The Ottawa Charter was introduced 35 years ago, with the goal of achieving health for all by the year 2000 (World Health Organization, 1986). In 1948, the World Health Organization (WHO) defined health as “A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity” (World Health Organization 2021). Which as we all know, this definition is not inclusive, and non-achievable by any year as most of us have some form of disease or disability. I wear contacts – does this make me unhealthy? The WHO defines health promotion as “the process of enabling people to increase control over, and to improve their health” (World health Organization 2021). This better encompasses health to include all forms of ‘healthy’ to use health promotion to work toward a healthier self & community.
That the basics of the Ottawa Charter & health promotion are today still very relevant and important in Canada, and globally. Trevor Hancock (2011) discussed that when the charter was created it was reacting to create a shift from a model of public health based on a medical model - looking at clinical and curative services. This model did not look at the more preventative upstream aspects of environmental, social, and economic challenges to health that we try to keep at the forefront today. The charter serves as a reminder that we need to be in a public health mindset rather than a medical model mindset. We need to continue to look at political and social forces that harm health status & equity. Thompson et al. (2017) discussed the Vienna Declaration in 1993 believed the principles of the Ottawa charter to still be relevant, but added four pledges: high-quality information systems, advocacy for health, making health effects of policies visible, and the creation of motivated and highly qualified work forces. In many aspects we have still not achieved health for all and acted upon the more upstream approach of health promotion. Especially now dealing with the lasting effects of COVID, our healthcare system is reeling and is in a medical model with many diseases and illnesses in advanced stages due to the shift to ‘crisis mode’ in healthcare.
The Charter does not speak to specific forms of bias, but it does encompass them still today. For example, there are many rural indigenous communities that do not have access to regular oral healthcare, even when funding for care exists. This is especially true with the new national policy program that will offer access to dental care across the country. This program helps all Canadians with the financial burden of accessing care. However many indigenous communities do not have care options within their community to begin with, which will further widen oral health equity gaps not taking access within indigenous communities into consideration with this proposed policy (James Vermes, 2022). James Vermes (2022) also mentioned an eye-opening point – Health can be thought of as a ladder, with those on the top rungs enjoying far better support than those on the bottom rungs, with it being critical to consider the most vulnerable, at the bottom of the ladder.
James Vermes. (2022). Federal Dental-care program cannot leave Indigenous Communities Behind, say advocates. CBC Radio. https://www.cbc.ca/radio/checkup/is-the-liberal-ndp-deal-a-bad-idea-1.6398294/federal-dental-care-program-cannot-leave-indigenous-communities-behind-say-advocates-1.6400342
Trevor Hancock. (2011). The Ottawa Charter at 25. Canadian Journal of Public Health. 102(6):404-6. https://doi.org/10.1007/bf03404186
World Health Organization. (1986). Ottawa charter for health promotion, 1986 (No. WHO/EURO: 1986-4044-43803-61677). World Health Organization. Regional Office for Europe. https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf
World Health Organization (2021). Health promotion glossary of terms 2021. Geneva: World Health Organization. https://apps.who.int/iris/rest/bitstreams/1398462/retrieve
Thompson, S. R., Watson, M. C., & Tilford, S. (2017). The Ottawa Charter 30 years on: Still an important standard for health promotion. International Journal of Health Promotion and Education, 56, 73-84. https://doi.org/10.1080/14635240.2017.1415765
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