Blum. The bridge to health promotion was constructed in Milio 1981, credited with launching the term “healthy public policy.”

                        • Antonovsky, A. 1979. Health, stress and coping. Jossey-Bass Social and Behavioral Science. San Francisco: Jossey-Bass.

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                          In studying the effects of stress and coping mechanisms on health, Aaron Antonovsky found that one should study and consider those factors that are, in fact, making health, rather than causing disease. This approach to positive health he called “salutogenesis,” and the idea that one can invest in one’s health to develop resilience in the face of health threats has become one of the strongest value drivers of the Ottawa Charter approach.

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                          • Boston Women’s Health Book Collective.

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                            With a feminist grounding, the collective published the self-help book Our Bodies Ourselves in a number of iterations over four decades. As a pivotal health movement, it has been most influential in advocating empowerment and full control over one’s fate, reflected in the Ottawa Charter’s perspective: “People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health.”

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                            • Crawford, R. 1980. Healthism and the medicalization of everyday life. International Journal of Health Services 10.3: 365–388.

                              DOI: 10.2190/3H2H-3XJN-3KAY-G9NYSave Citation »Export Citation »E-mail Citation »

                              Crawford saw an imminent danger in the apparent popularization and prioritization of health matters, in professional as well as lay circles, observed in the 1970s. Such “healthism” (i.e., a dominance of health arguments over any other) would inevitably lead to medicalization (i.e., bringing under a medical regime matters that should rightfully remain in the social domain).

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                              • Illich, I. 1976. Limits to medicine: Medical nemesis, the expropriation of health. London: Marion Boyars.

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                                Illich describes how medicine is part of a supply-driven disease market or medical-industrial complex. Where health should be owned by people, he argues, it has in fact become the domain of a caste of medical professionals. They contribute, mostly unwittingly, to “iatrogenesis” (ill health produced by medical activity). Illich identifies three types (clinical, social, and cultural) that, combined, outweigh the benefits of medicine.

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                                • Katz, A. H. 1981. Self-help and mutual aid: An emerging social movement? Annual Review of Sociology 7:129–155.

                                  DOI: 10.1146/annurev.so.07.080181.001021Save Citation »Export Citation »E-mail Citation »

                                  With Lowell Levin and David Mechanic, Alfred Katz became an influential health sociologist, a proponent of the view that people are their own best healers and carers. Such self-help and mutual-aid practices were required to be embedded in favorable social contexts or “supportive environments.”

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                                  • Lalonde, M. 1974. A new perspective on the health of Canadians—a working document. Ottawa, ON: Minister of Supply and Services Canada.

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                                    Canadian Minister of Health and Welfare Marc Lalonde adopted the “health field concept” developed by Laframboise and Blum in streamlining and reorienting the nation’s health policy directions. Whereas Canada had emphasized policies for the health-care system (and most countries indeed continue to do so), these authors recognized that because health is determined by biology, environment, behavior, and the health system, all these factors should be addressed through public policy.

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                                    • McKeown, T. 1982. The role of medicine: Dream, mirage or nemesis? Oxford: Blackwell.

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                                      McKeown challenges the view that population health has improved since the Industrial Revolution due to advances in clinical medical science, espousing germ theory and its consequent microbiological-intervention repertoire. In a tuberculosis case study, he demonstrates that rapid declines in morbidity and mortality from infectious disease had actually started before the introduction of clinical interventions. He attributes such changes to better nutrition, sanitation, and standards of living, thus becoming an advocate for a social model of health.

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                                      • Milio, N. 1981. Promoting health through public policy. Philadelphia: F. A. Davis.

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                                        The originator of the term “healthy public policy” determines approaches and connections between issues and players in all public-policy domains. She argues for a comprehensive executive-led but community-driven development of healthy public policy.

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                                        • Syme, S. L. 2005. Historical perspective: The social determinants of disease—some roots of the movement. Epidemiologic Perspectives and Innovation 2:2.

                                          DOI: 10.1186/1742-5573-2-2Save Citation »Export Citation »E-mail Citation »

                                          A personal history of social epidemiology by its sociologist-father. Describes the evolution of the increasing awareness of connections between health and social environments since the late 1950s. The author regrets that because of successful data “fishing expeditions,” the emphasis on explanatory theory has temporarily disappeared. Good bibliography pointing at redressing that flaw in social epidemiology.

