The Legacy of the Ottawa Charter: A Landmark Document

The Ottawa Charter has been praised as a catalyst for “a paradigm shift in the way in which public health problems are conceptualized and addressed” (Nutbeam, 2008). This landmark document has influenced political action and stimulated health promotion research to support an evidence-based approach to public health (WHO Regional Office for Europe, 2011). Its legacy includes a political commitment to advocate for individual and social actions that promote health, mediate between different communities or groups to protect health, and enable empowerment to optimize health (Thompson et al., 2017).

The Ottawa Charter was created by wealthy, industrialized countries that have functioning democratic governments and social welfare systems (Nutbeam, 2008). Therefore, the perspective of developing countries is lacking. How have significant changes, particularly in the areas of technology, work, energy production, and urbanization, hurt or benefited different countries? Inclusion of other countries will help us better understand the impacts of worldwide changes such as the globalization of trade, the internet, and mobile communications (Nutbeam, 2008). The Ottawa Charter aims to support countries to achieve their full health potential, as described in Video 1 (WHO Regional Office for Europe, 2011).

Video 1. The creation of the Ottawa Charter for Health Promotion (WHO Regional Office for Europe, 2011).

On a global scale, the Ottawa Charter can be used as a template to shape health practices that reduce health inequalities. Accessible, affordable, and appropriate healthcare still remains out of reach for many people in the world (Nutbeam, 2008). This demands a unified response to re-orient health services. Historically, there has been an overemphasis on personal responsibility and focusing on the individual’s health behaviours as opposed to demanding upstream changes that would influence populations by addressing societal-wide issues (Thompson et al., 2017). A successful re-orientation of health services requires identifying geographic areas or populations at high risk and creating culturally sensitive programs to support the needs of these vulnerable groups (Flynn, 2014). For example, food guidelines should take into account cultural traditions, the types of foods that are considered acceptable within the community, and the available food in the area (Flynn, 2014). One health promotion initiative is calorie menu labeling to create supportive environments (Flynn, 2014). Also, mandatory folic acid food fortification for birth defect prevention is a form of health promotion (Flynn, 2014). Within Canada, the Ottawa Charter has played a role in overcoming cultural and language barriers. For example, an Indo-Asian community in Calgary that was prone to diabetes received screening procedures by trained volunteers when and where their community gathered (e.g. after religious ceremonies in places of worship) in English, Punjabi, Gujarati, or Hindi (Flynn, 2014). Increasing the accessibility of the information regarding healthy diets and activity habits to prevent or manage diabetes was beneficial to this community (Flynn, 2014). Knowing which populations are at high risk for a poor health outcome helps leaders make strategic plans and target resources (Flynn, 2014).

Canada’s goals are to improve accessibility of good health care and reduce health hazards, both mental and physical, for high risk Canadians (Lalonde, 1974). The core strategies involved in health promotion are (Lalonde, 1974):

1. Health Promotion Strategy: Inform individuals and organizations about health matters and encourage them to be active participants in optimizing health.

2. Regulatory Strategy: Use federal and provincial regulatory powers to minimize health hazards.

3. Research Strategy: Understand health challenges and apply discoveries to solve mental and physical problems.

4. Health Care Efficiency Strategy: Deliver health care that balances the interests of Canadians with accessibility, cost, and effectiveness.

5. Goal-Setting Strategy: Create goals to reach the full health potential of Canadians and improve the health care system.

Lalonde (1974) argued that healthcare professionals, health institutions, educators, scientists, businesses, and trade unions should be brought together to implement changes in solidarity. Despite the creation of the Ottawa Charter and evidence that widespread consultation is needed to optimize strategies at the municipal, provincial and federal levels, there has yet to be substantial follow-through on health promotion commitments. Is Canada high on pro-health promotion rhetoric and low on activity? In my view, yes; insufficient healthcare funding, which has resulted in the underdevelopment of primary health services, lackluster disease prevention plans, and unsupported frontline workers, indicates that meaningful health promotion activities are a low priority to the Canadian government. In my role as a Regional Director for the Health Sciences Association, I amplify the voices of healthcare workers and put pressure on political and community leaders to implement necessary changes.

In my role as a Neurophysiology Technologist, I see the relevance of health promotion as it can significantly decrease the frequency and severity of seizures. A healthy diet, adequate sleep, avoiding drugs and alcohol, not missing doses of anti-epileptic medications, avoiding prolonged screen-time (e.g. playing video games) may contribute to improved seizure control. If a patient can understand the precipitating factors or triggers for their seizures, they can develop personal skills to help minimize their occurrence. Access to the newest research and trends is useful to people that are managing a seizure disorder. The Epilepsy Society is one example of a collection of people that strengthen community action and create supportive environments by providing patients and their families relevant information to discuss in support groups. Referring to the Ottawa Charter is useful when considering remedial actions to a health issue. The Ottawa Charter should be used to guide the development of strategies that support the health of Canadians, especially with an ageing population and the growing burden of chronic diseases. Moreover, the emergence of new threats such as Covid-19 and its variants, requires assessments that lead to recommendations on how to create living and working conditions that are safe, satisfying, and enjoyable.

References:

Flynn, M.A.T. (2014). Empowering people to be healthier: Public health nutrition through the Ottawa Charter. Proceedings of the Nutrition Society, 74, 303-312. https://www.doi.org/10.1017/S002966511400161X

Lalonde, M. (1974). A new perspective on the health of Canadians. Ottawa: Government of Canada. https://www.phac-aspc.gc.ca/ph-sp/pdf/perspect-eng.pdf

Nutbeam, D. (2008). What would the Ottawa Charter look like if it were written today? Critical Public Health, 18(4), 435-411. https://doi.org/10.1080/09581590802551208

Thompson, S. R., Watson, M. C., & Tilford, S. (2017). The Ottawa Charter 30 years on: Still an important standard for health promotion. International Journal of Health Promotion and Education, 56, 73-84. https://doi.org/10.1080/14635240.2017.1415765

UK Parliament Health Committee. 2015. Public Health Post 2013: Structures, Organisation, Funding and Delivery Enquiry. Health Committee. Retrieved from https://www.parliament.uk/business/committees/committees-a-z/commons-select/

health-committee/inquiries/parliament-2015/public-healthpost-2013-inquiry-15-16/

WHO Regional Office for Europe [WHO Regional Office for Europe]. (2011, September 13). The journey from Ottawa to health 2020. YouTube. Retrieved from https://www.youtube.com/watch?v=gJ1H2ojwb2Q