Milestones in Health Promotion: Statements from Global Conferences

health
PROMOTION


Milestones in Health Promotion
Statements from Global Conferences


Health Promotion


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Design and layout by Zando Escultura




Milestones in Health Promotion
Statements from Global Conferences




The Ottawa Charter for Health Promotionii


Contents
1 The Ottawa Charter for Health Promotion


17-21 November 1986


6 Adelaide Recommendations on Healthy Public Policy


5-9 April 1988


12 Sundsvall Statement on Supportive Environments for Health


9-15 June 1991


17 Jakarta Declaration on Leading Health Promotion into the 21st Century


21-25 July 1997


22 Mexico Ministerial Statement for the Promotion of Health: From Ideas to Action


5-9 June 2000


24 The Bangkok Charter for Health Promotion in a Globalized World


7-11 August 2005


29 Annex 1: A Discussion Document on the Concept and Principles of Health Promotion


9-13 July 1984


33 Annex 2: Health Promotion Emblem




Milestones in Health Promotion: Statements from Global Conferences 1


The Ottawa Charter for Health Promotion
First International Conference on Health Promotion
Ottawa, 17-21 November 1986


The first International Conference on Health Promotion, meeting in Ottawa this 21st day of November 1986,


hereby presents this CHARTER for action to achieve Health for All by the year 2000 and beyond.


This conference was primarily a response to growing expectations for a new public health movement around


the world. Discussions focused on the needs in industrialized countries, but took into account similar


concerns in all other regions. It built on the progress made through the Declaration on Primary Health Care


at Alma-Ata, the World Health Organization’s Targets for Health for All document, and the recent debate at


the World Health Assembly on intersectoral action for health.


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. 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.


Prerequisites for Health


The fundamental conditions and resources for


health are:


• 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 for Health Promotion2


MEDIATE


The prerequisites and prospects for health


cannot be ensured by the health sector alone.


More importantly, health promotion demands


coordinated action by all concerned: by


governments, by health and other social and


economic sectors, by nongovernmental and


voluntary organization, by local authorities, by


industry and by the media. People in all walks


of life are involved as individuals, families and


communities. Professional and social groups


and health personnel have a major responsibility


to mediate between differing interests in society


for the pursuit of health.


Health promotion strategies and programmes


should be adapted to the local needs and


possibilities of individual countries and regions


to take into account differing social, cultural and


economic systems.


ADvOCATE


Good health is a major resource for social,


economic and personal development and an


important dimension of quality of life. Political,


economic, social, cultural, environmental,


behavioural and biological factors can all favour


health or be harmful to it. Health promotion


action aims at making these conditions


favourable through advocacy for health.


ENABLE


Health promotion focuses on achieving equity


in health. Health promotion action aims at


reducing differences in current health status and


ensuring equal opportunities and resources to


enable all people to achieve their fullest health


potential. This includes a secure foundation in a


supportive environment, access to information,


life skills and opportunities for making healthy


choices. People cannot achieve their fullest


health potential unless they are able to take


control of those things which determine their


health. This must apply equally to women and


men.




Milestones in Health Promotion: Statements from Global Conferences 3


Health Promotion Action Means:


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.


Health promotion policy combines diverse but


complementary approaches including legislation,


fiscal measures, taxation and organizational


change. It is coordinated action that leads to


health, income and social policies that foster


greater equity. Joint action contributes to ensuring


safer and healthier goods and services, healthier


public services, and cleaner, more enjoyable


environments.


Health promotion policy requires the identification


of obstacles to the adoption of healthy public


policies in non-health sectors, and ways of removing


them. The aim must be to make the healthier choice


the easier choice for policy makers as well.


Create Supportive Environments


Our societies are complex and interrelated.


Health cannot be separated from other goals.


The inextricable links between people and


their environment constitutes the basis for a


socioecological approach to health. The overall


guiding principle for the world, nations, regions


and communities alike, is the need to encourage


reciprocal maintenance - to take care of each other,


our communities and our natural environment.


The conservation of natural resources throughout


the world should be emphasized as a global


responsibility.


Changing patterns of life, work and leisure have


a significant impact on health. Work and leisure


should be a source of health for people. 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.


Systematic assessment of the health impact of a


rapidly changing environment - particularly in


areas of technology, work, energy production and


urbanization - is essential and must be followed


by action to ensure positive benefit to the health


of the public. The protection of the natural and


built environments and the conservation of


natural resources must be addressed in any health


promotion strategy.


Strengthen Community Actions


Health promotion works through concrete and


effective community action in setting priorities,


making decisions, planning strategies and


implementing them to achieve better health. At


the heart of this process is the empowerment of


communities - their ownership and control of their


own endeavours and destinies.


Community development draws on existing human


and material resources in the community to enhance


self-help and social support, and to develop flexible


systems for strengthening public participation in


and direction of health matters. This requires full


and continuous access to information, learning


opportunities for health, as well as funding support.




The Ottawa Charter for Health Promotion4


Develop Personal Skills


Health promotion supports personal and social


development through providing information,


education for health, and enhancing life skills. By so


doing, it increases the options available to people to


exercise more control over their own health and over


their environments, and to make choices conducive


to health.


Enabling people to learn, throughout life, to prepare


themselves for all of its stages and to cope with


chronic illness and injuries is essential. This has to


be facilitated in school, home, work and community


settings. Action is required through educational,


professional, commercial and voluntary bodies, and


within the institutions themselves.


Reorient Health Services


The responsibility for health promotion in health


services is shared among individuals, community


groups, health professionals, health service


institutions and governments.


They must work together towards a health


care system which contributes to the pursuit of


health. The role of the health sector must move


increasingly in a health promotion direction,


beyond its responsibility for providing clinical


and curative services. Health services need to


embrace an expanded mandate which is sensitive


and respects cultural needs. This mandate should


support the needs of individuals and communities


for a healthier life, and open channels between


the health sector and broader social, political,


economic and physical environmental


components.


Reorienting health services also requires stronger


attention to health research as well as changes in


professional education and training. This must lead


to a change of attitude and organization of health


services which refocuses on the total needs of the


individual as a whole person.


Moving into the Future


Health is created and lived by people within the


settings of their everyday life; where they learn,


work, play and love. Health is created by caring for


oneself and others, by being able to take decisions


and have control over one’s life circumstances, and


by ensuring that the society one lives in creates


conditions that allow the attainment of health by all


its members.


Caring, holism and ecology are essential issues in


developing strategies for health promotion. Therefore,


those involved should take as a guiding principle


that, in each phase of planning, implementation and


evaluation of health promotion activities, women and


men should become equal partners.


Commitment to Health Promotion


The participants in this Conference pledge:


• to move into the arena of healthy public policy,


and to advocate a clear political commitment to


health and equity in all sectors;


• to counteract the pressures towards harmful


products, resource depletion, unhealthy living


conditions and environments, and bad nutrition;


and to focus attention on public health issues


such as pollution, occupational hazards, housing


and settlements;


• to respond to the health gap within and between




Milestones in Health Promotion: Statements from Global Conferences 5


societies, and to tackle the inequities in health


produced by the rules and practices of these


societies;


• to acknowledge people as the main health


resource; to support and enable them to keep


themselves, their families and friends healthy


through financial and other means, and to accept


the community as the essential voice in matters


of its health, living conditions and well-being;


• to reorient health services and their resources


towards the promotion of health; and to share


power with other sectors, other disciplines and,


most importantly, with people themselves;


• to recognize health and its maintenance as a


major social investment and challenge; and to


address the overall ecological issue of our ways


of living.


The Conference urges all concerned to join them in


their commitment to a strong public health alliance.


Call for International Action


The Conference calls on the World Health Organization and other international organizations to


advocate the promotion of health in all appropriate forums and to support countries in setting up


strategies and programmes for health promotion.


The Conference is firmly convinced that if people in all walks of life, nongovernmental and voluntary


organizations, governments, the World Health Organization and all other bodies concerned join forces


in introducing strategies for health promotion, in line with the moral and social values that form the


basis of this CHARTER, Health For All by the year 2000 will become a reality.


Charter adopted at an international conference on health promotion, ‘The move towards a new public health’, 17-21 November


1986 Ottawa, Ontario, Canada.*


www.who.int/healthpromotion/conferences/ottawa.pdf


* Co-sponsored by the Canadian Public Health Association, Health and Welfare Canada, and the World Health Organization.