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                                          Substance

                                          The Ottawa Charter for Health Promotion has as its subtitle The Move towards a New Public Health. This “new public health,” as discussed in Ashton and Seymour 1988 and World Health Organization 1996, would embrace a social model of health and salutogenic rather than pathogenic paradigm, revisiting the activist and radical roots of the “old” public health. Moving toward this new public health requires the pursuit of a number of objectives identified in the charter, as covered in a 1986 special issue of Health Promotion International (Turner, et al. 1986).

                                          • Ashton, J., and H. Seymour. 1988. The new public health. Milton Keynes, UK: Open Univ. Press.

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                                            Ashton and Seymour reflect on the radical public health development that took place during the British Industrial Revolution (in the mid-1800s), recognizing that the style for a new public health may be similar (advocacy for systemic change), but that the context and substance have changed dramatically. Issues of community health, equity, and sustainability require health social action.

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                                            • Scottish Health Education Group, ed. 1984. European monographs in health education research. Vol. 6. Edinburgh: Scottish Health Education Group.

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                                              The evolution of the substance of the Ottawa Charter is mapped. Kickbusch (pp. vi–vii) introduces health promotion as a social project. Anderson (pp. 1–126) describes the roots, discourses, and issues in developing consensus on the direction and substance of a new public health; that is, health promotion. Dean (pp. 127–150) presents a review of behavioral theories, linking individual beliefs and lifestyles. Robertson summarizes his scenarios for lifestyles and health (pp. 151–172), and Grossman explores the workplace as a setting for health.

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                                              • Turner, Jill, Robert Anderson, and John Catford, eds. 1986. Special issue: The Ottawa Charter. Health Promotion International 1.4.

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                                                This issue of Health Promotion can be considered the benchmark document for Ottawa Charter–style health promotion, containing all background documents and political statements pertinent to the charter. The special official conference report is included, with brief reflections on conference sessions that dealt with creating healthy public policy, strengthening communities, creating environments conducive to health, developing personal skills, and reorienting health services. The journal issue concludes with a strong statement on the need for health promotion in developing countries.

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                                                • World Health Organization. 1996. The new public health challenges and the World Health Organization Ninth General Programme of Work: Report of the Interregional Meeting on New Public Health, Geneva, 27–30 November 1995. Geneva, Switzerland: WHO.

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                                                  In the 1990s, “new public health” reentered the WHO political agenda, and a meeting was convened to explore its nature and thrust. Participants agreed that it was not that a new public health was needed, but rather a rebalancing from clinical to global and social perspectives in public health.

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                                                  Critiques

                                                  The Ottawa Charter was initially criticized (or rather, ignored), by the traditional public health and health education establishment for being too radical. Scholarly publications claimed the charter was not radical enough. Such a critique is particularly dominant in community development and empowerment circles. Robertson and Minkler 1994 cautions that a community base should be rigorously defended. Glenn Laverack further substantiates this by demonstrating that power is an essential ingredient in community-based health promotion work, and, with Ronald Labonte, he shows that this is an issue of global concern (Labonte and Laverack 2008).

                                                  • Labonte, R., and G. Laverack. 2008. Health promotion in action: From local to global empowerment. Basingstoke, UK: Palgrave Macmillan.

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                                                    The call for health promotion is further strengthened by means of analysis of the forces of globalization and the important role that empowered individuals, groups, communities, and agencies can play in generating a beneficial approach to global health promotion, fully in line with the Ottawa Charter.

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                                                    • Laverack, G. 2004. Health promotion practice: Power and empowerment. London: SAGE.

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                                                      The argument in Robertson and Minkler 1994 is presented consistently and at greater length in works by Laverack and colleagues such as Labonte and Raphael: the health promotion movement should remain vigilant in the face of liberal and new public-management politics for health, as the approach might be co-opted easily. Laverack demonstrates that the power that lies in people is the most important force in health promotion and development, and that health professionals and academics need to come to grips with balancing expert power with community engagement.

