Bangkok Charter: Reactions from Pacific Island Countries

Kabwea Tiban, Bootii Nauan, Tierata Ambo, Republic of Kiribati

Viliami Puloka, Siu Fangupo, Kingdom of Tonga

Miriam Abel, Graham Tabi, Republic of Vanuatu

Tony Lower, Secretariat of the Pacific Community, New Caledonia

Jan Ritchie, University of New South Wales, Australia

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The forthcoming Bangkok meeting, and the discussions which currently precede it, allow some of us working at promoting health with the roughly 8,000,000 people of the 22 Pacific island countries (PICs) of the Western Pacific Ocean, to add our perspective on the issues up for debate.  We value the opportunity provided by RHPEO to expose our comments to a wider audience.  Having worked together specifically in a regional health promotion project for the past three years where the Ottawa Charter (OC) has been the underlying framework for our project aims and activities, we feel confident we are speaking from firsthand experience (SPC, 2005).

To begin with, Kickbusch’s (2005) commentary raised some very relevant points for us.  Her first point on the fact that the OC was compiled for ‘developed countries’ and that therefore it was, and is, less relevant for ‘developing countries’ has been shown in our project to be as Kickbusch states “…a false dichotomy”.  Had we stuck with the Alma-Ata Declaration (1978) and only provided the community with ‘education concerning the prevailing health problems and the methods of controlling and preventing them’ the project would not have had the potential for sustainable results from advocacy undertaken, policies developed and legislation enacted – not to mention the supportive environments created or the health services reoriented.

Islanders do not separate physical health from mental, social and spiritual wellbeing so the OC’s attention to the integration of these is very well received by Pacific peoples.  Similarly, islanders are bothered when Western-style studies reveal ‘disease problems to be addressed’ whereas the Healthy Island approach of optimising health broadly across the PICs has been enthusiastically embraced.  Our project started off addressing risk factors for non-communicable disease and thus received the blessing of WHO, but our recent evaluation after three years has shown that where we have been able to address determinants of health beyond and beneath the risks for disease, the potential for beneficial outcomes has been far greater.  Finally, we agree wholeheartedly with Kickbusch’s (2005) emphasis on health being everybody’s business – again our evaluation has shown how effective it can be to work in partnerships forged between governments, NGOs and private collaborators.

So, having agreed that the OC has real meaning and forceful punch for less-resourced countries like the PICs, do we as a team see room for further developments that could be taken up in the Bangkok document?  Our first impression on reading the draft document a half-year before the Bangkok meeting is that it is rather long and somewhat repetitive.  Many of the statements are reinforcing the OC; we would prefer that rather than restating action areas determined in 1986, this document could overtly build on those of the OC, and only include new content.  On the other hand, there is a statement on page 9 under point 7 which says “Health is a global public good”. This very succinct phrase really underpins all the paragraphs on health and social justice, on health and globalisation, on the importance of health within the Millenium Development Goals, on the fact that health is often pitted against trade and economic growth, and on where health fits in good international, national and local governance.  We welcome these inclusions, but would prefer them presented more simply.

On a further point, as island nations intensely vulnerable to any deterioration in the state of the global environment, we are disappointed that the Bangkok document gives just fleeting acknowledgement of the fact that the health of Pacific islanders, like that of all citizens of our planet, is ultimately totally dependent on the health of the global environment.  Our fragile islands are already threatened with rapidly rising sea levels and increases in violent weather episodes, both of which are aggravated by human contribution to global warming, which we fear is sounding the death knell of our island atolls.  Consequently, we would like to have an emphasis put on promoting health through addressing the interaction between the relevant physical, social and economic determinants underpinning this issue, thus attempting to slow and ultimately reverse this ecological disaster in its tracks.

Finally, we are somewhat concerned about the language used in the Bangkok draft which tends to give the impression that health promotion is the answer to all the woes of the world.  We learned from our recent project that if we wish not to be perceived as a kind of health promotion Mafia, we need very careful use of words to indicate some degree of humility in seeking equality in partnerships with those from other sectors.  At present, we feel the document does not impart this humility.

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References

Kickbush, Ilona (2005), The dynamics of health promotion: from Ottawa to Bangkok, Reviews of Health Promotion and Education Online, 2005. RHP&EO.

Secretariat of the Pacific Community (2005) online at: WWW. Pacific Action for Health Project [accessed March 3, 2005].

WHO (1978) Alma-Ata Declaration on Primary Health Care, WHO, Geneva. WWW