Social inequalities in health from Ottawa to Vancouver: action for fair equality of opportunity

Abstract

The authors set out to show that the Ottawa Charter of 1986 has not been sufficiently accepted over the past twenty years, even by those who use it as a strategic tool to guide interventions for reducing social inequalities in health. Although some public health policies do emphasize the reduction of social inequalities in health, only the Ottawa Charter appears to possess the status of an international declaration on the matter. Social inequalities in health are the systematic, avoidable, and unjust differences in health that persist between individuals and subgroups of a population. Four examples from the field of health promotion serve to show that forgetting to combat social inequalities in health is not exclusive to the domain of public health. However, taking action against social inequalities in health does not equal tackling poverty. Moreover, intervening on the principle of equality of opportunity, on the basis of an ideology of meritocracy, or for the benefit of the population as a whole, without regard to subgroups , only tends, at best, to reproduce inequalities. Although evidence is insufficient, there are studies that show that reducing social inequalities in health is not an aporia. Three explanations are advanced as to why social inequalities in health have been ignored by health promotion professionals. The Ottawa Charter had the merit of highlighting the struggle against social inequalities in health. Now, moving beyond the declarations, from the strategic framework provided by the Ottawa Charter and in accordance with the Bangkok Charter, it is time to show proof of voluntarism. Several priorities for the future are suggested and the International Union for Health Promotion and Education (IUHPE) should be responsible for advocating for them. (Promotion & Education, 2007, Supplement (2): pp 12-16).

An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania - a qualitative study

“…HP&DP competences vary significantly across individual countries in Europe, from well-established systems to countries with little development [10,11]. Since many countries do not have positions dedicated to health promotion, such responsibility is shared by all health providers, communities and governments [12].…”

Health promotion and secondary prevention: response to Milat, O'Hara and Develin

“…14 The Ottawa Charter has influenced health promotion policy and (to a lesser degree) practice to shift its focus from information provision to the social determinants and contexts of health. 15,16 Milat et al state that diabetes prevention programs are 'opportunities to implement the Ottawa Charter actions'. 1,p87 They mention two of the Charter's strategies (developing personal skills and reorienting health services), but do not refer to the three remaining strategies (building healthy public policies, creating supportive environments, and strengthening community participation).…”

Lutter contre les inégalités sociales de santé

“…Pour introduire cette section, il convient de rappeler la manière dont Graham (2004) distingue, selon le public cible, les trois types de réponses politiques généralement mises en oeuvre : a) améliorer la santé des groupes défavorisés par des programmes ciblés; b) réduire les écarts de santé entre les groupes les plus nantis et ceux les plus défavorisés; c) prendre en compte l'ensemble du gradient de santé, c'est-à-dire s'intéresser aux liens entre la position socioéconomique et la santé à travers l'ensemble de la population. (Ridde, Guichard et al, 2007). Cela étant dit, « levels of health experienced by those who are most socially advantaged can suggest what is possible for everyone » (Braveman, 2003, p.185).…”

“…Après une longue période d'oubli, la problématique des inégalités sociales de santé figurent aujourd'hui comme un axe de réflexion incontournable des conférences internationales sur la santé des populations (Ridde, Guichard et al, 2007). S'il faut bien entendu se réjouir de la démultiplication des échanges sur ces questions, a priori favorables à l'émergence de nouvelles mesures pour infléchir la permanence des inégalités de santé, la « vacuité » des propos tenus, dès que l'on s'avance sur le délicat terrain des interventions visant à réduire les inégalités sociales de santé, ne saurait échapper à celles et ceux qui suivent l'actualité scientifique sur ce sujet.…”