“What’s love got to do, got to do with it? What’s love but a second-hand emotion?
What’s love got to do, got to do with it? What’s love but a sweet old-fashioned notion?”
(Schmitt, 2023)
Introduction
Now that I have Tina Turner’s hit song What’s Love Got To Do With It playing in your subconscious, I’d like to ask you – what does the Ottawa Charter got to do, got to do with health promotion?
To be completely honest, before we discussed this in my current MHST631 course at Athabasca University, I personally had not heard of The Ottawa Charter. Today, Public Health Ontario (2024) describes health promotion as the process of implementing a range of social and environmental interventions that enable people and communities to increase control over and to improve their health (PHO, 2024). But when and where did the notion of health promotion start? In this blog, I will discuss the role The Ottawa Charter has played in health promotion, globally and across Canada, as well as how it has influenced my professional practice.
What is the Ottawa Charter?
As a response to growing expectations for a new public health movement around the world, the first International Conference on Health Promotion was held in Ottawa in November 1986 (WHO, 1986). Almost thirty-eight years ago, this conference called upon the World Health Organization (WHO) to advocate the promotion of health in all appropriate forums and to support countries in setting up strategies and programs for health promotion (WHO, 1986). Described as a landmark document (Let’s Learn Public Health, 2017), the Ottawa Charter has been influential in providing guidance on the goals and concepts of health promotion, and the principles it laid out are still in use today (Let’s Learn Public Health, 2017). Let’s quickly review some of the key principles the Ottawa Charter provided for us (WHO, 1986):
PREREQUISITES FOR HEALTH: these include peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity. Improvement in health requires a secure foundation in these basic prerequisites.
The Ottawa Charter identified three strategies to promote health:
ADVOCATE: political, economic, social cultural, environmental, behavioural and biological factors can favour health or be harmful to it – health promotion action must aim at making these conditions favourable through advocacy for health.
ENABLE: health promotion focuses on achieving equity in health by ensuring equal opportunities and resources to enable all people to achieve their fullest health potential.
MEDIATE: health promotion requires coordinated action by everyone – the prerequisites for health cannot be ensured by the health sector alone.
The Ottawa Charter also described five action areas to drive health promotion:
BUILD HEALTHY PUBLIC POLICY: health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health.
CREATE SUPPORTIVE ENVIRONMENTS: the way society organizes work should help create a healthy society. Health promotion generates living and working conditions that are safe, stimulating, satisfying, and enjoyable.
STRENGTHEN COMMUNITY ACTION: health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. The empowerment of communities, their ownership and control of their own endeavors and destinies is at the heart of this process.
DEVELOP PERSONAL SKILLS: health promotion supports personal and social development through providing information, education for health and enhancing life skills. Enabling people to learn throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential.
REORIENT HEALTH SERVICES: the responsibility for health promotion is shared among individuals, community groups, health professionals, health service institutions and governments. Requires stronger attention to health research as well as changes in professional education and training that leads to a change of in attitude which refocuses on the total needs of the individual as a whole person.
Conference participants were convinced that if everyone joined forces in introducing strategies for health promotion, Health for All by the year 2000 would become a reality (WHO, 1986). Were they right?
What role has it played in globally?
As identified by Thompson et al, the Ottawa Charter galvanized health departments around the world and put health promotion on the agenda of many countries as never before (Thompson et al., 2018). Since 1986, the WHO Global Health Promotion Conferences have continued to establish and develop the global principles and action areas for health promotion (WHO, n.d.). For example, the ninth global conference, which was held in Shanghai in 2016, showcased the critical links between promoting health and the 2030 Agenda for Sustainable Development (WHO, n.d.). As described on their website, WHO’s core mission is to promote health, alongside keeping the world safe and serving the vulnerable (WHO, n.d.). As Thompson et al have identified, globally there remains significant challenges and the recognition of major and widening social inequalities in health requires further work at all levels of health promotion (Thompson et al., 2018). The Ottawa Charter created the foundation upon which these global initiatives could be built.
What role has it played in health promotion in Canada?
Across Canada, the Ottawa Charter has played a role in shaping health promotion through providing focus on collaboration and partnerships, to develop strategies to improve health (Government of Canada, 2013). As described by the Government of Canada (2013), a key element of a population health approach is recognition that improving health is a shared responsibility (Government of Canada, 2013). Each level of government, the private sector and every Canadian has a role to play in health promotion in Canada. Some examples of these roles as described the Government of Canada include:
FEDERAL LEVEL: create a climate for improving health by providing coordination and leadership; encouraging national and international collaboration; providing the public and other stakeholders with the information and tools they need.
PROVINCIAL AND TERRITORIAL LEVEL: collaborating across ministries and levels of government to develop health public policies; developing health goals and accountability frameworks; balancing investments across the health system.
