Health promotion comes of age: The Ottawa Charter 20 years later

1. Health promotion comes of age: The Ottawa Charter 20 years later Marcia Hills, RN. PhD VP World Conference, IUHPE President, Canadian Consortium For Health Promotion Research

2. Health promotion: the prodigal daughter of public health • “In the beginning”….the Ottawa Charter • The middle years: lost in the wilderness • The return of the promise: health promotion comes of age

3. Health Promotion… • “Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment.”

4. Health • “Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being..”

5. ‘Prerequisites’ and determinants of health • The fundamental conditions and resources for health are: • peace • shelter • education • food • income • a stable eco-system • sustainable resources • social justice • equity. • Improvement in health requires a secure foundation in these basic prerequisites.

6. Initial Promise: 1986-1994 • The Lalonde Report (1974) • The Epp Framework (1986) • Health promotion grew up in Canada without ‘health education’ grandparents • The Creation of ‘Centres of Excellence’ for health promotion

7. Health Promotion Infrastructure • The federal government creates a health promotion directorate (Irv Rootman) • Every province creates health promotion departments, offices, directorates etc. • Every province initiates work around health promotion settings (e.g. schools, communities, hospitals, workplaces, etc.)

8. The Middle Years: the exile of health promotion 1994-2002 • Health promotion is too elitist and exclusionary • Epidemiologists feel left out • Population health argues for the need to bring a ‘science base’ to the question of determinants of health (CIAR) • Health promotion ‘values’ are supressed • Population health promotion (Bhatti & Hamilton, 1996)

9. The Language of Population Health • Health & Welfare Canada drops ‘welfare’ and becomes ‘Health Canada’ • Health promotion ‘disappears’ and becomes the ‘population health approach’ • More emphasis on early childhood development and other areas open to easier measurement (this lead to a bias towards lifestyle approaches)

10. The Canadian Consortium for Health Promotion Research • Created in 1992, 16 academic Centres across the country • Never gave up hope that health promotion would come back and that its core values were fundamental for improving the health of all Canadians • The daughter laboured in the wilderness to sustain the development of health promotion despite its relative neglect at the centre of power

11. The International Union for Health Promotion & Health Education • Changed its name from International Union for Health Education..Lavada Pinder (A Canadian) was a key advocate for this change • Since this move IUHPE has been the lead international organization that pushes the development of health promotion as a field • Canadians have been at the forefront of IUHPE (e.g. Irv Rootman, Michel O’Neill) and this has had an important impact on Canadian policy development

12. The Return of the Promise • The creation of the Public Health Agency of Canada and the appointment of incredible leadership that advocates for health promotion and have a deep understanding and commitment to health promotion values • Linkages between CCHPR, PHAC & CPHA become stronger • CCHPR wins bid to hold next IUHPE World Conference in Vancouver, Canada in June, 2007.

13. “This is an exciting time as we renew our commitment to health promotion twenty-one years after the Ottawa Charter.” "Nous vivons présentement un temps très excitant.  Nous renouvelons notre engagement à la promotion de la santé vingt-et-un ans après la Charte d'Ottawa." "Estos son tiempos muy importantes en los que renovamos nuestro compromisocon la promoción de la salud 21 años después de la Carta de Ottawa". Marcia Hills, Conference Chair David Butler Jones, Honorary Co-Chair WELCOME! BIENVENUE! BIENVENIDO!

14. "The IUHPE Vancouver conference will be a sensitive barometer of progress since the health promotion movement burst onto the scene in Ottawa in 1986.” Maurice B Mittelmark President IUHPE

15. “The leadership of Canada in HP is recognized all over the world due notably to the Lalonde Report, the Ottawa Charter, the Epp document as well as projects like Healthy Communities.” (Helena Restrepo, Colombia)

16. “There are several examples of the Canadian influence on Brazilian health promotion.” (Márcia Faria Westphal & Tatiana Pluciennik Dowbor, Brazil)

17. “We see the Canadian Public Health system as a dynamic policymaker, capable of promoting crucial social and structural system changes.” (Hiram Arroyo, Puerto Rico)

18. “Health promotion experts advocate participatory approaches to evaluate programmes on which Canada has had significant influence. This Canadian way was adopted for the programmes implemented by Aide Médicale Internationale.” (Valéry Ridde, Suraya Dalile, Shukrrullah Wahidi., Linda Bartlett, Afghanistan)

19. “Canada contributes to improving the determinants of health by fostering basic education, promoting women’s rights, strengthening grassroots economy in rural areas as well as stimulating decentralization and community participation in local decisions.” (Awa Seck, Senegal, March, 2006)

20. “It is mainly through its donor capacity that Canada has influenced the development of Health Promotion, a role often underestimated and misunderstood.” (Jan Ritchie, Pacific Islands March , 2006)

21. “PAHO looks towards Canada, searching for expertise to acquire and disseminate knowledge and experiences among developing countries.” (Helena Restrepo, Colombia)

22. “No olvidemos que la enfermedad de muchos chilenos no es más que expresión de la desigualdad social y la pobreza... Asimismo señalamos que la forma más segura de alcanzar la equidad en salud es evitando la enfermedad, poniendo al alcance de todos los conocimientos e instrumentos que permitan mantener sana a la población. Por eso, nuestro primer compromiso es reforzar la salud pública de modo de actuar integralmente en la promoción de la salud y la prevención de la enfermedad.” Presidente Ricardo Lagos Hospital Barros Luco, 2004

23. “Thousands of participants from every continent and most countries will attend with eagerness, enthusiasm and dedication to the cause of equity in health. On that basis alone, we can declare already that Ottawa spawned a healthy, vigorous, effective and growing movement. How fitting that we celebrate this success in Vancouver!” Maurice B MittelmarkPresident, IUHPE

24. “Professionals exchange experiences with Canadian counterparts and Canadian professors regularly visit and students go to Canada for graduate studies in health promotion.” (Márcia Faria Westphal & Tatiana Pluciennik Dowbor, Brazil)