Adelaide Recommendations on Healthy Public Policy6


Adelaide Recommendations on Healthy
Public Policy
Second International Conference on Health Promotion, Adelaide, South
Australia, 5-9 April 1988


The adoption of the Declaration of Alma-Ata a decade ago was a major milestone in the Health for All


movement which the World Health Assembly launched in 1977. Building on the recognition of health as


a fundamental social goal, the Declaration set a new direction for health policy by emphasizing people’s


involvement, cooperation between sectors of society and primary health care as its foundation.


The Spirit of Alma-Ata


The spirit of Alma-Ata was carried forward in the


Charter for Health Promotion which was adopted in


Ottawa in 1986. The Charter set the challenge for a


move towards the new public health by reaffirming


social justice and equity as prerequisites for health,


and advocacy and mediation as the processes for


their achievement.


These actions are interdependent, but healthy public


policy establishes the environment that makes the


other four possible.


The Adelaide Conference on Healthy Public


Policy continued in the direction set at Alma-Ata


and Ottawa, and built on their momentum. Two


hundred and twenty participants from forty-two


countries shared experiences in formulating and


implementing healthy public policy. The following


recommended strategies for healthy public policy


action reflect the consensus achieved at the


Conference.


Healthy Public Policy


Healthy public policy is characterized by an explicit


concern for health and equity in all areas of policy


and by an accountability for health impact. The


main aim of healthy public policy is to create a


supportive environment to enable people to lead


healthy lives. Such a policy makes health choices


possible or easier for citizens. It makes social


and physical environments health-enhancing. In


the pursuit of healthy public policy, government


The Charter identified five health promotion


action areas:


• build Healthy Public Policy,


• create supportive environments,


• develop personal skills,


• strengthen community action, and


• reorient health services.




7 Milestones in Health Promotion: Statements from Global Conferences


sectors concerned with agriculture, trade,


education, industry, and communications need


to take into account health as an essential factor


when formulating policy. These sectors should be


accountable for the health consequences of their


policy decisions. They should pay as much attention


to health as to economic considerations.


The value of health


Health is both a fundamental human right and a


sound social investment. Governments need to


invest resources in healthy public policy and health


promotion in order to raise the health status of all


their citizens. A basic principle of social justice is


to ensure that people have access to the essentials


for a healthy and satisfying life. At the same time,


this raises overall societal productivity in both


social and economic terms. Healthy public policy


in the short term will lead to long-term economic


benefits as shown by the case studies presented a


this Conference. New efforts must be made to link


economic, social, and health policies into integrated


action.


Equity, access and development


Inequalities in health are rooted in inequities


in society. Closing the health gap between


socially and educationally disadvantaged people


and more advantaged people requires a policy


that will improve access to health-enhancing


goods and services, and create supportive


environments. Such a policy would assign high


priority to underprivileged and vulnerable groups.


Furthermore, a healthy public policy recognizes


the unique culture of indigenous peoples, ethnic


minorities, and immigrants. Equal access to health


services, particularly community health care, is a


vital aspect of equity in health.


New inequalities in health may follow rapid


structural change caused by emerging technologies.


The first target of the European Region of the World


Health Organization, in moving towards Health for


All is that:


“by the year 2000 the actual differences in health


status between countries and between groups


within countries should be reduced by at least 25%


by improving the level of health of disadvantaged


nations and groups.”


In view of the large health gaps between countries,


which this Conference has examined, the developed


countries have an obligation to ensure that their


own policies have a positive health impact on


developing nations. The Conference recommends


that all countries develop healthy public policies that


explicitly address this issue.


Accountability for Health


The recommendations of this Conference will be


realized only if governments at national, regional


and local levels take action. The development


of healthy public policy is as important at the


local levels of government as it is nationally.


Governments should set explicit health goals that


emphasize health promotion.


Public accountability for health is an essential


nutrient for the growth of healthy public policy.


Governments and all other controllers of resources


are ultimately accountable to their people for the


health consequences of their policies, or lack of




Adelaide Recommendations on Healthy Public Policy8


policies. A commitment to healthy public policy


means that governments must measure and report


the health impact of their policies in language that


all groups in society readily understand. Community


action is central to the fostering of healthy public


policy. Taking education and literacy into account,


special efforts must be made to communicate with


those groups most affected by the policy concerned.


The Conference emphasizes the need to evaluate the


impact of policy. Health information systems that


support this process need to be developed. This will


encourage informed decision-making over the future


allocation of resources for the implementation of


healthy public policy.


Moving beyond health care


Healthy public policy responds to the challenges


in health set by an increasingly dynamic and


technologically changing world, with its complex


ecological interactions and growing international


interdependencies. Many of the health consequences


of these challenges cannot be remedied by present


and foreseeable health care. Health promotion


efforts are essential, and these require an integrated


approach to social and economic development


which will reestablish the links between health and


social reform, which the World Health Organization


policies of the past decade have addressed as a basic


principle.


Partners in the policy process


Government plays an important role in health,


but health is also influenced greatly by corporate


and business interests, nongovernmental bodies


and community organizations. Their potential for


preserving and promoting people’s health should be


encouraged. Trade unions, commerce and industry,


academic associations and religious leaders have


many opportunities to act in the health interests of


the whole community. New alliances must be forged


to provide the impetus for health action.


Action Areas


The Conference identified four key areas as priorities


for health public policy for immediate action:


Supporting the health of women


Women are the primary health promoters all over


the world, and most of their work is performed


without pay or for a minimal wage. Women’s


networks and organizations are models for the


process of health promotion organization, planning


and implementation. Women’s networks should


receive more recognition and support from policy-


makers and established institutions. Otherwise, this


investment of women’s labour increases inequity.


For their effective participation in health promotion


women require access to information, networks


and funds. All women, especially those from ethnic,


indigenous, and minority groups, have the right to


self-determination of their health, and should be full


partners in the formulation of healthy public policy


to ensure its cultural relevance.


This Conference proposes that countries start


developing a national women’s healthy public policy


in which women’s own health agendas are central


and which includes proposals for:


• equal sharing of caring work performed in


society;


• birthing practices based on women’s preferences




9 Milestones in Health Promotion: Statements from Global Conferences


and needs;


• supportive mechanisms for caring work, such


as support for mothers with children, parental


leave, and dependent health-care leave.


Food and nutrition


The elimination of hunger and malnutrition is a


fundamental objective of healthy public policy. Such


policy should guarantee universal access to adequate


amounts of healthy food in culturally acceptable


ways. Food and nutrition policies need to integrate


methods of food production and distribution, both


private and public, to achieve equitable prices. A


food and nutrition policy that integrates agricultural,


economic, and environmental factors to ensure a


positive national and international health impact


should be a priority for all governments. The first


stage of such a policy would be the establishment of


goals for nutrition and diet. Taxation and subsidies


should discriminate in favour of easy access for all to


healthy food and an improved diet.


The Conference recommends that governments take


immediate and direct action at all levels to use their


purchasing power in the food market to ensure that


the food-supply under their specific control (such


as catering in hospitals, schools, day-care centres,


welfare services and workplaces) gives consumers


ready access to nutritious food.


Tobacco and alcohol


The use of tobacco and the abuse of alcohol are two


major health hazards that deserve immediate action


through the development of healthy public policies.


Not only is tobacco directly injurious to the health of


the smoker but the health consequences of passive


smoking, especially to infants, are now more clearly


recognized than in the past. Alcohol contributes


to social discord, and physical and mental trauma.


Additionally, the serious ecological consequences


of the use of tobacco as a cash crop in impoverished


economies have contributed to the current world


crises in food production and distribution.


The production and marketing of tobacco and


alcohol are highly profitable activities - especially


to governments through taxation. Governments


often consider that the economic consequences


of reducing the production and consumption of


tobacco and alcohol by altering policy would be too


heavy a price to pay for the health gains involved.


This Conference calls on all governments to consider


the price they are paying in lost human potential


by abetting the loss of life and illness that tobacco


smoking and alcohol abuse cause. Governments


should commit themselves to the development


of healthy public policy by setting nationally-


determined targets to reduce tobacco growing and


alcohol production, marketing and consumption


significantly by the year 2000.


Creating supportive environments


Many people live and work in conditions that


are hazardous to their health and are exposed to


potentially hazardous products. Such problems


often transcend national frontiers.