PRIVATE SECTOR: provide a safe and healthy working environment with opportunities for continuous learning; considers its responsibilities for protecting the environment; contributes to the overall well-being of the community.
LOCAL LEVEL: develop partnerships that address determinants of health; planning and providing high-quality services; sharing information and resources to maximize health impacts; involve citizens in setting priorities and implementing programs.
INDIVIDUAL LEVEL: take responsibility for our own health and well-being; actively seeking information we need to make informed health decisions; building supportive communities.
(Government of Canada, 2013)
How has the Ottawa Charter influenced my professional practice?
Reflecting on the strategies and action areas identified in the Ottawa Charter, I was drawn to review what characteristics were identified by my regulatory bodies. The Canadian Society of Medical Laboratory Science has identified that the medical laboratory profession may be right for you if you are curious, process-oriented, accurate, and self-sufficient (CSMLS, n.d.). I believe each of these characteristics could be used to describe me and my approach to leadership. Within the Code of Ethics for Medical Laboratory Technologists, we are obligated through our professional and personal conduct to serve our patients, the public, and the profession (CMLTO, 2017). Some expectations defined by the College of Medical Laboratory Technologists in Ontario that align with the Ottawa Charter are:
Value, respect and protect the rights, welfare and dignity of all patients by providing patient care with respect for human rights, regardless of race, ethnicity, religion, language, sexual orientation, gender identity, age, socio-economic status, and mental or physical abilities.
Promoting a culture of safety with colleagues and other healthcare team members
Take appropriate action in situations which may jeopardize patient care or harm the profession.
Contribute to ongoing quality improvement in the provision of healthcare services.
Promote learning by facilitating the sharing of knowledge, skills and judgment with colleagues, students, other healthcare professionals, and the public. (CMLTO,2017)
Although these characteristics and professional expectations may not be directly linked to the Ottawa Charter, I believe that the five action areas and the focus on health promotion initiated by the Charter has had an impact on shaping the expected culture in my regulatory body.
Conclusion:
Is the Ottawa Charter a second-hand emotion or a sweet old-fashioned notion?
As Thompson et al have identified, even though there are well documented achievements stemming from the Ottawa Charter, there is still work to be done (Thompson et al., 2018). I agree with Wilberg et al who identified that the Ottawa Charter remains a relevant concept as its vision highlights relevant issues that have yet to be resolved and presents roles for health promoters yet to be fulfilled and action areas yet to be optimally implemented (Wilberg et al., 2021). As such, I believe the Ottawa Charter is neither a second-hand emotion nor a sweet old-fashioned notion. It continues to provide a framework for which health promotion should continue to develop globally and across Canada. For me personally, and professionally, I believe the strategies and action areas laid out in the Ottawa Charter are applicable to health promotion within my organization and across my community. I look forward to continuing my learning on how to utilize health promotion effectively and efficiently to improve the services my organization provides for our patients and their families.
References
Canadian Society for Medical Laboratory Science. (n.d.). Key characteristics of a medical laboratory professional. Medical Laboratory Professionals. https://csmls.org/Medical-Laboratory-Professionals/Why-become-a-Medical-Lab-Professional/Key-Characteristics.aspx
College of Medical Laboratory Technologists of Ontario. (2017, September). Code of ethics for medical laboratory technologists. http://cmlto.com/images/stories/About_CMLTO/cmlto_coe_sept_2017.pdf
Government of Canada. (2013, January 15). Health is everyone’s business. Population Health. https://www.canada.ca/en/public-health/services/health-promotion/population-health/health-is-everyones-business.html
Let’s Learn Public Health. (2017, March 4). Introduction to health promotion and the Ottawa charter [Video]. YouTube. https://youtu.be/G2quVLcJVBk
Public Health Ontario. (2014, May 1). Health promotion. Health topics. https://www.publichealthontario.ca/en/Health-Topics/Health-Promotion
Schmitt, Dick. (2023, May 24). What’s love got to do with it (lead sheet with lyrics). Musescore. https://musescore.com/user/498481/scores/10961887
Thompson, S. R., Watson, M. C., & Tilford, S. (2018). The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education, 56(2), 73–84. https://doi.org/10.1080/14635240.2017.1415765
Tina Turner. (2020, November 26). What’s love got to do with it (black & white version) [Video]. YouTube. https://www.youtube.com/watch?v=0_HlgOJYp04
Wilberg, A., Saboga-Nunes, L., & Stock, C. (2021). Are we there yet? Use of the Ottawa Charter action areas in the perspective of European health promotion professionals. Journal of Public Health (Germany), 29(1), 1–7. https://doi.org/10.1007/s10389-019-01108-x
World Health Organization. (1986). Ottawa charter for health promotion, 1986 (No. WHO/EURO: 1986-4044-43803-61677). World Health Organization. Regional Office for Europe. https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf
World Health Organization. (n.d.). Health promotion. Health topics. https://www.who.int/health-topics/health-promotion
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