01.11.2011 Health promotion: the story of a successful concept
25 Years of the Ottawa Charter. The approval in 1986 of the Ottawa Charter, the blueprint for health promotion efforts the world over, represented a paradigm shift in perceptions of health. A book by Brigitte Ruckstuhl describes the origins and development of the concept of health promotion.
Nowadays health promotion is an accepted and key pillar of health policy. The concept stands for both a field of action in health policy and for an understanding of health that extends well beyond the purely biomedical aspects. It maintains that health and illness are not simply the responsibility of doctors or of Fate; they can be influenced by, and are the responsibility of, the individual and society as a whole. Each and every one of us can promote or maintain our health by pursuing a healthy lifestyle. But the task of society and politicians is to create the prerequisites for health.
With the approval of the Ottawa Charter at the «First International Conference on Health Promotion» by 210 delegates from 35 industrialised countries, this understanding of health was for the first time given tangible expression in the form of action strategies and fields. But its roots reach back over a hundred years.
From social hygiene to criticism of medicine
The basic idea of health promotion can be clearly discerned in the ideas of «social hygiene» advocated as far back as the early 20th century. With this theory German scientists for the first time focused attention on social conditions as being responsible for the development of disease. But the speed with which social hygiene established itself as a scientific discipline was matched by the rapidity with which it fell from grace with the accession of the Nazis to power in Germany. For a long time afterwards, this approach was absent from debates on health policy. During the economic boom after the Second World War, the focus shifted markedly to medicine, with its emphasis on cure, and to the medical profession. Efforts were concentrated on securing primary medical care and progress in medical technology. The outcome was a deterioration in public health and an emphatically personalised understanding of disease prevention.
This changed in the 1960s and 1970s. The increase in chronic diseases and spiralling healthcare costs exposed the limitations of the system. The social changes that began in the late 1960s also affected people’s understanding of health: instead of «provision of care», which was perceived as being disempowering, greater emphasis was put on self-determination with regard to their own bodies, and people began to demand more of a say in matters relating to health and disease. This new way of thinking prepared the ground for the institutionalisation of health promotion and prevention. In the early 1980s, under the leadership of WHO Europe, a systematic process was initiated that culminated in these trends being enshrined in the Ottawa Charter.
Today the Ottawa Charter is regarded worldwide as a blueprint for health promotion and preventive medicine as set out in the WHO’s «Health for All» strategy. According to Brigitte Ruckstuhl, however, the concept has become somewhat blurred by the many different ways in which it has been interpreted over the last 25 years. She calls for clarification of the functions and tasks that health promotion seeks to fulfil today and of where it perceives its role in health policy or public health.
The book: Gesundheitsförderung. Entwicklungsgeschichte einer neuen Public Health-Perspektive. [Health promotion. History of a new public health perspective]. Brigitte Ruckstuhl. Publisher: Juventa, 2011. With interviews from Rosmarie Erben, Alf Trojan, Bernhard Badura, Rolf Rosen-brock, Eberhard Göpel, Peter Franzkowiak, Helmut Milz, Werner Schmidt, François van der Linde, BertinoSomaini, Horst Noack, Ralph Grossmann, Jürgen Pelikan and llona Kickbusch.
The strategy of the Ottawa Charter
The following three action strategies constitute the core of the Ottawa Charter:
1. Advocacy for health by exerting influence on political, biological and social factors.
2. Promotion of health skills in order to reduce inequities in health status and enable people to achieve their fullest health potential.
3. Cooperation with all players within and beyond the health sector.
Regula Ricka, Health Policy Directorate, firstname.lastname@example.org