The Ottawa Charter has been an important basis for health promotion in Canada and worldwide since its inception in 1986. It has shaped the way we think about health globally. The Ottawa Charter’s values resonate with many countries and as a result there has been widespread global acceptance (Kirk et al, 2014). The charter has been seen as the formal birthplace of health promotion as it prompted action into a number of countries (Kirk et al, 2014). The Ottawa Charter defines health promotion as the process of enabling people with increased control over, and ability to improve their health (Fry and Zask, 2017). The Ottawa Charter highlights the core values of equity, participation and empowerment and the five areas of action (Fry and Zask, 2017). The Ottawa Charter has also played an impact on my own practice as a Respiratory Therapist (RT) as well.
Canada
The impact of the Ottawa Charter in Canada has been immense. Health promotion has become a vital part of the national health framework. The Ottawa Charter’s principles have helped shift the focus onto the social determinants of health within Canada. By focusing on the social determinants of health, Canada’s healthcare system recognizes that social factors such as education, income, childhood experiences, gender, culture and living conditions can significantly impact health (Government of Canada, n.d.). As a result, Canada has focused on implementing policies that reflect equity, access and reduce health inequalities such as the Pan-Canadian Healthy Living Strategy (Government of Canada, n.d.). Prior to this national initiative, provincial governments were prioritizing healthcare policies and initiatives that reflected the principles found in the Ottawa Charter. British Columbia had previously implemented the Core Functions Framework. The Core Functions Framework strategies were used for the implementation of programs that addressed the population and inequity (Fry and Zask, 2017). As illustrated, the Ottawa Charter has had a strong influence in Canadian healthcare.
Worldwide
Globally, the implementation of the Ottawa Charter has been mixed. A study by Wilberg et al (2019) found that 50% of respondents felt that health promotion was well established in Europe. Additionally, only 43.7% of respondents felt that the field of health promotion is well established in their country (Wilberg et al, 2019). This demonstrates that the overall impact of well-known health promotion innovations in Europe such as the Investment for Health Approach, Healthy Cities, Health-Promoting Hospitals, and Health-Promoting Schools have been relatively limited (Wilberg et al, 2019). However, promisingly, 80.0% of survey participants felt that the topic of health promotion has progressed over the past 30 years in Europe (Wilberg et al, 2019). In England, in a response to an over emphasis on an individualistic approach to healthcare the government implemented an increase in initiatives directed towards the underlying determinants of health and health promotion (Thompson et al, 2018). However, in recent years there has been a shift back to an individualistic approach with changing ideologies in England (Thompson et al, 2018). Similarly, the implementation of health promotion in India has been very limited. In India, health promotion is built into the concept of all the national health programs. These health programs incorporate principles such as equitable distribution, community participation, intersectoral coordination and appropriate technology (Kumar and Preetha, 2012). However, a stronger priority is placed on clinical care compared to health promotion. The Indian government has placed strong priority on addressing the issue of lack of knowledge within the population of India as it is a major barrier in the accessibility of health care services (Kumar and Preetha, 2012). In Korea, there has been an increase in health promotion. There has been some progress made in equity, public and community participation, empowerment, and socio-ecological approaches (Lee, 2015). However, more work still needs to be done. Areas like intersectoral collaboration and partnership have not been considered in public efforts relating to health promotion in Korea (Lee, 2015). In China, healthcare reforms have placed a greater emphasis on health promotion and disease prevention (Lee et al, 2007). Although, there still needs to be further reform in policies and infrastructure to incorporate multisectoral cooperation (Lee et al, 2007). As illustrated, the implementation of the Ottawa Charter has greatly varied globally. Globally, the ideology of the Ottawa Charter is widely accepted however the implementation of the charter has been relatively limited.
Health Promotion and Me
The Ottawa Charter has played a significant impact in my role as an RT. As an RT, we are often required to provide respiratory education to our patients. I am often providing education that promotes healthy living. An example of this would be in the capacity of smoking cessation. I often educate patients of the negative effects smoking can have on one’s health and provide resources to help quit. Additionally, I often provide education around the proper use and technique of bronchodilators in the hopes to help prevent patient acute exacerbations. Furthermore, in my role I am often align my patients with the appropriate resources and support tools need. This often required me to refer my patients to the appropriate support programs such as Lung Health, community respiratory services, home oxygen program, the Provincial Respiratory Outreach Program (PROP) and CPAP companies. My role as an RT has helped develop my knowledge and understanding of the impact socio-economic factors can have on health outcomes for individuals. This knowledge and understanding allows me to tailor my care to help support health promotion for my patients. In the future, I hope to have the opportunity to develop and disseminate health promotion initiatives to further expand my reach.
Conclusion
The Ottawa Charter has been played a significant role in health promotion in Canada and globally. In Canada, healthcare is guided by the principles set forth in the Ottawa Charter and this is clearly evident in the Pan-Canadian Healthy Living Strategy. Additionally, the Ottawa Charter has played a significant role globally, however the implementation and adoption of health promotion has been mixed. Many countries across the world have taken great strides to incorporate health promotion and the principles set forth in the Ottawa Charter, but much work still needs to be done. The impact of the Ottawa Charter is still present globally and has had a significant impact in my role as a RT. The principles of the Ottawa Charter and health promotion help guide the care I provide as an RT to my patients.
References:
Fry, D., & Zask, A. (2017). Applying the Ottawa Charter to inform health promotion programme design. Health Promotion International, 32(5), 901-912.
Government of Canada. (n.d.). Social determinants of health and health inequalities. Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Kirk, M., Tomm-Bonde, L., & Schreiber, R. (2014). Public health reform and health promotion in Canada. Global health promotion, 21(2), 15-22.
Kumar, S., & Preetha, G. S. (2012). Health promotion: an effective tool for global health. Indian Journal of Community Medicine, 37(1), 5-12.
Lee, A., Fu, H., & Chenyi, J. (2007). Health promotion activities in China from the Ottawa Charter to the Bangkok Charter: revolution to evolution. Promotion & education, 14(4), 219-223.
Lee, M. S. (2015). The principles and values of health promotion: building upon the Ottawa charter and related WHO documents. Korean Journal of Health Education and Promotion, 32(4), 1-11.
Pdhpe (2008). The Ottawa Charter as an effective health promotion framework. YouTube. Retrieved from https://www.youtube.com/watch?v=90bGyRWCAd8&t=5s
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.
Wilberg, Angelika, Luis Saboga-Nunes, and Christiane Stock. "Are we there yet? Use of the Ottawa Charter action areas in the perspective of European health promotion professionals." Journal of Public Health 29 (2021): 1-7.
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