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                                                      • Robertson, A., and M. Minkler. 1994. New health promotion movement: A critical examination. Health Education Quarterly 21.3: 295–312.

                                                        DOI: 10.1177/109019819402100303Save Citation »Export Citation »E-mail Citation »

                                                        Robertson and Minkler review the thrust of the “health promotion movement” that emerged from the Ottawa Conference and its subsequent International Health Promotion Conferences (see Follow-Up Statements), and discuss the danger that the political agenda that has driven the development of the charter will be corrupted by more functional rather than ideological approaches.

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                                                        Follow-Up Statements

                                                        The conference at which the Ottawa Charter was adopted was the first in a series that continues into the early 21st century (World Health Organization 2009). Initially, it appeared that all action areas of the charter were to be addressed by individual conferences. For instance, the conference at Adelaide (1988) addressed healthy public policy, and the conference at Sundsvall (1991) looked at supportive environments for health. With changes in global (geo)politics and a recognition of the potency of health promotion, however, conference themes shifted. The conference at Jakarta (1997) intimately reviewed the potential of health promotion partnerships. The conference in Mexico (2000) was intended to produce a powerful global political commitment to health promotion but ended with a lower prioritization of health promotion on the World Health Organization (WHO) agenda and a functional rather than visionary rhetoric in the conference statement. The original visionary drive of the Ottawa Charter reemerged in Bangkok (2006), where health promotion in a globalizing world firmly positioned itself as an agent of sustainability and change. The Nairobi (2009) conference produced an (African) call to action for health promotion and a continued commitment to health equity and investment in the social determinants of health. The Helsinki 2013 conference (de Leeuw, et al. 2014) took a new look at the original Ottawa Charter call to “Build Healthy Public Policy” and explored the notion of Health in All Policies (HiAP).

                                                        Adelaide

                                                        The Second International Conference on Health Promotion (Adelaide, South Australia, 5–9 April 1988) was concluded by the Adelaide Recommendations on Healthy Public Policy, as seen in World Health Organization and Commonwealth Department of Community Services and Health 1988. The concept was refined and redefined by its original proponent in Milio 1987, and the definitive glossary was published thirteen years later. Over the years, healthy public policy has become a corrupted and disused concept, and more recently (with stronger public-policy support from, for instance, Finland and the state government of South Australia) rebranded as “Health in All Policies” (Ståhl, et al. 2006; Kickbusch 2010).

                                                        • Kickbusch, I. 2010. Health in all policies: Where to from here? Health Promotion International 25.3: 261–264.

                                                          DOI: 10.1093/heapro/daq055Save Citation »Export Citation »E-mail Citation »

                                                          Kickbusch shows that the context and politics of health have changed considerably since the Adelaide Conference, due to changes in temporal, cognitive, and spatial perceptions and understandings of global health governance. Using John Kingdon’s multiple-streams policy theory, she demonstrates that the 2010s are more opportune for the development of HiAPs than the 1990s were for Health Public Policy (HPP).

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                                                          • Milio, N. 1987. Making healthy public policy—developing a science by learning the art: An ecological framework for policy studies. Health Promotion International 2.3: 263–274.

                                                            DOI: 10.1093/heapro/2.3.263Save Citation »Export Citation »E-mail Citation »

                                                            The originator of the term “healthy public policy” determines approaches and connections between issues and players in all public-policy domains. She argues for a comprehensive executive-led but community-driven development of healthy public policy.

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                                                            • Milio, N. 2001. Glossary: Healthy public policy. Journal of Epidemiology and Community Health 55.9: 622–623.

                                                              DOI: 10.1136/jech.55.9.622Save Citation »Export Citation »E-mail Citation »

                                                              Benchmark publication (encyclopedic rather than glossary) on terms and concepts associated with health policy and its range of permutations (e.g., public health policy, health promotion policy, health policy, health-care policy, and population health policy).

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                                                              • Ståhl, T., M. Wismar, E. Ollila, E. Lahtinen, and K. Leppo, eds. 2006. Health in all policies: Prospects and potentials. Helsinki: Ministry of Social Affairs and Health.

