Over a quarter of a century later, and as health promotors strive to enhance health and reduce inequities, they still consider the Ottawa Charter for Health Promotion as the "gold standard" (Watson, 2008, as cited in Thompson et al., 2017) and a fundamental document proposing a positive empowering view of health. Embedded in the work of health promotors include core activities to prevent illness and promote good health through 'advocacy,' 'enabling,' and 'mediation' (Thompson et al., 2017).
The Ottawa Charter brought health promotion to the forefront in many countries. In many ways, it is responsible for shifting the focus of public health to an upstream approach that identifies the root causes of a problem and solves it through organizations, systems and environments instead of merely focusing on individuals at risk. Implementation of prevention and health promotion strategies is essential once a root cause is determined. The Ottawa Charter's (World Health Organization, [WHO], 1986) five main strategies include:
Building Healthy Public Policy;
Creating Supportive Environments;
Strengthening Community Action;
Developing Personal Skills and
Reorienting Health Services
Nutbeam et al. (2021) indicate that these five strategies are important
aspects of the comprehensive and inclusive framework for health promotion to address any significant threat to public health and offer consistency with changing health, societal and economic issues. Despite the well-documented achievements and relevance of the Ottawa Charter's key strategies to guide health promotion efforts, there are some areas for improvement in using the document, such as potential cultural biases due to the underrepresentation of indigenous people and perspectives on health and health promotion in its development. Albeit the goals of health promotion appear to be universally beneficial, the fundamental economic and ethical basis for this practice has been framed according to the needs, context, and circumstances of predominately Western and industrialized countries in mind (Nutbeam, 2008; Sanchez-Pimienta & Masuda, 2020).In McPhail et al. (2013) article critiquing the Ottawa Charter in postcolonial times, it is argued that "health promotion is for all people" and that the development "masked underpinning power imbalances and Western-centric worldviews, while also silencing non-western voices" (p.27). Sanchez-Pimenta and Masuda (2020) state that the absence of Indigenous leaders' representation and Indigenous concerns in the Ottawa Charter demonstrated colonization with the notion of "control" underpinning much of its development (para 1). The current definition of health promotion emphasizes the value of having control over one's health but represents a vision of what is important from a Western perspective (Sanchez-Pimienta & Masuda, 2020). An Indigenous approach to health promotion embodies an "ethos of connection," which contains principles of equality and knowledge inclusivity, emphasizing reestablishing balance in a network of interwoven relationships, including connection to the environment, community, culture, language, and spirituality, and support provided from Indigenous solid leadership, which drastically differs from the "ethos of control" (Sanchez-Pimienta & Masuda, 2020, p. 8). As a public health professional, it is clear that the strategies outlined within the Ottawa Charter offer a valuable template and should be utilized to help guide health promotion practices; however, Indigenous health promotion goes beyond making mainstream health promotion more 'culturally appropriate' and includes making space to Indigenous voices and knowledge is one way forward to overcoming this limitation and decolonizing the field (Jackson et al., 2006). Implementers should work from a culturally informed lens, be mindful of representation from marginalized populations and prioritize adapting health promotion needs, context, and circumstances to prevent illness and promote good health through advocacy, enabling and medication inclusive of all people.
References
Jackson, S. F., Perkins, F., Khandor, E., Cordwell, L., Hamann, S., & Buasai, S. (2006). Integrated health promotion strategies: A contribution to tackling current and future health challenges. Health Promotion International, 21 Suppl 1, 75–83. https://doi.org/10.1093/heapro/dal054
McPhail-Bell, K., Fredericks, B., & Brough, M. (2013). Beyond the accolades: a postcolonial critique of the foundations of the Ottawa Charter. Global health promotion, 20(2), 22–29. https://doi.org/10.1177/1757975913490427
Nutbeam, D. (2008). What would the Ottawa Charter look like if it were written today? Critical Public Health, 18(4), 435-441. http://www.doi.org/10.1080/09581590802551208
Nutbeam, D., Corbin, J. H., & Lin, V. (2021). The continuing evolution of health promotion. Health Promotion International, 36, i1–i3. https://doi.org/10.1093/heapro/daab150
Sanchez-Pimienta, C. E., & Masuda, J. (2020). From controlling to connecting: M’Wikwedong as a place of urban Indigenous health promotion in Canada. Health Promotion International, 36(3), 703–713. http://doi.org/10.1093/heapro/daaa066
Thompson, S. R., Watson, M. C., & Tilford, S. (2018). The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education, 56(2), 73–84. http://www.doi.org/10.1080/14635240.2017.1415765
World Health Organization. (1986). Ottawa charter for health promotion, 1986 (No. WHO/EURO: 1986-4044-43803-61677). World Health Organization. Regional Office for Europe. https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf
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