Environmental management must protect human


health from the direct and indirect adverse effects


of biological, chemical, and physical factors, and


should recognize that women and men are part


of a complex ecosystem. The extremely diverse




Adelaide Recommendations on Healthy Public Policy10


but limited natural resources that enrich life are


essential to the human race. Policies promoting


health can be achieved only in an environment that


conserves resources through global, regional, and


local ecological strategies.


A commitment by all levels of government is


required. Coordinated intersectoral efforts are


needed to ensure that health considerations are


regarded as integral prerequisites for industrial and


agricultural development. At an international level,


the World Health Organization should play a major


role in achieving acceptance of such principles


and should support the concept of sustainable


development.


This Conference advocates that, as a priority,


the public health and ecological movements


join together to develop strategies in pursuit of


socioeconomic development and the conservation of


our planet’s limited resources.


Developing New Health Alliances


The commitment to healthy public policy demands


an approach that emphasizes consultation and


negotiation. Healthy public policy requires strong


advocates who put health high on the agenda of


policy-makers. This means fostering the work of


advocacy groups and helping the media to interpret


complex policy issues.


Educational institutions must respond to the


emerging needs of the new public health by


reorienting existing curricula to include enabling,


mediating, and advocating skills. There must be


a power shift from control to technical support


in policy development. In addition, forums for


the exchange of experiences at local, national and


international levels are needed.


The Conference recommends that local, national


and international bodies:


• establish clearing-houses to promote good


practice in developing healthy public policy;


• develop networks of research workers, training


personnel, and programme managers to help


analyse and implement healthy public policy.


Commitment to Global Public Health


Prerequisites for health and social development are


peace and social justice; nutritious food and clean


water; education and decent housing; a useful role


in society and an adequate income; conservation of


resources and the protection of the ecosystem. The


vision of healthy public policy is the achievement of


these fundamental conditions for healthy living. The


achievement of global health rests on recognizing


and accepting interdependence both within and


between countries. Commitment to global public


health will depend on finding strong means of


international cooperation to act on the issues that


cross national boundaries.


Future Challenges


1. Ensuring an equitable distribution of resources


even in adverse economic circumstances is a


challenge for all nations.


2. Health for All will be achieved only if the creation


and preservation of healthy living and working


conditions become a central concern in all public


policy decisions. Work in all its dimensions -


caring work, opportunities for employment,


quality of working life - dramatically affects




11 Milestones in Health Promotion: Statements from Global Conferences


people’s health and happiness. The impact of


work on health and equity needs to be explored.


3. The most fundamental challenge for individual


nations and international agencies in


achieving healthy public policy is to encourage


collaboration (or developing partnerships) in


peace, human rights and social justice, ecology,


and sustainable development around the globe.


4. In most countries, health is the responsibility of


bodies at different political levels. In the pursuit


of better health it is desirable to find new ways


for collaboration within and between these levels.


5. Healthy public policy must ensure that advances


in health-care technology help, rather than hinder,


the process of achieving improvements in equity.


The Conference strongly recommends that the


World Health Organization continue the dynamic


development of health promotion through the five


strategies described in the Ottawa Charter. It urges


the World Health Organization to expand this


initiative throughout all its regions as an integrated


part of its work. Support for developing countries is


at the heart of this process.


Renewal of Commitment


In the interests of global health, the participants


at the Adelaide Conference urge all concerned to


reaffirm the commitment to a strong public health


alliance that the Ottawa Charter called for.


Extract from the report on the 2nd International Conference


on Health Promotion, ‘Healthy Public Policy’, 5-9 April 1988


Adelaide, South Australia.*


www.who.int/healthpromotion/conferences/adelaide.pdf


* Co-sponsored by the Department of Community Services & Health, Canberra,


Australia and the World Health Organization Regional Office for Europe,


Copenhagen, Denmark.




Sundsvall Statement on Supportive Environments for Health12


Sundsvall Statement on Supportive Environments
for Health
Third International Conference on Health Promotion, Sundsvall,
Sweden, 9-15 June 1991


The Third International Conference on Health Promotion: Supportive Environments for Health - the


Sundsvall Conference - fits into a sequence of events which began with the commitment of WHO to the


goals of Health For All (1977). This was followed by the UNICEF/WHO International Conference on


Primary Health Care, in Alma-Ata (1978), and the First International Conference on Health Promotion in


Industrialized Countries (Ottawa 1986). Subsequent meetings on Healthy Public Policy, (Adelaide 1988)


and a Call for Action: Health Promotion in Developing countries, (Geneva 1989) have further clarified the


relevance and meaning of health promotion. In parallel with these developments in the health arena, public


concern over threats to the global environment has grown dramatically. This was clearly expressed by the


World Commission on Environment and Development in its report Our Common Future, which provided a


new understanding of the imperative of sustainable development.


The Third International Conference on Health


Promotion: Supportive Environments for Health


- the first global conference on health promotion,


with participants from 81 countries - calls upon


people in all parts of the world to actively engage in


making environments more supportive to health.


Examining today’s health and environmental


issues together, the Conference points out that


millions of people are living in extreme poverty


and deprivation in an increasingly degraded


environment that threatens their health, making the


goal of Health For All by the Year 2000 extremely


hard to achieve. The way forward lies in making


the environment - the physical environment, the


social and economic environment, and the political


environment - supportive to health rather than


damaging to it.


The Sundsvall Conference identified many


examples and approaches for creating supportive


environments that can be used by policy-makers,


decision-makers and community activists in the


health and environment sectors. The Conference


recognized that everyone has a role in creating


supportive environments for health.


A Call for Action


This call for action is directed towards policy-


makers and decision-makers in all relevant sectors




13 Milestones in Health Promotion: Statements from Global Conferences


and at all levels. Advocates and activists for health,


environment and social justice are urged to form a


broad alliance towards the common goal of Health


for All. We Conference participants have pledged


to take this message back to our communities,


countries and governments to initiate action. We


also call upon the organizations of the United


Nations system to strengthen their cooperation and


to challenge each other to be truly committed to


sustainable development and equity.


A supportive environment is of paramount


importance for health. The two are interdependent


and inseparable. We urge that the achievement of


both be made central objectives in the setting of


priorities for development, and be given precedence


in resolving competing interests in the everyday


management of government policies.


Inequities are reflected in a widening gap in health


both within our nations and between rich and


poor countries. This is unacceptable. Action to


achieve social justice in health is urgently needed.


Millions of people are living in extreme poverty and


deprivation in an increasingly degraded environment


in both urban and rural areas. An unforeseen and


alarming number of people suffer from the tragic


consequences for health and well-being of armed


conflicts. Rapid population growth is a major threat


to sustainable development. People must survive


without clean water, adequate food, shelter or


sanitation.


Poverty frustrates people’s ambitions and their


dreams of building a better future, while limited


access to political structures undermines the basis


for self-determination. For many, education is


unavailable or insufficient, or, in its present forms,


fails to enable and empower. Millions of children


lack access to basic education and have little hope


for a better future. Women, the majority of the


world’s population, are still oppressed. They are


sexually exploited and suffer from discrimination in


the labour market and many other areas, preventing


them from playing a full role in creating supportive


environments.


More than a billion people worldwide have


inadequate access to essential health care. Health


care systems undoubtedly need to be strengthened.


The solution to these massive problems lies in social


action for health and the resources and creativity


of individuals and their communities. Releasing


this potential requires a fundamental change in the


way we view our health and our environment, and


a clear, strong political commitment to sustainable


health and environmental policies. The solutions lie


beyond the traditional health system.


Initiatives have to come from all sectors that


can contribute to the creation of supportive


environments for health, and must be acted upon


by people in local communities, nationally by


government and nongovernmental organizations,


and globally through international organizations.


Action will predominantly involve such sectors


as education, transport, housing and urban


development, industrial production and agriculture.


Dimensions of Action on Supportive
Environments for Health


In a health context the term supportive environments


refers to both the physical and the social aspects


of our surroundings. It encompasses where people


live, their local community, their home, where they




Sundsvall Statement on Supportive Environments for Health14


work and play. It also embraces the framework


which determines access to resources for living, and


opportunities for empowerment. Thus action to create


supportive environments has many dimensions:


physical, social, spiritual, economic and political.


