Toward a post-Charter health promotion

Abstract

The past 25 years have seen enormous shifts in the environmental, political, economic and social landscapes that condition people's abilities to be healthy. Climate change is now a reality. China, India, Brazil and other 'developing' countries are emerging as new axes of political and economic power. Global capitalism has become increasingly predatory and crisis ridden, a result of unregulated and irresponsible greed of unimaginable scale. The elite response has been the increased erosion of the health and other social protection policies of redistribution that characterized the first-world run-up to the Ottawa Charter. These new realities challenge health promoters in ways unforeseen a quarter century ago. It is imperative that local determinants of health, to which health promoters give their attention, be traced to broader, even global levels of determinants. Support for groups acting at these levels should become a fundamental practice tenet. So, too, should advocacy for the social state, in which progressive taxation and hefty social investment blunt the health inequalities created by unfettered markets. As environmental and economic insecurities and inequalities increase in many of the world's countries, so does the risk of xenophobia and conflict. The roots of racism are complex; but weeding them out becomes another health promotion practice of the new millennium. There are some hopeful signs of health promoting political change, much of it emanating now from countries in the global South; but the threat of a return to health behaviourism in the face of the new global pandemic of chronic disease is real and must be confronted.

Social determinants of health in Canada: Are healthy living initiatives there yet? A policy analysis

“…Although individual behaviour change theories were popular early in the health promotion movement, the field of public health has matured to embrace a more multi-level approach. This change of focus was in recognition of the fact that individual behaviour change strategies are not enough for lasting health improvements, given structural conditions which predispose people to illness [39][40][41]. They may actually be counterproductive; they tend to place responsibility to change directly on individuals and can lead to victimblaming should barriers prove too great for them to be successful [42][43][44].…”

Subnational health management and the advancement of health equity: a case study of Ethiopia

“…Subnational health managers are attuned to inequities, both within and adjacent to their work, and often rely on personal ingenuity to circumvent deficits in material, infrastructure, human and financial resources. By acknowledging, legitimizing, and supporting local solutions, the health sector can improve efficiencies, although localizing issues of distributional justice can lead to ignoring national or even global political and economic policies that exacerbate resource inequities far beyond the capabilities of local or subnational levels to mitigate [56]. Further explorations of such local solutions and means of facilitating knowledge sharing between subnational stakeholders within and between countries are warranted.…”

Health Promotion in an Age of Normative Equity and Rampant Inequality

“…Five years ago in a Supplement in the journal, Health Promotion International , I celebrated the Ottawa Charter’s 25th anniversary by urging an advocacy platform remarkably similar to the one elaborated upon above. 44 I exhorted health promoters to support social movements and civil society activists working at national and global scales to pressure for economic reform and ecological salvation. I called for a re-valorization of the social state and progressive taxation as antidote to apathy and global corporatization.…”

“…Our task, as we continue our quotidian and localized best health promoting efforts, all the time supporting those attempting to leverage change at national and global levels, is to nurture the blueprint for what a social order could look like, if human, animal and ecological health formed its core rather than being relegated to its periphery. 44 …”