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                                                                Healthy public policy in its new incarnation is called “health in all policies.” This book, launched on the occasion of the Finnish presidency of the EU, for the first time commits national governments to the idea that all public and private policy may have health impact. It also provides lengthy case studies on HiAPs and marks a renewed wave of (scholarly) publications on health policy development.

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                                                                • World Health Organization, and Commonwealth Department of Community Services and Health. 1988. Report on the Adelaide Conference—Healthy Public Policy. Geneva, Switzerland: World Health Organization.

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                                                                  Results of the Second International Conference on Health Promotion, 5–9 April 1988, in Adelaide. Analysis and political call for action to develop “healthy public policy.”

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                                                                  Sundsvall

                                                                  Participants from eighty-one countries gathered in Sundsvall (Sweden) in June 1991 to discuss and review “supportive environments for health.” In the Sundsvall Statement, such environments were recognized to have social and physical dimensions. Equity and social action were found to be essential issues, at a global level, in creating and sustaining supportive environments, as seen in “Supportive Environments for Health” (Action for Public Health 1991). An impressive array of case studies were developed by the Swedish organizers shortly thereafter (Haglund, et al. 1996). These case studies expressly and in great detail illustrate the recommendations embedded in the Sundsvall Statement. Hancock 2007 cautions that the cutting-edge perspective embraced by the statement should not be lost in an era of globalization and dominance of economic considerations.

                                                                  Jakarta

                                                                  The Fourth International Conference on Health Promotion, Jakarta, 1997 was the first to be organized in and by the South. The conference responded to an increased recognition that health is dependent not just on public-sector action and investment but, possibly more significantly, on a range of other actors, including nongovernmental organizations and industry. This was reflected in the title of the conference “New Players for a New Era: Leading Health Promotion into the 21st Century,” and the resulting Jakarta Declaration (World Health Organization 1997) argued that health promotion is a sound investment in health and social development for all. The social determinants of health approach as an intersectoral responsibility was prioritized as central to the success of 21st-century health promotion action. As such, it endorsed new policy tools such as health and social impact assessment (Scott-Samuel, et al. 2001).

                                                                  • Scott-Samuel, A., M. Birley, and K. Ardern. 2001. The Merseyside guidelines for health impact assessment. 2d ed. Liverpool, UK: International Health Impact Assessment Consortium.

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                                                                    Health and social impact assessment has grown into a critical public-policy mechanism for partnership development. These guidelines form the benchmark for any new public health action.

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                                                                    • World Health Organization. 1997. The Jakarta Declaration on leading health promotion into the 21st century. Health Promotion International 12.4: 261–264.

                                                                      DOI: 10.1093/heapro/12.4.261Save Citation »Export Citation »E-mail Citation »

                                                                      This statement recognizes the importance of joint action and partnership among public, private, and voluntary sectors and calls for the development of such mechanisms and the tools required to enable them.

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                                                                      Mexico

                                                                      Many delegates at the Fifth Global Conference on Health Promotion (Mexico, 5–9 June 2000) believed that the Ottawa Charter, in the hands of WHO, had lost its shine and social-activist perspective (Mittelmark, et al. 2001). The Mexico Ministerial Statement (Ministers of Health 2000), they assert, was formulated in the standard rhetoric of the UN, and keynote addresses connected health promotion with specific diseases rather than with the equity, social action, and determinants approach espoused at earlier conferences. In a response, Kickbusch 2001 states that although this might seem the case within the WHO system, a decade and a half of health promotion development has been successful, and that many perspectives from sectors and disciplines, earlier considered peripheral to the movement, now very closely align in their value system (e.g., Nussbaum and Sen 1993).

                                                                      • Kickbusch, I. 2001. Mexico and beyond. Health Promotion International 16.1: 1.

                                                                        DOI: 10.1093/heapro/16.1.1Save Citation »Export Citation »E-mail Citation »

                                                                        The “Mother of the Ottawa Charter” subtly lends support to Mittelmark, et al. 2001 in demonstrating that perhaps WHO has lost its health promotion bearings but that, more importantly, it has found sustained attention in a literature much more profound than health sciences alone.

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                                                                        • Ministers of Health. 2000. Mexico Ministerial Statement for the Promotion of Health: From ideas to action. Health Promotion International 15.4: 275–276.