Each of these dimensions is inextricably linked to


the others in a dynamic interaction. Action must be


coordinated at local, regional, national and global


levels to achieve solutions that are truly sustainable.


The Conference highlighted four aspects of


supportive environments:


• The social dimension, which includes the ways


in which norms, customs and social processes


affect health. In many societies traditional


social relationships are changing in ways that


threaten health, for example, by increasing


social isolation, by depriving life of a meaningful


coherence and purpose, or by challenging


traditional values and cultural heritage.


• The political dimension, which requires


governments to guarantee democratic


participation in decision-making and the


decentralization of responsibilities and


resources. It also requires a commitment to


human rights, peace, and a shifting of resources


from the arms race.


• The economic dimension, which requires a re-


channelling of resources for the achievement


of Health for All and sustainable development,


including the transfer of safe and reliable


technology.


• The need to recognize and use women’s skills


and knowledge in all sectors - including policy-


making, and the economy - in order to develop


a more positive infrastructure for supportive


environments. The burden of the workload


of women should be recognized and shared


between men and women. Women’s community-


based organizations must have a stronger voice


in the development of health promotion policies


and structures.


Proposals for Action


Sundsvall Conference believes that proposals to


implement the Health for All strategies must reflect


two basic principles:


1. Equity must be a basic priority in creating


supportive environments for health, releasing


energy and creative power by including all


human beings in this unique endeavour. All


policies that aim at sustainable development


must be subjected to new types of accountability


procedures in order to achieve an equitable


distribution of responsibilities and resources.


All action and resource allocation must be based


on a clear priority and commitment to the very


poorest, alleviating the extra hardship borne by


the marginalized, minority groups, and people


with disabilities. The industrialized world needs


to pay the environmental and human debt that


has accumulated through exploitation of the


developing world.


2. Public action for supportive environments for


health must recognize the interdependence of


all living beings, and must manage all natural


resources, taking into account the needs of future


generations. Indigenous peoples have a unique


spiritual and cultural relationship with the


physical environment that can provide valuable


lessons for the rest of the world. It is essential,


therefore, that indigenous peoples be involved


in sustainable development activities, and


negotiations be conducted about their rights to


land and cultural heritage.




15 Milestones in Health Promotion: Statements from Global Conferences


It Can be Done: Strengthening Social
Action


A call for the creation of supportive environments


is a practical proposal for public health action at


the local level, with a focus on settings for health


that allow for broad community involvement and


control. Examples from all parts of the world


were presented at the Conference in relation to


education, food, housing, social support and care,


work and transport. They clearly showed that


supportive environments enable people to expand


their capabilities and develop self-reliance. Further


details of these practical proposals are available in


the Conference report and handbook.


Using the examples presented, the Conference


identified four key public health action strategies to


promote the creation of supportive environments at


community level.


1. Strengthening advocacy through community


action, particularly through groups organized by


women.


2. Enabling communities and individuals to take


control over their health and environment


through education and empowerment.


3. Building alliances for health and supportive


environments in order to strengthen the


cooperation between health and environmental


campaigns and strategies.


4. Mediating between conflicting interests in


society in order to ensure equitable access to


supportive environments for health.


In summary, empowerment of people and community


participation were seen as essential factors in a


democratic health promotion approach and the


driving force for self-reliance and development.


Participants in the Conference recognized, in


particular, that education is a basic human right


and a key element in bringing about the political,


economic and social changes needed to make health


a possibility for all. Education should be accessible


throughout life and be built on the principle of


equity, particularly with respect to culture, social


class and gender.


The Global Perspective


People form an integral part of the earth’s


ecosystem. Their health is fundamentally


interlinked with the total environment. All available


information indicates that it will not be possible to


sustain the quality of life, for human beings and all


living species, without drastic changes in attitudes


and behaviour at all levels with regard to the


management and preservation of the environment.


Concerted action to achieve a sustainable,


supportive environment for health is the challenge


of our times.


At the international level, large differences in per


capita income lead to inequalities not only in access


to health but also in the capacity of societies to


improve their situation and sustain a decent quality


of life for future generations. Migration from rural


to urban areas drastically increases the number of


people living in slums, with accompanying problems


- including lack of clean water and sanitation.


Political decision-making and industrial


development are too often based on short-term


planning and economic gains which do not take


into account the true costs to people’s health


and the environment. International debt is




Sundsvall Statement on Supportive Environments for Health16


seriously draining the scarce resources of the poor


countries. Military expenditure is increasing, and


war, in addition to causing deaths and disability,


is now introducing new forms of ecological


vandalism.


Exploitation of the labour force, the exportation


and dumping of hazardous substances, particularly


in the weaker and poorer nations, and the wasteful


consumption of world resources all demonstrate


that the present approach to development is in


crisis. There is an urgent need to advance towards


new ethics and global agreement based on


peaceful coexistence to allow for a more equitable


distribution and utilization of the earth’s limited


resources.


Achieving Global Accountability


The Sundsvall Conference calls upon the


international community to establish nw


mechanisms of health and ecological accountability


that build upon the principles of sustainable health


development. In practice this requires health and


environmental impact statements for major policy


and programme initiatives. WHO and UNEP are


urged to strengthen their efforts to develop codes of


conduct on the trade and marketing of substances


and products harmful to health and the environment.


WHO and UNEP are urged to develop guidelines


based on the principle of sustainable development for


use by Member States. All multilateral and bilateral


donor and funding agencies such as the World


Bank and International Monetary Fund are urged


to use such guidelines in planning, implementing


and assessing development projects. Urgent action


needs to be taken to support developing countries in


identifying and applying their own solutions. Close


collaboration with nongovernmental organizations


should be ensured throughout the process.


The Sundsvall Conference has again demonstrated


that the issues of health, environment and human


development cannot be separated. Development


must imply improvement in the quality of life and


health while preserving the sustainability of the


environment. Only worldwide action based on global


partnership will ensure the future of our planet.


Document resulting from the 3rd International Conference on


Health Promotion, 9-15 June 1991, Sundsvall, Sweden.*


www.who.int/healthpromotion/conferences/sundsvall.pdf


*Co-sponsored by the United Nations Environment Programme, the Nordic


Council of Ministers, and the World Health Organization




17 Milestones in Health Promotion: Statements from Global Conferences


Jakarta Declaration on Leading Health Promotion
into the 21st Century
The Fourth International Conference on Health Promotion: New Players
for a New Era - Leading Health Promotion into the 21st Century, Jakarta,
Indonesia, 21-25 July 1997


The Fourth International Conference on Health Promotion: New Players for a New Era - Leading Health


Promotion into the 21st Century, meeting in Jakarta from 21 to 25 July 1997, has come at a critical moment


in the development of international strategies for health. It is almost 20 years since the World Health


Organization’s Member States made an ambitious commitment to a global strategy for Health for All and


the principles of primary health care through the Declaration of Alma-Ata. It is 11 years since the First


International Conference on Health Promotion was held in Ottawa, Canada. That Conference resulted


in proclamation of the Ottawa Charter for Health Promotion, which has been a source of guidance and


inspiration for health promotion since that time. Subsequent international conferences and meetings have


further clarified the relevance and meaning of key strategies in health promotion, including healthy public


policy (Adelaide, Australia, 1988), and supportive environments for health (Sundsvall, Sweden, 1991).


The Fourth International Conference on Health Promotion is the first to be held in a developing country,


and the first to involve the private sector in supporting health promotion. It has provided an opportunity to


reflect on what has been learned about effective health promotion, to re-examine the determinants of health,


and to identify the directions and strategies that must be adopted to address the challenges of promoting


health in the 21st century. The participants in the Jakarta Conference hereby present this Declaration on


action for health promotion into the next century.


Health promotion is a key
investment


Health is a basic human right and is essential for


social and economic development. Increasingly,


health promotion is being recognized as an essential


element of health development. It is a process of


enabling people to increase control over, and to


improve, their health. Health promotion, through


investment and action, has a marked impact on the


determinants of health so as to create the greatest


health gain for people, to contribute significantly


to the reduction of inequities in health, to further


human rights, and to build social capital. The




Jakarta Declaration on Leading Health Promotion into the 21st Century18


ultimate goal is to increase health expectancy, and


to narrow the gap in health expectancy between


countries and groups.


The Jakarta Declaration on Health Promotion


offers a vision and focus for health promotion into


the next century. It reflects the firm commitment


of participants in the Fourth International


Conference on Health Promotion to draw upon the


widest possible range of resources to tackle health


determinants in the 21st century.


