In March 2005, while attending the Australian Health Promotion Conference in Canberra, I was invited to present my opinion on the Ottawa Charter as a young professional in the field, at the conference’s final plenary session. The theme of the conference was 20/20 Vision: 20 years since Ottawa, 20 years from now. Over the three days I sat through discussions, presentations and panel sessions on the Ottawa Charter; how it was developed, how it has impacted on health promotion and what role it may play in the future.

The Speech

I woke up yesterday morning without a care in the world. I was looking forward to some exciting days ahead at the conference and was glad my official duties had finished and I now could relax.

It only took until morning tea for this dream to be over, as I was invited to present at today’s plenary session. It was around that time that I started to panic. I was going to be presenting at the National Health Promotion Conference, at the plenary session, and replacing the likes of John Catford!

However, after several small panic attacks throughout the day I decided to take up the challenge of speaking this morning, and as a result I stand before you now a changed woman.

Perhaps before I begin I should let you in on my world and my journey through health promotion:

Lets start in 1986, the birth of the Ottawa Charter. I was five years old and my world consisted of pigtails, Rainbow Bright and Cabbage Patch Kids. While men and women were sweating it out over the details of the Ottawa Charter I was contemplating what I could buy with my 50 cents worth of pocket money. I think it is safe to say, that since 1986, my world has changed, I have grown and my priorities in life have evolved.

This began me thinking. If I have changed and evolved so much in 20 years, then surely health promotion has as well. And if this is the case, then how has a document such as the Ottawa Charter survived for so long without changing and evolving? And as a result how has the Ottawa Charter remained relevant to people in health promotion? And then more importantly is it still relevant today?

Let me leave that thought with you.

In 2000 I enrolled myself in the Community Education, Health Promotion degree at the University of Canberra. I spent the next three years exploring health promotion. I was challenged with different ideas about health, battled over theories and models, and dream of how I was going to save the world.

By far, the most influential thing I learnt, and probably the one thing I truly recall is the Ottawa Charter. The Charter became my commandments and Don Nutbeam’s Theory in a Nutshell my bible. I left my degree feeling inspired. I was going to change the world through the Ottawa Charter! All my programs and projects would strongly reflect the Charters five core areas, or so I thought…

In 2003 I left my life as a uni student behind, and took up a job as the health promotion program manager at Diabetes Australia-ACT. Since working the in field as a “professional”, and dealing with the reality of working in health promotion, some of my ideas, aspirations and goals have changed – just slightly.

So this is my world. I still work for DA-ACT and during my time there I have certainly grown and developed, as has my perception of health promotion.

I have to admit though, yesterday morning was the first time since studying it at university that I really sat back and thought about the Charter and how it is relevant to me. Do I really practice the Charter in my work as a health promoter? And is my lack of thought about the Charter a reflection on how relevant it is to my work? Or is it more that the Charter automatically underpins all my work so that I don’t need to think about it at all?

When I reflect on how I apply the core areas of the Charter to my everyday work, I could be left feeling disappointed. It is very clear that a majority of my work if focused around building personal skills. What I wanted to know when I discovered this is why I’m not focusing on the other four areas? What are the barriers before me?

Working as a sole health promoter in a small non-government organisation, in a small city, I do not have the means or the power to re-orientate health services, to develop healthy public policy or to create supportive environments. All I can do in my role, at a grassroots level, is to continue to advocate for changes in these essential areas. It is up to the community and the government to make these changes. And these changes will only be made once the community and government can see that they are priorities. And it is only once these areas are identified as priorities that we can begin to strengthen community action.

I don’t need to tell you that diabetes is the fastest growing chronic disease in the world, and that there is a proven link between diabetes, diet, physical activity and obesity. Diabetes and other chronic diseases have multiple, complex causes. Does the Ottawa Charter help to guide me to address these multiple issues?

When I think of a successful health promotion initiative in Australia, I immediately think of the significant changes that have been made in reducing tobacco use. The QUIT smoking campaign is an excellent example of how, through applying several aspects of the Charter at multiple levels you can achieve sustainable outcomes.

I guess when comparing reducing tobacco use and preventing diabetes, I am concerned that perhaps the Ottawa Charter isn’t enough. Perhaps the Charter does not provide me with enough of a guide to help me address chronic disease in today’s world? So I guess my real question is, do we now need something else to guide us?

So this brings me to my opinion of the Charter. The Charter to me is a guide. It is five values that underpin health promotion. A friend said to me yesterday that she saw the Ottawa Charter as the stars that guide us through the big, scary and complex world of health promotion. This sums up my view the Ottawa Charter today.

I see the Charter as working at a macro level;, it is the overarching set of values of our work. However, in my case, I do not feel that these values or goals are always obtainable. We have been working for years to re-orientate health services, but have we made changes? I don’t really think so, but are we going to stop fighting for change? No way.

What I think we need is something new that helps people like me, and you, working at a micro, or grassroots level to connect with the Charter. We need a framework that will guide us in how to achieve these sometimes unobtainable goals; something that will link the Charter to the social determinants of health. I guess if I go back the metaphor I used about the stars, yes, the Charter is the star that guides us, but people tell me I can’t hold a star in my hand. What I want in the future is a framework, which guides me so one day  I can hold that star.

So I bet you are all wondering why I am now a changed woman?

Well, the challenge of presenting my opinion of the Charter made me really think about health promotion and what it truly means to me. I sometimes feel disheartened at the end of conferences such as this. The problem seems so big, and my contribution too small. Re-examining the Charter has helped me see that what I do is important, and one day, down the track, I know that my work in developing personal skills will lead to healthy public policies, supportive environments, community action, and who knows, even re-orientated health services.

Reflections

It has been 12 months since I presented the above speech, and although I was not aware of it at the time, the opportunity to express my opinion of the Charter has had a profound impact on my daily work as well as on my reflection on my studies and my future outlook of health promotion. I am now conscious of the Charter in my everyday work. I am constantly looking for new opportunities to apply to principles of the Charter, and looking at ways to challenge or educate areas of the health system where either the Charter is not known of, or is not properly understood.

In the last 12 months my “professional world” has been turned upside down. I am no longer a part of a small NGO, but am now one of over 4000 staff members in the Australian Commonwealth Department of Health and Ageing. I went from micro to macro in one giant leap. I am no longer dealing with the daily tasks of program management, but am working on longer term strategic health policy.

When accepting my new job I was concerned that I was leaving my beloved world of health promotion behind. I knew my new position would have nothing directly to do with health promotion, and I was concerned that I was making the wrong decision.

However, upon reflection, working in this different environment has provided me with new challenges, and most importantly has proved to me that health promotion does not, nor can not exist in isolation.

Although this thought is already widely acknowledged among health promoters, the challenge for us young professionals is: how do we begin to integrate health promotion into all aspect of our society? How do we ensure that health promotion is involved when people are planning new suburbs, writing school curricula or developing public transport systems? How do we change the discourse of our society so people are aware that health promotion is more than mass media campaign?

Although I know longer have health promotion on my business card, I still sleep well at night knowing that I am doing my part – I have just chosen a new avenue to do it. Taking this job has given me the opportunity to influence the health of Australians through public policy, something that eluded me in my old work. But more than that, it has given me the opportunity to challenge the attitudes of my colleagues, and to begin to integrate health promotion into all areas of my work – one step at a time.

(The views expressed in this article are not necessarily those of the Australian Department of Health and Ageing)

Note: having heard about the presentation, we invited the author to submit it to RHPEO in our “Renewal of the leadership in Health Promotion” series as a way to encourage submissions of younger people in the field. Michel O’Neill, Editor in chief, RHPEO.

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