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On the 11th of August 2005, the Bangkok Charter will be proclaimed in Thailand during the 6th international conference for health promotion sponsored by the World Health Organization (WHO). Whatever the final version looks like, and in my opinion it will not be too different from the preliminary versions that have been circulating for a while, this Charter (or whatever it will end up being called) will necessarily be of the same type than what such conferences generate : values and broad principles as well as noble and generous suggestions that are increasingly difficult to apply by Member States, crippled by less and less freedom of action in our era of globalization. Given the very nature of the WHO, it could hardly be otherwise.

Why did the Ottawa Charter have such an impact then, while the final documents proclaimed at the four other WHO international conferences were much less influential? Because it’s content was particularly convincing? Because it was a Charter and not like in Adelaide a set of Recommendations, or in Sundsvall, Djakarta or Mexico, a Declaration (« ministerial » in the case of Mexico)? Is the fact that it will most likely be a Charter in Bangkok a guaranteed recipe for success?

I suggest here to explain the success of the Ottawa Charter and the relatively small impact of the final documents of following WHO international health promotion conferences not by their contents nor by the fact that they are labeled a Charter or not. I think the key element is the historical and political circumstances in which each of them has been proclaimed. If this analysis is correct, it can already provide us with some interesting indications relating to the possibilities of the new Bangkok Charter. So why were the historical and political circumstances of the Ottawa Charter so special?

First and foremost, there was a novelty factor involved: this Charter was the first of it’s kind, proclaimed at the first of WHO international conferences in health promotion. I would argue that this “first kid on the block” syndrome played a similar role with the famous Lalonde report (1974): it was followed very closely by similar reports from the USA and most of the industrialized countries but with much less international impact. Being the first matters thus.

A second phenomenon of importance : the Ottawa conference was the outcome of almost ten years of work, reflections and exchanges. It was in the wake of the Health for All  declaration of the World Health Assembly in 1977 and the Primary HealthCare conference of Alma Ata in 1978, where lots of people were trying to operationalize all over the world the first major reorientation proposed by the WHO since it’s creation in 1948.

Thirdly, we must also recall that in 1986 the WHO, like all the other organizations of the UN system, still had strong credibility and leadership; 20 years of economic conservatism and « new world order » have seriously weakened these two important characteristics. Is today’s WHO moral authority, whatever the content of the new charter produced in Bangkok, as strong as yesterday’s?

Finally, the leadership in the production of the Ottawa Charter came from northern countries : the WHO European office in Copenhagen in interaction with the Canadian federal government. This charter also benefited from the tenacious efforts of a group of people like Ilona Kickbusch, Ron Draper and several other intellectual visionaries who were very well networked and occupied relatively powerful positions. Even if the international macro-economical leadership in the last 20 years, has somewhat shifted from Europe and North America to South-East Asia, will the proclamation of the Bangkok Charter next August benefit from the same positioning in the global political economy than the Ottawa one in 1986?

Only time will allow to answer the questions above. I nevertheless thought important to point out that it is not necessarily the exact wording nor the name of the Bangkok Charter that will explain the impact (or lack of) of this document on the international health promotion scene but the broader context in which they occur.

Note : a first version of this paper was published in French in the Bangkok Charter electronic discussion group of the Institut national de prevention et d’éducation pour la santé (INPES) in Paris in February 2005; it was reprinted in the same month in RHPEO. Thanks to Sébastien Courchesne-O’Neill for a first draft of translation in English.

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