Determinants of health: new
challenges


The prerequisites for health are peace, shelter,


education, social security, social relations, food,


income, the empowerment of women, a stable


eco-system, sustainable resource use, social justice,


respect for human rights, and equity. Above all,


poverty is the greatest threat to health.


Demographic trends such as urbanization, an


increase in the number of older people and


the high prevalence of chronic diseases pose


new problems in all countries. Other social,


behavioural and biological changes such as


increased sedentary behaviour, resistance to


antibiotics and other commonly available drugs,


increased drug abuse, and civil and domestic


violence threaten the health and well-being of


hundreds of millions of people.


New and re-emerging infectious diseases, and the


greater recognition of mental health problems,


require an urgent response. It is vital that


approaches to health promotion evolve to meet


changes in the determinants of health.


Transnational factors also have a significant impact


on health. These include the integration of the


global economy, financial markets and trade, wide


access to media and communications technology,


and environmental degradation as a result of the


irresponsible use of resources.


These changes shape peoples values, their


lifestyles throughout the lifespan, and living


conditions across the world. Some have great


potential for health, such as the development of


communications technology, while others, such


as international trade in tobacco, have a major


negative impact.


Health promotion makes a difference


Research and case studies from around the


world provide convincing evidence that health


promotion is effective. Health promotion strategies


can develop and change lifestyles, and have an


impact on the social, economic and environmental


conditions that determine health. Health promotion


is a practical approach to achieving greater equity


in health.


The five strategies set out in the Ottawa Charter for


Health Promotion are essential for success:


• build healthy public policy


• create supportive environments


• strengthen community action


• develop personal skills


• reorient health services.


There is now clear evidence that:


• comprehensive approaches to health


development are the most effective. Those


that use combinations of the five strategies




19 Milestones in Health Promotion: Statements from Global Conferences


are more effective than single- track


approaches.


• particular settings offer practical opportunities


for the implementation of comprehensive


strategies. These include mega-cities, islands,


cities, municipalities, local communities,


markets, schools, the workplace, and health


care facilities.


• participation is essential to sustain


efforts. People have to be at the centre of


health promotion action and decision-making


processes for them to be effective.


• health learning fosters participation.


Access to education and information is


essential to achieving effective participation


and the empowerment of people and


communities.


These strategies are core elements of health


promotion and are relevant for all countries.


New responses are needed


To address emerging threats to health, new


forms of action are needed. The challenge for


the coming years will be to unlock the potential


for health promotion inherent in many sectors


of society, among local communities, and within


families.


There is a clear need to break through traditional


boundaries within government sectors, between


governmental and nongovernmental organizations,


and between the public and private sectors.


Cooperation is essential; this requires the creation


of new partnerships for health, on an equal footing,


between the different sectors at all levels of


governance in societies.


Priorities for health promotion in the 21st


Century


1. Promote social responsibility for health


Decision-makers must be firmly committed to social


responsibility. Both the public and private sectors


should promote health by pursuing policies and


practices that:


• avoid harming the health of individuals


• protect the environment and ensure sustainable


use of resources


• restrict production of and trade in


inherently harmful goods and substances


such as tobacco and armaments, as well as


discourage unhealthy marketing practices


• safeguard both the citizen in the marketplace


and the individual in the workplace


• include equity-focused health impact


assessments as an integral part of policy


development.


2. Increase investments for health


development


In many countries, current investment in health is


inadequate and often ineffective.


Increasing investment for health development


requires a truly multisectoral approach including,


for example, additional resources for education and


housing as well as for the health sector.


Greater investment for health and reorientation


of existing investments, both within and among


countries, has the potential to achieve significant


advances in human development, health and quality


of life.




Jakarta Declaration on Leading Health Promotion into the 21st Century20


Investments for health should reflect the needs of


particular groups such as women, children, older


people, and indigenous, poor and marginalized


populations.


3. Consolidate and expand partnerships for


health


Health promotion requires partnerships for health


and social development between the different


sectors at all levels of governance and society.


Existing partnerships need to be strengthened


and the potential for new partnerships must be


explored.


Partnerships offer mutual benefit for health through


the sharing of expertise, skills and resources. Each


partnership must be transparent and accountable


and be based on agreed ethical principles, mutual


understanding and respect. WHO guidelines should


be adhered to.


4. Increase community capacity and


empower the individual


Health promotion is carried out by and with people,


not on or to people. It improves both the ability


of individuals to take action, and the capacity of


groups, organizations or communities to influence


the determinants of health.


Improving the capacity of communities for


health promotion requires practical education,


leadership training, and access to resources.


Empowering individuals demands more


consistent, reliable access to the decision-making


process and the skills and knowledge essential to


effect change.


Both traditional communication and the new


information media support this process. Social,


cultural and spiritual resources need to be harnessed


in innovative ways.


5. Secure an infrastructure for health


promotion


To secure an infrastructure for health promotion,


new mechanisms for funding it locally, nationally


and globally must be found. Incentives should be


developed to influence the actions of governments,


nongovernmental organizations, educational


institutions and the private sector to make sure


that resource mobilization for health promotion is


maximized.


“Settings for health” represent the organizational


base of the infrastructure required for health


promotion. New health challenges mean that new


and diverse networks need to be created to achieve


intersectoral collaboration. Such networks should


provide mutual assistance within and among


countries and facilitate exchange of information on


which strategies have proved effective and in which


settings.


Training in and practice of local leadership skills


should be encouraged in order to support health


promotion activities. Documentation of experiences


in health promotion through research and project


reporting should be enhanced to improve planning,


implementation and evaluation.


All countries should develop the appropriate


political, legal, educational, social and economic


environments required to support health


promotion.




21 Milestones in Health Promotion: Statements from Global Conferences


Call for action


The participants in this Conference are committed to sharing the key messages of the Jakarta


Declaration with their governments, institutions and communities, putting the actions proposed into


practice, and reporting back to the Fifth International Conference on Health Promotion.


In order to speed progress towards global health promotion, the participants endorse the formation of a


global health promotion alliance. The goal of this alliance is to advance the priorities for action in health


promotion set out in this Declaration.


Priorities for the alliance include:


• raising awareness of the changing determinants of health


• supporting the development of collaboration and networks for health development


• mobilizing resources for health promotion


• accumulating knowledge on best practice


• enabling shared learning


• promoting solidarity in action


• fostering transparency and public accountability in health promotion


National governments are called on to take the initiative in fostering and sponsoring networks for health


promotion both within and among their countries.


The participants call on WHO to take the lead in building such a global health promotion alliance and


enabling its Member States to implement the outcomes of the Conference. A key part of this role is for WHO


to engage governments, nongovernmental organizations, development banks, organizations of the United


Nations system, interregional bodies, bilateral agencies, the labour movement and cooperatives, as well as


the private sector, in advancing the priorities for action in health promotion.


Document resulting from 4th International Conference on Health Promotion, 21-25 July 1997, Jakarta, Indonesia.*




www.who.int/healthpromotion/conferences/jakarta.pdf


* The success of the fourth ICHP is due to the active contribution of many, the host country, WHO, HQ and the Regional Offices, WR Country Offices, WHO CCs,


UN, IGOs and NGOs.




Mexico Ministerial Statement for the Promotion of Health: From Ideas to Action22


Mexico Ministerial Statement for the Promotion of
Health: From Ideas to Action
Fifth Global Conference on Health Promotion, Health Promotion:
Bridging the Equity Gap, Mexico City, 5-9 June 2000


Statement


Gathered in Mexico City on the occasion of the


Fifth Global Conference on Health Promotion, the


Ministers of Health who sign this Statement:


1. Recognize that the attainment of the highest


possible standard of health is a positive asset for


the enjoyment of life and necessary for social and


economic development and equity.


2. Acknowledge that the promotion of health


and social development is a central duty and


responsibility of governments, that all sectors of


society share.


3. Are mindful that, in recent years, through the


sustained efforts of governments and societies


working together, there have been significant


health improvements and progress in the


provision of health services in many countries of


the world.


4. Realize that, despite this progress, many health


problems still persist which hinder social and


economic development and must therefore


be urgently addressed to further equity in the


attainment of health and well being.


5. Are mindful that, at the same time, new and re-


emerging diseases threaten the progress made in


health.