                                                                          DOI: 10.1093/heapro/15.4.275Save Citation »Export Citation »E-mail Citation »

                                                                          Of all Global Conference on Health Promotion statements, the briefest and most diplomatic. Reads as a UN General Assembly resolution without any of the sharper edges that characterized other statements. Ministers of Health commit themselves to health promotion action.

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                                                                          • Mittelmark, M. B., M. Akerman, D. Gillis, et al. 2001. Mexico Conference on Health Promotion: Open letter to WHO Director General, Dr Gro Harlem Brundtland. Health Promotion International 16.1: 3–4.

                                                                            DOI: 10.1093/heapro/16.1.3Save Citation »Export Citation »E-mail Citation »

                                                                            The authors, who were leaders in the development and diffusion of the Ottawa Charter body of knowledge, analyze the preparations and proceedings of the Mexico Conference as technocratic and coming from a pathogenic paradigm. They call for the support and explicit commitment of the WHO to a social model of health and a salutogenic paradigm.

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                                                                            • Nussbaum, M. C., and A. Sen, eds. 1993. The quality of life. WIDER Studies in Development Economics. Oxford: Clarendon.

                                                                              DOI: 10.1093/0198287976.001.0001Save Citation »Export Citation »E-mail Citation »

                                                                              Martha Nussbaum and Amartya Sen compiled and edited a critical text looking at ethics, morality, and developmental capacity to make a world that sheds its materialistic (hyperexpansionist [HE] scenario) parameters. Freeing themselves from traditional economics and adopting a feminist and emancipatory paradigm, they align closely with the text of the Ottawa Charter and see life as a resource, not a product.

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                                                                              Bangkok

                                                                              The Bangkok Global Conference on Health Promotion (2005) explicitly addressed health in a globalized and globalizing world. The conference and its outcome (the Bangkok Charter) recognized that many phenomena and issues affecting health transcend the traditional nation-state governance systems and in some cases fully escape public-policy control (Tang, et al. 2006). In such a networked environment, where actors and institutions have started to play new “glocal” (global and local; see Kickbusch 1999) roles, full consideration must be given to new governance mechanisms. Porter 2007, however, suggests that the Bangkok Charter uses a different semantic from the Ottawa Charter and that this may signify a shift toward resource-dominated rather than social-globalization discourses.

                                                                              • Kickbusch, I. 1999. Global + local = glocal public health. Journal of Epidemiology and Community Health 53.8: 451–452.

                                                                                DOI: 10.1136/jech.53.8.451Save Citation »Export Citation »E-mail Citation »

                                                                                Kickbusch introduces the glocalization concept into the health sciences, reviewing the Healthy Cities project (an Ottawa Charter spin-off). Whereas other social scientists regard this as a challenge (reconciling the importance of the local in a global context), this author sees an opportunity where local entities network and learn at global levels.

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                                                                                • Porter, C. 2007. Ottawa to Bangkok: Changing health promotion discourse. Health Promotion International 22.1: 72–79.

                                                                                  DOI: 10.1093/heapro/dal037Save Citation »Export Citation »E-mail Citation »

                                                                                  The author demonstrates a shift from the “new social movements” discourse of ecosocial justice in Ottawa to a “new capitalist” discourse of law and economics in Bangkok. She accuses the Bangkok Charter of being apolitical and at risk of perpetuating the detrimental consequences of globalization, rather than—as the Bangkok Charter claims— contributing to an improvement of social determinants of health at a global level.

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                                                                                  • Tang, K. C., R. Beaglehole, and E. de Leeuw, eds. 2006. Special Issue: Sixth Global Conference on Health Promotion, Bangkok, August 2005. Health Promotion International 21.S1.

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                                                                                    This special issue contains the Bangkok Charter and background documentation on phenomena affecting the globalization of health (e.g., climate change, gender issues), its consequences (e.g., governance and diplomacy for health, trade), and three reviews showing the need to build individual, scholarly, and institutional capacity to make globalization work for health promotion.

