(introduction...)

The first formal commitment to health promotion at an international level was made at the First International Conference on Health Promotion held in Ottawa, Canada in 1986. This conference resulted in the Ottawa Charter. This milestone document enshrines the idea of health creation as the cornerstone of the health promotion approach: “Health is created where people live, love, work and play”.

The Ottawa Charter defined health promotion as “the process of enabling people to increase control over and to improve their health” and it identified five priority action areas:

* Build healthy public policy;
* Create supportive environments;
* Strengthen community action;
* Develop personal skills; and
* Reorient health services.

In the wake of the Charter’s adoption, a new approach to improving and promoting public health was developed: Settings for Health.

Settings for Health emphasizes practical networks and projects to create healthy environments such as healthy schools, health-promoting hospitals, healthy workplaces and healthy cities. Settings for Health builds on the premise that there is a health development potential in practically every organization and/or community.

The health of an organization or community, the Settings for Health approach argues, is thus much more than the aggregate health of its citizens. The presence of environmental stress can predict the likelihood of people becoming sick, but not which disease they might contract. The appropriate public health response is thus to promote and build the potential for good health before it becomes a question of combating a specific disease or other health problem.

Settings for Health projects have come to have the following elements in common which can be fostered through a series of defined strategies:

* Policy/Strategic objectives;

* Action at both political and technical levels;

* Focus on organizational development and institutional change;

* Building alliances and collaboration between sectors, disciplines and political/executive decision-makers;

* Community involvement and community empowerment.

ADELAIDE - 1988

The Adelaide Conference in 1988 started from the position that health is both a fundamental human right and a sound social investment. The Conference urged governments to promote health through linked economic, social and health policies. Delegates stressed the need for equity in health and the need for governments to forge new alliances for health promotion with partners such as corporations and businesses, trade unions, nongovernmental organizations and community groups.

Participants reaffirmed the commitment to the strong public health alliance which the Ottawa Charter called for.

The Conference identified four key priority areas for healthy public policy:

* improving the health of women - the world’s primary health promoters;
* food and nutrition - ensuring adequate amounts of healthy food for all;
* tobacco and alcohol - major health hazards that deserve immediate action;
* creating supportive environments - so that health is nurtured and protected.

Since 1988 many international organizations, countries and sub-national governments have adopted public health policies which embody the spirit of Adelaide.

UNICEF included the five action areas of the Ottawa Charter as part of its health strategy in 1995, while in Europe, 17 countries have formulated “Health of the Nation”-type documents and an additional four countries are in the process of doing so. Australia and several Canadian provinces have also adopted public health policies in the spirit of Ottawa and Adelaide.

SUNDSVALL - 1991

The Sundsvall Conference in 1991 highlighted the essential link between health and the physical environment. Environments are not just the visible structures and services surrounding us but have spiritual, social, cultural, economic, political and ideological dimensions as well. Building on the fact that health promotion addresses broad determinants of health - to create better health, the Conference focused on the six areas of education, food and nutrition, home and neighbourhood, work, transport, and social support and care. Delegates recognized that everyone has a role in making the world more supportive of health. They grouped strategies for environmental change in support of health into seven headings:

* policy development;
* regulation;
* reorientation of organizations;
* advocacy;
* building alliances/creating awareness;
* enabling;
* mobilizing/empowering.

For example, if a community’s drinking water is polluted, the necessary action of cleaning up the water or getting people to stop drinking it could be tackled from several directions, using different strategies. One could develop a “clean water” policy (policy development), take legal action (regulation), transform a wildlife protection society to include human health issues (reorienting organizations), call for change via the authorities, politicians or the media (advocacy), persuade appropriate ministries to cooperate (building alliances), help supply safe drinking water (enabling), or organize residents to fence off the area, educate the people, or facilitate these and other possible measures (mobilizing/empowering).

Sundsvall introduced three models for analysing, describing, understanding and addressing environmental problems and how to influence them to improve health. The first of these was the Health Promotion Strategy Analysis Model (HELPSAM), the second the “Sundsvall Pyramid of Supportive Environments”, and the third was the “Supportive Environments Action” model (SESAME), which illustrates a logical sequence of actions that takes place in many areas of human activity.

JAKARTA - 1997

The Jakarta Conference was held against the background of major worldwide economic and political changes which had taken place since the three previous International Conferences on Health Promotion (see above). It had three objectives:

* to review and evaluate the impact of health promotion;

* to identify innovative strategies to achieve success in health promotion;

* to facilitate the development of partnerships in health promotion to meet the global health challenges.

The Conference not only endorsed the results of the previous International Conferences on Health Promotion, but also confirmed the relevance for both developing and developed countries of placing health promotion firmly at the centre of health development. The five strategies set out in the Ottawa Charter remained essential to successful health promotion efforts, while clear evidence was presented to show that comprehensive approaches to health development are the most effective, and that settings for health (such as “healthy cities”, “healthy Islands”, “health promoting schools”, “health promoting workplaces”, “healthy communities”) offer practical opportunities for the implementation of comprehensive strategies.

The Jakarta Declaration, unanimously endorsed by the Conference’s participants, sets out WHO’s priorities for leading health promotion into the 21st Century:

* Promote social responsibility for health;
* Increase investments for health development;
* Consolidate and expand partnerships for health;
* Increase community capacity and empower the individual;
* Secure an infrastructure for health promotion.

WHO follow-up activities in 1998 include:

* health promotion in the ten most populous countries (Mega Country Health Promotion Network);

* further strengthening of the Global School Health Initiative;

* developing the “Health Promoting Workplaces” concept;

* developing tools for health promotion review and evaluation;

* co-sponsoring two international conferences: the XVI World Conference on Health Promotion and Health Education in San Juan, Puerto Rico, June 1998; and the ‘Working together for better Health’ International conference in Cardiff, United Kingdom, September 1998.

* implementing the 51^st World Health Assembly Resolution on Health Promotion (WHA51.12).

The WHA Resolution endorsed the call to break through traditional boundaries between government sectors, between government and nongovernmental organizations, and between the public and private sectors. WHO is called on to take the lead in elaborating a Global Alliance for Health Promotion, while all Member States are urged to implement the five priorities of the Jakarta Declaration and to adopt an evidence-based approach to health promotion policy and practice. In 2000, a progress report will be submitted to WHO’s Executive Board and World Health Assembly, and it will also provide input into the Fifth International Conference on Health Promotion, to be held in Mexico City, Mexico in April 2000.