6. Realize that it is urgent to address the social,


economic and environmental determinants


of health and that this requires strengthened


mechanisms of collaboration for the promotion of


health across al sectors and at all levels of society.


7. Conclude that health promotion must be a


fundamental component of public policies and


programmes in all countries in the pursuit of


equity and better health for all.


8. Realize that there is ample evidence that good


health promotion strategies of promoting health


are effective.


Actions


Considering the above, we subscribe to the


following:


a. To position the promotion of health as a


fundamental priority in local, regional, national


and international policies and programmes.


b. To take the leading role in ensuring the active


participation of all sectors and civil society, in


the implementation of health promoting actions




23 Milestones in Health Promotion: Statements from Global Conferences


which strengthen and expand partnerships for


health.


c. To support the preparation of country-wide


plans of action for promoting health, if necessary


drawing on the expertise in this area of WHO


and its partners. These plans will vary according


to the national context, but will follow a basic


framework agreed upon during the Fifth Global


Conference on Health Promotion, and may


include among others:


Š The identification of health priorities and the
establishment of healthy public policies and


programmes to address these.


Š The support of research which advances
knowledge on selected priorities.


Š The mobilization of financial and operational
resources to build human and institutional


capacity for the development, implementation,


monitoring and evaluation of country-wide


plans of action.


d. To establish or strengthen national and


international networks which promote health.


e. To advocate that UN agencies be accountable for


the health impact of their development agenda.


f. To inform the Director General of the World


Health Organization, for the purpose of her


report to the 107th session of the Executive


Board, of the progress made in the performance


of the above actions.


Signed in Mexico City, on 5 June 2000, in Arabic, Chinese,
English, French, Portuguese, Russian and Spanish, all texts
being equally authentic.*


www.who.int/healthpromotion/conferences/mexico.pdf


* Jointly organized by the World Health Organization, the Pan American Health


Organization (PAHO/AMRO) and the Ministry of Health of Mexico.


Signing countries


This Ministerial Statement was signed by the following countries:


Algeria
Angola
Argentina
Aruba
Australia
Austria
Bangladesh
Belize
Bhutan
Bolivia
Brazil
Bulgaria
Cameroon
Canada
China
Colombia
Costa Rica
Cuba


Czech Republic
Denmark
Dominica
Dominican Republic
Ecuador
El Salvador
Egypt
Finland
France
Gabon
Germany
Guatemala
Haiti
Hungary
India
Indonesia
Iran
Israel


Jamaica
Korea
Kuwait
Lao PDR
Lebanon
Madagascar
Malaysia
Maldives
Malta
Marshall Islands
Mexico
Morocco
Mozambique
Myanmar
Namibia
Nepal
Netherlands
New Zealand


Nicaragua
Niger
Norway
Oman
Pakistan
Panama
Paraguay
Poland
Portugal
Puerto Rico
Russian Federation
Rwanda
Saint Kitts and
Nevis
Saint Lucia
Samoa
Slovakia
Slovenia


South Africa
Spain
Sudan
Swaziland
Sweden
Switzerland
Thailand
Turkey
United Kingdom
United States
Uruguay
vanuatu
venezuela
Yugoslavia
Zambia
Zimbabwe




The Bangkok Charter for Health Promotion in a Globalized World24


The Bangkok Charter for Health Promotion in
a Globalized World
7-11 August 2005


Introduction


Scope


The Bangkok Charter identifies actions,


commitments and pledges required to address the


determinants of health in a globalized world through


health promotion.


Purpose


The Bangkok Charter affirms that policies and


partnerships to empower communities, and to


improve health and health equality, should be at the


centre of global and national development.


The Bangkok Charter complements and builds upon


the values, principles and action strategies of health


promotion established by the Ottawa Charter for


Health Promotion and the recommendations of the


subsequent global health promotion conferences


which have been confirmed by Member States


through the World Health Assembly.


Audience


The Bangkok Charter reaches out to people,


groups and organizations that are critical to the


achievement of health, including:


• governments and politicians at all levels


• civil society


• the private sector


• international organizations, and


• the public health community.


Health promotion


The United Nations recognizes that the enjoyment


of the highest attainable standard of health is one


of the fundamental rights of every human being


without discrimination.


Health promotion is based on this critical human


right and offers a positive and inclusive concept


of health as a determinant of the quality of life


and encompassing mental and spiritual well-


being.


The ‘Bangkok Charter for Health Promotion in a globalized world’ has been agreed to by participants at the


6th Global Conference on Health Promotion held in Thailand from 7-11 August, 2005.




25 Milestones in Health Promotion: Statements from Global Conferences


Health promotion is the process of enabling people to


increase control over their health and its determinants,


and thereby improve their health. It is a core function


of public health and contributes to the work of tackling


communicable and noncommunicable diseases and


other threats to health.


Addressing the determinants of health


Changing context


The global context for health promotion has


changed markedly since the development of the


Ottawa Charter.


Critical factors


Some of the critical factors that now influence health


include:


• increasing inequalities within and between


countries


• new patterns of consumption and communication


• commercialization


• global environmental change, and


• urbanization.


Further challenges


Other factors that influence health include rapid and


often adverse social, economic and demographic


changes that affect working conditions, learning


environments, family patterns, and the culture and


social fabric of communities.


Women and men are affected differently.


The vulnerability of children and exclusion of


marginalized, disabled and indigenous peoples have


increased.


New opportunities


Globalization opens up new opportunities for


cooperation to improve health and reduce


transnational health risks; these opportunities include:


• enhanced information and communications


technology, and


• improved mechanisms for global governance and


the sharing of experiences.


Policy coherence


To manage the challenges of globalization, policy


must be coherent across all:


• levels of governments


• United Nations bodies, and


• other organizations, including the private sector.


This coherence will strengthen compliance,


transparency and accountability with international


agreements and treaties that affect health.


Progress made


Progress has been made in placing health at the


centre of development, for example through the


Millennium Development Goals, but much more


remains to be achieved; the active participation of


civil society is crucial in this process.


Strategies for health promotion in a
globalized world


Effective interventions


Progress towards a healthier world requires strong


political action, broad participation and sustained


advocacy.




The Bangkok Charter for Health Promotion in a Globalized World26


Health promotion has an established repertoire of


proven effective strategies which need to be fully


utilized.


Required actions


To make further advances in implementing these


strategies, all sectors and settings must act to:


• advocate for health based on human rights and


solidarity


• invest in sustainable policies, actions and


infrastructure to address the determinants of


health


• build capacity for policy development,


leadership, health promotion practice,


knowledge transfer and research, and health


literacy


• regulate and legislate to ensure a high level


of protection from harm and enable equal


opportunity for health and well-being for all


people


• partner and build alliances with public,


private, nongovernmental and international


organizations and civil society to create


sustainable actions.


Commitments to Health for All


Rationale


The health sector has a key leadership role in the


building of policies and partnerships for health


promotion.


An integrated policy approach within government


and international organizations, as well as a


commitment to working with civil society and the


private sector and across settings, are essential


if progress is to be made in addressing the


determinants of health.


Key commitments


The four key commitments are to make the


promotion of health:


1. central to the global development agenda


2. a core responsibility for all of government


3. a key focus of communities and civil society


4. a requirement for good corporate practice.


1. Make the promotion of health central to


the global development agenda


Strong intergovernmental agreements that increase


health and collective health security are needed.


Government and international bodies must act


to close the health gap between rich and poor.


Effective mechanisms for global governance for


health are required to address all the harmful


effects of:


• trade


• products


• services, and


• marketing strategies.


Health promotion must become an integral part


of domestic and foreign policy and international


relations, including in situations of war and


conflict.


This requires actions to promote dialogue and


cooperation among nation states, civil society,


and the private sector. These efforts can build on


the example of existing treaties such as the World


Health Organization Framework Convention for


Tobacco Control.




27 Milestones in Health Promotion: Statements from Global Conferences


2. Make the promotion of health a core


responsibility for all of government


All governments at all levels must tackle poor health


and inequalities as a matter of urgency because


health is a major determinant of socioeconomic and


political development. Local, regional and national


governments must:


• give priority to investments in health, within and


outside the health sector


• provide sustainable financing for health


promotion.


To ensure this, all levels of government should make


the health consequences of policies and legislation


explicit, using tools such as equity-focused health


impact assessment.


