This paper is the first within a new sub-series of the Ottawa 1986-Vancouver 2007: should the Ottawa Charter be revisited ? series, a sub-series which has been created to provide the participants to a symposium on the Ottawa Charter held during the 10^th Journées annuelles de santé publiques (JASP) in Montréal on October 25^th 2006 with the possibility to pursue the exchanges begun then on different issues. Over 1200 people, coming from Canada and about 12 other countries, were at the symposium and tried to answer the question: Is the Ottawa Charter for health promotion still useful for today’s public health practice? At the end of the day, after a final vote, the “message of Montreal” seemed clear: over 70% answered yes to that question! As an opener to the new sub-series, the aim of this paper is thus to explore a bit further the meaning of this message and, at the same time, to trigger additional thoughts on this subject in preparation of  IUHPE’s international conference in Vancouver in June 2007 (http://iuhpeconference.org).

Three other papers are also planned to introduce the sub-series: one describing the sophisticated process that guided the planning and the realization of the Montréal symposium; one focusing on the different themes that emerged throughout the day; and, finally, another on the theatrical performances that took place during the day. In order to partake even more in the preliminary work of IUHPE’s Vancouver conference, a special call for papers has finally been made to the 1200 participants in the context of the sub-series, and the articles retained by a group of peer-reviewers  gathered especially for the circumstance will be placed online as soon as there are available, but on May 1^st  2007 at the latest.

The intent of the Symposium: bring the participants to reflect and to take position

The Ottawa Charter Symposium was developed by a scientific committee of about twelve persons coming from a variety of jobs and perspectives (see JASP, 2006, for further details) under the leadership of M. O’Neill and S. Dupéré, within the JASP’s general rules regarding the organization of symposia. The day began with a general plenary dedicated to the past (from 1986 on), present and future of public health, followed by five sub-plenaries focusing on the Charter’s five strategies. After lunch, the participants were split into 20 parallel workshops devoted to diverse forms of practice and were gathered again, in conclusion, for a final plenary. Adopting a peculiar format after a popular TV show in Quebec by the name of Droit de Parole, that plenary allowed confrontation between the views of the participants, as reported by the Mise au jeu theater troop (N. Roberge et P. Parent), and those of nine “key witnesses”, coming from a diversified set of academic and practice environments; the plenary ended by a final vote.

Principally designed by two members of the scientific committee (S. Dupéré and E. Pedneault), a sophisticated approach was implemented in order to supply Mise au jeu and the facilitator of the Droit de Parole (R. Perrault) with meaningful content. The participant’s viewpoints were collected using such mechanisms as vox pop, a thorough and systematic note taking process in each of the activities as well as a mural and pictures. All these elements were synthesized by two “key reporters”, M. Forster and K. Perreault. A breakfast with authors of recent books on public health, over a hundred posters as well as an exibit called “Objet: pauvreté” also nourished the reflections of the participants.

The main issues that emerged during the day

Among the issues raised using the techniques mentioned above, two seem to stand out.

The Ottawa Charter: useful, usable, used?

Even if the majority of the participants judged that the Ottawa Charter was still useful today, it seems important to question the contemporary meaning of this usefulness. The participants provided a multitude of answers, which lead to believe that every person uses the Charter in his or her own manner. The Charter was even designated in several miscellaneous ways: a reference framework; a philosophy; a set of ideas, of orientations, of directions, of guidelines; a vision; a manifesto; and even…a bible! Only a few persons explicitly described the Ottawa Charter as an intervention tool to be used directly in the field; the Charter thus seems to be perceived more as a conceptual or theoretical instrument, several persons having specifically mentioned that they do not use it in their daily work.

The conceptual usefulness of the Charter, which seemed undisputable for the participants, is thus suffering of a lack of application. The reasons evoked to explain this deficiency seem to lie in the difficulty to concretely adapt the Charter, combined to a weak political will regarding its implementation. These issues were brought up during the opening plenary of the day: according to the speakers, the enthusiasm generated by the implementation of the Charter in 1986 was soon followed by a period where nothing really happened. Is the Charter necessarily confined to occasional pilot projects or can it truly inspire or influence public policy ? Could the Charter be a wall levied against governmental decision based on electoral considerations, thus protecting society from ill-informed governmental positions? As an example, mentioned  during the day, the spirit of the Charter could be utilized to oppose Canada’s sudden withdrawal of the Kyoto Protocol by a conservative government in Ottawa.

Is the Ottawa Charter still up to date ?

Besides, is the Ottawa Charter still up to date in several key domains such as international relations, environmental conditions or global health, given the changes observed during the last two last decades? A number of participants mentioned that the Charter still constitutes an up to date document, hence its widely perceived utility as mentioned above. Nevertheless, the necessity to take stock of the issues linked to globalization as well as of the non-recognition of population’s needs, notably in the developing countries, are among the arguments defended by some participants thinking that the Charter deserves to be revisited.

For the participants, the model proposed by the Charter did not seem therefore to have attained it’s full potential on both social and political levels and its real impact still awaits to be felt.  Consequently, despite being 20 years old, the Charter did not look for them like a theoretical fossil, dried out by the heat of much more recent paradigms.

Conclusion: is the “Montreal message” a mere hay fire ? 

Contrary to a lot of the discussions that took place around the Bangkok Charter and that left often the impression of a certain obsolescence of the Ottawa Charter (RHPEO, 2005, 2006; Van Steenberghe and St-Amand, 2006), participants at the Montréal Symposium seemed to agree that the Charter is still useful although not easy to apply. During the days that followed, in another symposium on social exclusion held in Québec City as well as in a speech of the Quebec minister of Health and social Services pronounced in honor of the 20^th anniversary of Réseau québécois des Villes en villages en santé, the Charter was explicitly evoked. Were these evocations simply a happenstance, or do they reflect the sturdiness of the Ottawa Charter and its capacity to formulate, in an effective manner, some important public health issues still not resolved even after 20 years ? In June 2007, IUHPE Vancouver’s conference will continue to explore these important questions.

Note :

¹ A slightly modified version of this paper will be published early 2007, in a pre-conference special issue of Promotion & Education in preparation of the 19^th World Health Promotion and Health Education conference to be held in Vancouver in June 2007.

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