Health promoters who strive to enhance health and reduce inequities still consider the Ottawa Charter for Health Promotion as a fundamental document to this day (Thompson et al., 2018). According to McPhail et al. (2013), it is commendable that the Ottawa Charter recognizes the importance of addressing the social and economic determinants of health and seeks to strengthen community capacity. As a public health professional in today’s society, it is clear that the strategies outlined within the Ottawa Charter should be utilized to help guide health promotion practices. According to Thompson et al. (2018), the Ottawa Charter is still applicable, and decision-makers and experts in the field of health promotion should study and consider the key strategies that have been identified. The Ottawa Charter's five main strategies of — building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services — remain relevant because they consistently offer a thorough and comprehensive framework for addressing any significant threat to public health (Nutbean et al., 2021). No matter the changing health, societal and economical issue that presents itself, the five key strategies outlined within the Ottawa Charter remain important aspects for health promotion practices.
Despite the advantages of using the Ottawa Charter's key strategies to guide health promotion efforts, there are drawbacks to using the document as a whole, such as the lack of representation of marginalized groups in its development. One example is the underrepresentation of indigenous communities, which represents the need to give priority to indigenous perspectives on health and health promotion. The absence of Indigenous leader’s representation and indigenous concerns in the Ottawa Charter demonstrates colonization in the field of health promotion (Sanchez-Pimienta & Masuda, 2020). According to McPhail et al. (2013) “…the development of the Ottawa Charter masked underpinning power imbalances and Western-centric worldviews, while also silencing non-western voices” (p. 27). Although the goals of health promotion appear to be universally beneficial, the fundamental ethical and economic basis for this practice have been built predominantly with western and industrialized nation's needs and circumstances in mind (Sanchez-Pimienta & Masuda, 2020).
The current definition of health promotion emphasizes the value of having control over one's health and represents a westernized vision of what is important (Sanchez-Pimienta & Masuda, 2020). The Ottawa Charter (1986) states “health promotion is the process of enabling people to increase control over, and to improve, their health” (p.1). Sanchez-Pimienta and Masuda (2020), believe that the ‘ethos of connection’ calls into question the westernized concept of "control" in the definition of health promotion, and highlights the distinct knowledge and methods used by Indigenous communities and organizations as the foundation of health promotion.
They define ‘ethos of connection’ as:
Containing principles of equality and knowledge inclusivity
Placing an emphasis on reestablishing balance in a network of interwoven relationships, including connection to the environment, community, culture, language, and spirituality
Support provided from strong Indigenous leadership
(Sanchez-Pimienta & Masuda, 2020).
The Ottawa Charter would likely gain credibility as a framework for health promotion if additional representation from marginalized populations, in this case indigenous populations, was prioritized. While the five key strategies outlined in the Ottawa Charter remain highly relevant for guiding health promotion practice, the document must be adapted to be inclusive of all groups and cultures.
References
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., 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.
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.
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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