3. Make the promotion of health a key focus


of communities and civil society


Communities and civil society often lead in


initiating, shaping and undertaking health


promotion. They need to have the rights, resources


and opportunities to enable their contributions


to be amplified and sustained. In less developed


communities, support for capacity building is


particularly important.


Well organized and empowered communities are


highly effective in determining their own health, and


are capable of making governments and the private


sector accountable for the health consequences of


their policies and practices.


Civil society needs to exercise its power in the


marketplace by giving preference to the goods,


services and shares of companies that exemplify


corporate social responsibility.


Grass-roots community projects, civil society


groups and women’s organizations have


demonstrated their effectiveness in health


promotion, and provide models of practice for


others to follow.


Health professional associations have a special


contribution to make.


4. Make the promotion of health a


requirement for good corporate practice


The corporate sector has a direct impact on the


health of people and on the determinants of health


through its influence on:


• local settings


• national cultures


• environments, and


• wealth distribution.


The private sector, like other employers and the


informal sector, has a responsibility to ensure


health and safety in the workplace, and to promote


the health and well-being of their employees, their


families and communities.


The private sector can also contribute to lessening


wider global health impacts, such as those


associated with global environmental change by


complying with local national and international


regulations and agreements that promote and


protect health. Ethical and responsible business


practices and fair trade exemplify the type of


business practice that should be supported by


consumers and civil society, and by government


incentives and regulations.




The Bangkok Charter for Health Promotion in a Globalized World28


A global pledge to make it happen


All for health


Meeting these commitments requires better


application of proven strategies, as well as the use of


new entry points and innovative responses.


Partnerships, alliances, networks and collaborations


provide exciting and rewarding ways of bringing people


and organizations together around common goals and


joint actions to improve the health of populations.


Each sector – intergovernmental, government,


civil society and private – has a unique role and


responsibility.


Closing the implementation gap


Since the adoption of the Ottawa Charter, a


significant number of resolutions at national and


global level have been signed in support of health


promotion, but these have not always been followed


by action. The participants of this Bangkok Conference


forcefully call on Member States of the World Health


Organization to close this implementation gap and


move to policies and partnerships for action.


Call for action


Conference participants request the World


Health Organization and its Member States, in


collaboration with others, to allocate resources


for health promotion, initiate plans of action


and monitor performance through appropriate


indicators and targets, and to report on progress at


regular intervals. United Nations organizations are


asked to explore the benefits of developing a Global


Treaty for Health.


Worldwide partnership


This Bangkok Charter urges all stakeholders


to join in a worldwide partnership to promote


health, with both global and local engagement and


action.


Commitment to improve health


We, the participants of the 6th Global Conference on


Health Promotion in Bangkok, Thailand, pledge to


advance these actions and commitments to improve


health.


This charter contains the collective views of an
international group of experts, participants of the 6th
Global Conference on Health Promotion, 7-11 August 2005,
Bangkok, Thailand, and does not necessarily represent
the decisions or the stated policy of the World Health
Organization.*


www.who.int/healthpromotion/conferences/bangkok.pdf


* Jointly organized by the World Health Organization and the Ministry of Public


Health, Thailand.




Milestones in Health Promotion: Statements from Global Conferences 29


Annex 1


A Discussion Document on the Concept and Principles of Health
Promotion, Copenhagen, 9-13 July 1984


Background


In January 1984 a new programme in Health Promotion
was established in the WHO Regional Office for Europe. As
part of the continuing process of programme development,
a working group met in July 1984 to discuss “Concepts
and Principles in Health Promotion”. This paper is a result
of that working group. It is designed to clarify some of
the most important issues in relation to the development
of policy and programmes in health promotion. It is not
intended as a final statement, but as a focus for discussion
on which to base the development of health promotion
activities in Europe.


The group is fully aware that the development of
priorities and practices for health promotion depends
upon the prevailing economic and cultural conditions.
In each country, region and district, health promotion
should involve the full participation of all people in the
development of their health.


Introduction


At a general level, health promotion has come to represent
a unifying concept for those who recognize the need for
change in the ways and conditions of living, in order to
promote health. Health promotion represents a mediating
strategy between people and their environments,
synthesizing personal choice and social responsibility in
heath to create a healthier future.


Basic resources for health are income, shelter and food.
Improvement in health requires a secure foundation
in these basics, but also: information and life skills; a
supportive environment, providing opportunities for
making healthy choices among goods, services and
facilities; and conditions in the economic, physical, social


and cultural environments (the “total” environment)
which enhance health.


The inextricable link between people and their
environment constitutes the basis for a socio-ecological
approach to health and this provided the conceptual
framework for discussions by the working group. The
discussions were organized around four main themes -
principles, subject areas, priorities for the development of
policies, and dilemmas in health promotion.


Principles


Health promotion is the process of enabling people to
increase control over, and to improve, their health. This
perspective is derived from a conception of “health” as
the extent to which an individual or group is able, on the
one hand, to realise aspirations and satisfy needs; and, on
the other hand, to change or cope with the environment.
Health is, therefore, seen as a resource for everyday
life, not the objective of living; it is a positive concept
emphasising social and personal resources, as well as
physical capacities.


1. Health promotion involves the population as a whole
in the context of their everyday life, rather than
focusing on people at risk for specific diseases. It
enables people to take control over, and responsibility
for, their health as an important component of every
day life - both as spontaneous and organized action
for health. This requires full and continuing access
to information about health and how it might be
sought for by all the population, using, therefore, all
dissemination methods available.


2. Health promotion is directed towards action on the
determinants or causes of health. Health promotion,
therefore, requires a close cooperation of sectors




Annexes30


beyond health services, reflecting the diversity of
conditions which influence health. Government,
at both local and national levels, has a unique
responsibility to act appropriately and in a timely
way to ensure that the “total” environment, which
is beyond the control of individuals and groups, is
conductive to health.


3. Health promotion combines diverse, but
complementary, methods or approaches, including
communication, education, legislation, fiscal measures,
organizational change, community development and
spontaneous local activities against health hazards.


4. Health promotion aims particularly at effective and
concrete public participation. This focus requires
the further development of problem-defining and
decision-making lifeskills both individually and
collectively.


5. While health promotion is basically an activity in the
health and social fields, and not a medical service,
health professionals - particularly in primary health
care - have an important role in nurturing and
enabling health promotion. Health professionals
should work towards developing their special
contributions in education and health advocacy.


Subject Areas


Health promotion best enhances health through integrated
action at different levels on factors influencing health,
economic, environmental, social and personal. Given
these basic principles an almost unlimited list of issues
for health promotion could be generated: food policy,
housing, smoking, coping skills, social networks. The
working group sought to frame the general subjects for
health promotion in the following areas:


1. The focus of health promotion is access to health:
to reduce inequalities in health and to increase
opportunities to improve health. This involves
changing public and corporate policies to make them
conducive to health, and involves reorienting health
services to the maintenance and development of health
in the population, regardless of current health status.


2. The improvement of health depends upon the
development of an environment conducive to


health, especially in conditions at work and at
home. Since this environment is dynamic, health
promotion involves monitoring and assessment of the
technological, cultural and economic state and trends.


3. Health promotion involves the strengthening of
social networks and social supports. This is based
on the recognition of the importance of social forces
and social relationships as determinants of values
and behaviour relevant to health, and as significant
resources for coping with stress and maintaining
health.


4. The predominant way of life in society is central to
health promotion, since it fosters personal behaviour
patterns that are either beneficial or detrimental to
health. The promotion of lifestyles conducive to health
involves consideration of personal coping strategies
and dispositions as well as beliefs and values relevant
to health, all shaped by lifelong experiences and living
conditions. . . Promoting positive health behaviour
and appropriate coping strategies is a key aim in


health promotion.
5. Information and education provide the informed


base for making choices. They are necessary and
core components of health promotion, which
aims at increasing knowledge and disseminating
information related to health. This should include:
the public’s perceptions and experiences of health
and how it might be sought; knowledge from
epidemiology, social and other sciences on the
patterns of health and disease and factors affecting
them; and descriptions of the “total” environment
in which health and health choices are shaped. The
mass media and new information technologies are
particularly important.