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                                                                                    Nairobi

                                                                                    The Seventh Global Conference on Health Promotion, Nairobi, 2009 resulted in the Nairobi Call to Action (World Health Organization 2009). The meeting stood out in two ways: it was the first to mobilize and amalgamate a very strong African voice in the health promotion discourse and departed from the regurgitation of rhetoric in formulating a number of priority areas for health promotion action (Amuyunzu-Nyamongo and Nyamawa 2009, Catford 2010) on the basis of a series of systematic-review background documents (World Health Organization 2010).

                                                                                    • Amuyunzu-Nyamongo, M., and D. Nyamawa, eds. 2009. Evidence of health promotion effectiveness in Africa. Nairobi, Kenya: African Institute for Health and Development.

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                                                                                      Case studies and analyses from across Africa demonstrating the validity and effectiveness of health promotion approaches as formulated at earlier Global Health Promotion Conferences.

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                                                                                      • Catford, J. 2010. Implementing the Nairobi call to action: Africa’s opportunity to light the way. Health Promotion International 25.1: 1–4.

                                                                                        DOI: 10.1093/heapro/daq018Save Citation »Export Citation »E-mail Citation »

                                                                                        Catford reviews the (empowerment) process of the Nairobi Conference and identifies its unique opportunity to accelerate the social and political prioritization of health promotion and the consequences of the WHO Report on Social Determinants of Health for Africa.

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                                                                                        • World Health Organization. 2009. Nairobi Call to Action. Geneva, Switzerland: World Health Organization.

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                                                                                          The Nairobi Call to Action formulates concrete approaches for individuals, groups, governments, and other institutions to strengthen leadership and workforces, mainstream health promotion, empower communities and individuals, enhance participatory processes, and build and apply knowledge.

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                                                                                          • World Health Organization. 2010. Seventh Global Conference on Health Promotion Geneva. Geneva, Switzerland: World Health Organization.

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                                                                                            This conference’s background work consisted of a number of systematic reviews resulting in working documents: health literacy and health promotion, community empowerment, health-promoting health systems, moving forward to equity in health, building capacity, a primer for mainstreaming health promotion, and mainstreaming health promotion—a practical toolkit.

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                                                                                            Helsinki

                                                                                            The Eighth Global Conference on Health Promotion (de Leeuw, et al. 2014) reconsidered the original call to build Healthy Public Policy and adopted the Helsinki Statement on Health in All Policies and the Health in All Policies Framework for Country Action. The meeting was driven by developmental work on Health in All Policies in Finland (Ståhl, et al. 2006), South Australia (Kickbusch and Buckett 2010), and regional offices of the World Health Organization supported by the Rockefeller Foundation (World Health Organization 2013). The conference started a global movement toward development of Health in All Policies (de Leeuw, et al. 2014; Rudolph, et al. 2013).

                                                                                            Evolution

                                                                                            The Ottawa Conference and its charter have evolved by means of the formal World Health Organization (WHO) endeavors in subsequent conferences and their statements. At an applied level, a number of spin-off ventures can be identified. The first is an emphasis on healthy settings (Poland, et al. 2000; Dooris 2006; Frank and Engelke 2001)—the Ottawa Charter states that “(H)ealth is created and lived by people within the settings of their everyday life; where they learn, work, play and love”—and a multitude of settings for health promotion have been identified (e.g., islands, marketplaces, prisons), of which healthy cities (Tsouros and Green, 2009) and health-promoting schools (Lister-Sharp, et al. 1999) have been documented most convincingly. Clearly the evidence-based policy/practice argument has entered the Ottawa Charter health promotion discourse as well, and its main champions (International Union for Health Promotion and Education [IUHPE], Centers for Disease Control and Prevention [CDC], WHO, and the European Union) contributed to the launch of the Global Programme on Health Promotion Effectiveness (GPHPE) in 2000. GPHPE is a continuous endeavor that has delivered three comprehensive reviews at this stage (Rootman, et al. 2001; McQueen and Jones 2007; Amuyunzu-Nyamongo and Nyamawa 2009).

                                                                                            • Amuyunzu-Nyamongo, M., and D. Nyamawa, eds. 2009. Evidence of health promotion effectiveness in Africa. Nairobi, Kenya: African Institute for Health and Development.

