Introduction

The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, gender, age, religion, political belief, economic or social condition. Health promotion is based on the values and principles of social justice and equity; respect for diversity, dignity and human rights; reduction of health inequalities within and between countries; and health defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Background

This Charter, adopted on 11 August 2005 in Bangkok, Thailand, by the participants of the 6th Global Conference on Health Promotion, confirms the importance of the Ottawa Charter of 1986 and reaffirms its values, principles and purposes. It also builds on the recommendations of the previous international health promotion conferences in Adelaide, Australia (1988), Sundsvall, Sweden (1991), Jakarta, Indonesia (1997) and Mexico City, Mexico (2000). In doing so, the Charter highlights the new challenges that need to be met and the commitments that need to be made at the beginning of the 21st century. Health promotion is equity-driven. It is a key public health function and this Charter aims to engage and give direction to the many stakeholders that have the opportunity to contribute to the reduction of health inequities and the promotion of health: governments, the private sector, communities, academia, media, nongovernmental organizations, civil society and individual persons.

Health promotion – a reaffirmation of purpose

Health promotion is the process of enabling people to increase control over the determinants of health and thereby to improve their health. It is a cultural, social, environmental, economic and political process. It embraces empowering actions undertaken by individuals, groups and communities, together with supportive actions taken by decision-makers to change the social, environmental and economic conditions that affect health. The purpose of these activities is to strengthen the capacity of individuals, communities and decision-makers to act collectively to exert control over the determinants of health.

A changing context for health promotion

Globalization, environmental change, urbanization, political and demographic transition, new and emerging diseases, advances in medical science and information technology, and the role of the state have all evolved since the Ottawa Charter. The health inequalities between and within countries remain a grave concern, as does the limited national capacity to promote health in many countries. Health promotion strategies must respond to these changes and concerns. Greater effort is needed to address the risks to health and the broader determinants of health. Globalization has opened new avenues for cooperation; at the same time, it has reduced governmental control over a growing number of health determinants and has fuelled the emergence of new health threats. The globalization process underscores the central importance of health for poverty reduction and the wider economic and social development of nations. This emphasis is reinforced by the prominence given to health in the Millennium Development Goals. New opportunities for the promotion of health are emerging at all levels and in diverse sectors. There are new stakeholders whose commitment and action are critical for health promotion in an increasingly interdependent world. Health promotion cannot be effectively delivered by the health sector alone but requires the contribution of different levels and departments of government, industries and all sections of the wider community.

Health promotion works

Health promotion is effective in tackling important threats to health in all countries. Evidence is available to show that:

·      Interventions that use combinations of strategies are the most effective.

·      Settings such as schools, workplaces, communities and cities offer practical opportunities for the implementation of comprehensive strategies.

·      Active participation, especially by the community, is essential for the sustainability of health promotion efforts.

·      Access to education and information is critical to achieving a high level of health literacy, effective participation and the empowerment of individuals and communities.

·      Political leadership, good governance and policy support are key ingredients.

Responding to current and emerging challenges

The Bangkok Conference considered a wide range of existing, emerging and potential future challenges that need to be met to ensure continuing progress in health promotion and disease prevention. Four key action areas were highlighted:

Action area 1

Harnessing globalization for health

This will include actions that:

·      Make public health an integral part of foreign and domestic policy and international relations.

·      Address health concerns in international trade and investment agreements.

·      Support national government actions and intergovernmental alliances that protect people from the potentially harmful effects of products, services and marketing strategies (or business activities) through regulatory measures. 

·      Facilitate dialogue and cooperation among civil society, the private sector, government and intergovernmental bodies to coordinate action on public health.

·      Address the brain drain from developing countries.

·      Support government health promotion actions in areas of conflict, war and natural disasters.

Action area 2

Making health promotion a core responsibility of all governments

To promote health and development, governments should:

·      Ensure that health promotion is an integral part of socioeconomic and political development by tackling the social and economic causes of poor health.

·      Ensure that investments outside the health sector contribute to the achievement of health outcomes.

·      Strengthen health promotion in all sectors, including the adoption of the whole-of-government approach.

·      Work with the business and corporate sector to develop healthy workplace and business practices, and enforce the necessary regulations.

·      Invest in health promotion research and its application to practice.

Action area 3

Making health a key component of sound corporate practices

The business sector is a key stakeholder in the achievement of population health. A healthy workforce also makes good business sense. This sector needs to:

·      Invest in health and safety in the workplace.

·      Ensure that production processes, products and marketing strategies do not undermine health and that staff are protected against vulnerabilities such as HIV/AIDS and disability.

·      Foster public–private partnerships and multinational alliances to enhance health through greater corporate social responsibilities.

·      Undertake collaborative efforts with public sector health care providers to enhance access to basic, quality health care services.

Action area 4

Engaging and empowering individuals and communities

The challenge is to make a reality the commitment to engage and empower people. Health promotion works with and for people, either as individuals or as groups. This area will include actions that:

·      Provide policy environments which enable communities to engage in self-determined health promotion action.

·      Establish networks and partnerships that strengthen community actions for tackling local, national and global health issues.

·      Support evidence-based traditional and complementary approaches to health.

·      Make health-promoting information available to every individual.

Making it  happen

Health promotion is action-oriented. The successes and lessons learnt since Ottawa highlight the need to adopt integrated strategies in different settings across different age groups. Such experience also underlines the importance of public–private partnerships and the urgent need to strengthen health promotion capacity at all levels in all countries through an evidence-based approach. To ensure continuing progress on health promotion, a global framework is required and will be developed in support of a set of implementation strategies:

·      Invest – in actions that tackle the determinants of health and in health systems that are appropriate, affordable and accessible.

·      Advocate – for evidence-based policies, resources and practices that support and protect health by engaging the political system at all levels, and by working with nongovernmental and community organizations.

·      Build – capacity to promote health, particularly in the areas of policy development and practice, health literacy, community actions, leadership and research.

·      Enable and mobilize – individuals and communities to overcome structural barriers to health, to enhance social support, and to reinforce social norms conducive to health, in particular through information and communication technology.

·      Form partnerships – with public, private and nongovernmental organizations to create sustainable actions across sectors to address the determinants of health.

Benchmarks for progress

Health promotion is outcome-oriented. To measure progress on implementation of the Bangkok Charter, the World Health Organization in collaboration with other partners will support countries in developing appropriate indicators, processes and mechanisms.  This will enable countries, in cooperation with all concerned, to report the following in 2009:

·      Existence of a tangible capacity and structure for health promotion.

·      Levels of investment in health promotion.

·      Progress on including health concerns in international trade agreements.

·      Extent of adoption and implementation of policies focusing on health determinants in all sectors.

·      Level of community, civil society and non-health sector participation in policy formulation, planning and implementation in health promotion.

Commitment

This Bangkok Charter encourages international organizations, governments, communities, the health professions, the private sector and all other stakeholders to work together in a worldwide health promotion partnership effort by committing themselves to the key action areas and implementation strategies outlined above.

We, the participants of the 6th Global Conference on Health Promotion in Bangkok, Thailand, commit ourselves to the principles, action areas and implementation strategies outlined in this Charter.