Priorities for the Development of Policies in
Health Promotion


Health promotion stands for the collective effort to attain
health. Governments, through public policy, have a special
responsibility to ensure basic conditions for a healthy life
and for making the healthier choices the easier choices.
At the same time, supporters of health promotion within
governments need to be aware of the role of spontaneous
action for health, i.e., the role of social movements,




Milestones in Health Promotion: Statements from Global Conferences 31


self-help and self-care, and the need for continuous
cooperation with the public on all health promotion issues.


1. The concept and meaning of “health promotion”
should be clarified at every level of planning,
emphasizing a social, economic and ecological, rather
than a purely physical and mental perspective on
health. Policy development in health promotion can
then be related and integrated with policy in other
sectors such as work, housing, social services and
primary health care.


2. Political commitment to health promotion can be
expressed through the establishment of focal points
for health promotion at all levels - local, regional and
national. These would be organizational mechanisms
for intersectoral, coordinated planning in health
promotion. They should provide leadership and
accountability so that, when action is agreed, progress
will be secured. Adequate funding and skilled
personnel are essential to allow the development
of systematic long-term programmes in health
promotion.


3. In the development of health promotion policies,
there must be continuous consultation, dialogue and
exchange of ideas between individuals and groups,
both lay and professional. Policy mechanisms must be
established to ensure opportunities for the expression
and development of public interest in health.


4. When selecting priority areas for policy development
a review should be made of:


Š indicators of health and their distribution in the
population


Š current knowledge, skills and health practices of
the population


Š current policies in government and other sectors.


Further, an assessment should be made of:
Š the expected impact on health of different policies


and programmes
Š the economic constraints and benefits
Š the social and cultural acceptability
Š the political feasibility of different options.


5. Research support is essential for policy development
and evaluation to provide an understanding of
influences on health and their development, as


well as an assessment of the impact of different
initiatives in health promotion. There is a need to
develop methodologies for research and analysis, in
particularly, to devise more appropriate approaches
to evaluation. The results of research should be
disseminated widely and comparisons made within
and between nations.


Dilemmas


Health-related public policy will always be confronted with
basic political and moral dilemmas, as it aims to balance
public and personal responsibility for health. Those
involved in health promotion need to be aware of possible
conflicts of interest both at the social and the individual
level.


1. There is a possibility with health promotion
that health will be viewed as the ultimate goal
incorporating all life. This ideology sometimes called
healthism, could lead to others prescribing what
individuals should do for themselves and how they
should behave, which is contrary to the principles of
health promotion.


2. Health promotion programmes may be
inappropriately directed at individuals at the expense
of tackling economic and social problems. Experience
has shown that individuals are often considered by
policy makers to be exclusively responsible for their
own health. It is often implied that people have the
power to completely shape their own lives and those
of their families so as to be free from the avoidable
burden of disease. Thus, when they are ill, they are
blamed for this and discriminated against.


3. Resources, including information, may not be
accessible to people in ways which are sensitive to
their expectations, beliefs, preferences or skills. This
may increase social inequalities. Information alone
is inadequate; raising awareness without increasing
control or prospects for change may only succeed in
generating anxieties and feelings of powerlessness.


4. There is a danger that health promotion will be
appropriated by one professional group and made
a field of specialisation to the exclusion of other
professionals and lay people. To increase control over




Annexes32


their own health the public require a greater sharing of
resources by professionals and government.


Conclusions


The concept of health promotion is positive, dynamic
and empowering which makes it rhetorically useful and


politically attractive. By considering the recommended
principles, subject areas, policy priorities and dilemmas
it is hoped that future activities in the health promotion
field can be planned, implemented and evaluated more
successfully. Further development work is clearly required
and this will be an ongoing task of the WHO Regional
Office for Europe.




Milestones in Health Promotion: Statements from Global Conferences 33


Strengthen Community Action
ReinfoRceR l’Action communAutAiRe


Develop Personal Skills
DéveloppeR les AptituDes


peRsonnelles


Create
Supportive


Environments


cRéeR Des milieux
fAvoRAbles


Enable
conféReR les moyens


Mediate
seRviR De méDiAteuR


Advocate
pRomouvoiR l’iDée


Reorient
Health Services


RéoRienteR les seRvices
De sAnté


Build Healthy Public Policy étAbliR u
ne


pol
itiq


ue
p


ub
liq


ue
s


Ai
ne


Annex 2
Health Promotion Emblem


This logo was created for the First International
Conference on Health Promotion held in Ottawa, Canada,
in 1986. At that conference, the Ottawa Charter for Health
Promotion was launched. Since then, WHO kept this
symbol as the Health Promotion logo (HP logo), as it
stands for the approach to health promotion as outlined in
the Ottawa Charter.


The logo represents a circle with 3 wings. It incorporates
five key action areas in Health Promotion (build healthy
public policy, create supportive environments for health,
strengthen community action for health, develop personal


skills, and re-orient health services) and three basic HP
strategies (to enable, mediate, and advocate).


The main graphic elements of the HP logo are:
• one outside circle,
• one round spot within the circle, and
• three wings that originate from this inner spot, one of


which is breaking the outside circle.


a) The outside circle, originally in red colour, is
representing the goal of “Building Healthy Public Policies”,
therefore symbolising the need for policies to “hold things




Annexes34


together”. This circle is encompassing the three wings,
symbolising the need to address all five key action areas
of health promotion identified in the Ottawa Charter in an
integrated and complementary manner.


b) The round spot within the circle stands for the
three basic strategies for health promotion, “enabling,
mediating, and advocacy”, which are needed and applied
to all health promotion action areas. (Complete definitions
of these terms can be found in the Health Promotion
Glossary, WHO/HPR/HEP/98.1, www.who.int/
healthpromotion/about/HPG/en/).


c) The three wings represent (and contain the words of)
the five key action areas for health promotion that were
identified in the Ottawa Charter for Health Promotion
in 1986 and were reconfirmed in the Jakarta Declaration
on Leading Health Promotion into the 21st Century in
1997.


More specifically:
• the upper wing that is breaking the circle represents


that action is needed to “strengthen community
action” and to “develop personal skills”. This wing
is breaking the circle to symbolise that society and
communities as well as individuals are constantly
changing and, therefore, the policy sphere has to
constantly react and develop to reflect these changes: a
“Healthy Public Policy” is needed;


• the middle wing on the right side represents that
action is needed to “create supportive environments
for health”


• the bottom wing represents that action is needed to
“reorient health services” towards preventing diseases
and promoting health.


Overall, the logo visualises the idea that Health Promotion
is a comprehensive, multi-strategy approach. HP applies


diverse strategies and methods in an integrated manner
- one of the preconditions “for Health Promotion to be
effective” (Jakarta Declaration 1997). Health Promotion
addresses the key action areas identified in the Ottawa
Charter in an integrated and coherent way.


The term Health Promotion (HP) was, and still today
is sometimes, narrowly used as equivalent for Health
Education (HE). But HE is one of several key components
and action areas of HP as illustrated by the HP logo (see
the key action area of “develop personal skills”).


The HP logo and approach were reinforced at the second
and third conferences on Health Promotion that took place
in Sundsvall and in Adelaide.


In the light of the venue of the Fourth International
Conference on Health Promotion, that was held in Jakarta,
Indonesia, in July 1997, the design of the Ottawa logo was
slightly modified to reflect culture and atmosphere of the
host country of the conference, making sure that the shape
and elements of the original logo were preserved, together
with its inner meaning.


The Jakarta Conference logo is a more open and slightly
more abstract version of the original HP logo from Ottawa.
The three wings, that are now in brick-red colour, still
represent the key HP action areas. The outside circle and
the inner spot of the Ottawa logo are merged into a unique
blue spot from where the three wings originate. This still
symbolises that HP addresses its action areas with an
integrated multi-strategic approach. Overall, the design
of the HP logo adapted for the Conference in Jakarta is
more open and lively; all the wings are now reaching out of
the circle. This, visualizes the fact that the field of HP has
grown and developed, and that today and in the future HP
is outreaching to new players and partners, at all levels of
society, from local to global level.




Milestones in Health Promotion: Statements from Global Conferences 35


The Health Promotion emblem and its interpretations in successive conferences


Ottawa 1986 Adelaide 1988


Sundsvall 1991 Jakarta 1997


Mexico 2000 Bangkok 2005


Nairobi 2009








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PROMOTION


Milestones in Health Promotion
Statements from Global Conferences


Health Promotion


World Health Organization


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Milestones in Health Promotion: Statements from Global Conferences
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