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                                                                                              Contributors from the great diversity of African nations describe case-based reviews demonstrating the validity of the original Ottawa Charter approaches. They successfully connect primary health care, population health concepts, and the development discourse with core notions of the charter, including empowerment, community capacity, and health as a human resource.

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                                                                                              • Dooris, M. 2006. Healthy settings: Challenges to generating evidence of effectiveness. Health Promotion International 21.1: 55–65.

                                                                                                DOI: 10.1093/heapro/dai030Save Citation »Export Citation »E-mail Citation »

                                                                                                Dooris argues that research for evidence in settings for health creates particular methodological and theoretical challenges. Evidence generated in (quasi-)experimental studies may not apply to settings, and settings may not lend themselves to mechanistic theory. Dooris proposes an ecological, community-driven approach that would generate appropriate evidence for policy and practice.

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                                                                                                • Frank, L. D., and P. O. Engelke. 2001. The built environment and human activity patterns: Exploring the impacts of urban form on public health. Journal of Planning Literature 16.2: 202–218.

                                                                                                  DOI: 10.1177/08854120122093339Save Citation »Export Citation »E-mail Citation »

                                                                                                  Classic review of the connection between the larger built environment and population health. The overwhelming evidence shows that physical environments in settings for health are a critical determinant. The authors demonstrate that such a link is strong, and their article is widely used for legitimizing further research into the “how” question in a range of disciplines.

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                                                                                                  • Lister-Sharp, D., S. Chapman, S. Stewart-Brown, and A. Sowden. 1999. Health promoting schools and health promotion in schools: Two systematic reviews. Health Technology Assessment 3.22. Southampton, UK: National Coordinating Centre for Health Technology Assessment.

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                                                                                                    Elaborate and powerful review of the two iterations of the school as a setting for health: “health promotion in schools” (mostly a North American denomination) and “health-promoting schools” (a term adopted by the WHO, Europe, and Australia). Either is found effective. Challenges include the sustainable integration of the approach in institutional and public-policy environments.

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                                                                                                    • McQueen, D., and C. M. Jones, eds. 2007. Global perspectives on health promotion effectiveness. New York: Springer.

                                                                                                      DOI: 10.1007/978-0-387-70974-1Save Citation »Export Citation »E-mail Citation »

                                                                                                      Synthesis of the first body of evidence literature on global effectiveness. Discusses successes and failures in evidence generation, highlighting some tough arenas such as peace building, globalization, and policy development. Other areas (such as school health, mental health, and physical evidence) have a fairly solid evidence base that needs to be strengthened in the context of particular settings for health or political developments.

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                                                                                                      • Poland, B., L. Green, and I. Rootman. 2000. Settings for health promotion: Linking theory and practice. London: SAGE.

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                                                                                                        Excellent and comprehensive review of the theoretical and conceptual foundations of settings for health, with a good collection of case studies. Challenges identified include the integration of different settings-based endeavors in consistent policy frameworks.

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                                                                                                        • Rootman, I., M. Goodstadt, B. Hyndman, et al, eds. 2001. Evaluation in health promotion: Principles and perspectives. WHO Regional Publications, European Series 92. Copenhagen: World Health Organization Europe.

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                                                                                                          First comprehensive and systemic review of all aspects of health promotion evaluation. A foundational document for approaches further developed in the GPHPE. Includes a powerful discussion of the nature of evidence in and for practice, and practice for evidence.

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                                                                                                          • Tsouros, A., and G. Green, eds. 2009. Special supplement on European Healthy Cities. Health Promotion International 24.S1.

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                                                                                                            First published comprehensive and methodologically sound review of a phase in the official European WHO Healthy Cities Project. Focuses on theoretical and methodological foundations and innovations then proceeds to review key tenets: equity, urban planning, intersectoral action (partnerships and networking), health impact assessment, and community action and empowerment.

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                                                                                                            • Tsouros, A., and G. Green, eds. 2013. Special Supplement on WHO European Healthy Cities Network. Journal of Urban Health 90.S1.

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                                                                                                              Comprehensive evaluation document of Phase IV of the European WHO Healthy Cities Project, with empirical evidence of efficacy of local action for health promotion, most notably partnership work, collaborative action on health equity, health impact assessment, and methodology.

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