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On the morning of 11 August 2005, I sat among 700 other health promoters in a UN conference room in Bangkok, Thailand with my hand in the air.

We were having our final feedback session to make contributions and changes to the Bangkok Charter for Health Promotion in a Globalised World. I was honoured with an invitation to the conference as a Next Generation Rapporteur and by mid-morning on the last day of the conference, after processing all I had seen and heard over the previous four days, I had just one more word I wanted to add to the Charter: pragmatic.

The drafters of the Bangkok Charter did an impressive job of incorporating much of the feedback they received. However, when the final version was printed, they had not added the word “pragmatic” as I suggested. Perhaps if I had been able to explain why I feel the word is important, it would have made the cut. Perhaps, it is not too late.

The need for pragmatism in health promotion became profoundly clear to me during one of the technical discussions on the 2^nd day of the Bangkok conference. David Fidler gave a presentation entitled Health Promotion as Foreign Policy, in which he rightly described health promoters as motivated to promote health because we see health as a human right (a notion reiterated in the Bangkok Charter). He then contrasted this with policy makers’ interest in health. According to Fidler, policy makers’ priorities are (in this order): security, economic well-being, development and human dignity. He explained they will be much more likely to promote health if they readily see how it impacts their core interests. Therefore, policy makers may not be persuaded to protect their citizens from Avian Flu, for instance, on the basis that health is a human right but would be compelled on the basis of its potential as a security threat. Health promoters can more effectively partner with foreign policy makers by thinking and acting pragmatically.

Another example of where such pragmatism could be useful is in dealing with the corporate sector. The corporate sector is motivated by profit. While this makes some of us uncomfortable, corporations are legally beholden to their share-holders to make money. Their actions will always be connected to their bottom line. Restaurants can not be persuaded to introduce healthy foods on their menus simply because health is human right. However, if they are convinced that there is a market demand for healthy food then suddenly, the healthy choice becomes an easy choice.

I am not suggesting that health promoters should stop thinking of health as a human right. Of course not -- this is central to everything we do. But for 20 years, we have recognised that the goals of health promotion require intersectoral partnerships. To initiate and sustain such partnerships, we must be realistic about the motivations and values of other sectors.

Pragmatism encourages us to be practical. While we hold our values in our hearts and minds, we must recognise there are other ways of seeing the world. We need to learn the languages of other sectors. We need to look at the determinants of their behaviour, to look at their cultural context. We must meet them where they are.

As you can see, these concepts are perfectly in line with our values. Our ways of working inherently respect people’s motivations and actions. To truly promote health in a globalised world, we must apply this understanding not just to our work in micro health promotion but to our macro health promotion as well.

If you agree, I encourage you to take out your copy of The Bangkok Charter (available for download at : http://www.who.int/healthpromotion/conferences/6gchp/hpr_050829_%20BCHP.pdf) and between the words “requires” and “actions”, on page 4, in the first sentence of the last paragraph under point 1, in the section “Key Commitments,” insert the word “pragmatic” so the sentence reads: “This requires pragmatic actions to promote dialogue and cooperation among nation states, civil society, and the private sector.”

Note: This article was commissioned for publication in Promotion & Education, and will be printed in Volume XII, Number 2 (in press).

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