Moving Upstream together: Celebrating the 20^th anniversaries of the Ottawa Charter of Health Promotion and of the Ontario Prevention Clearinghouse

Subha Sankaran

The Moving Upstream conference

To mark the 20^th anniversaries of the Ottawa Charter and of the organization, OPC organized a working conference to celebrate the successes and discuss the effectiveness of health promotion strategies in improving health in our society. Entitled Moving Upstream[2] Together: Partnering for Ontario’s Future Health and Well-Being[3], the conference took place in February 2006 at the University of Toronto and was inaugurated by the Ontario Minister for Health Promotion, the Honourable Jim Watson. The conference brought together over 200 professionals, volunteers and students working in the health and social sectors in Ontario to identify and strategize how to achieve real social change and healthier individuals and communities across the province.  Using multiple formats including presentations, panel discussions, conversation cafes, graphic recording, large and small group discussions, plenary and concurrent sessions, the conference gave ample opportunity for people to interact, share ideas, build connections, and learn from each other[4].

The first day of the conference opened with a presentation-workshop led by Suzanne Jackson, director of the Centre for Health Promotion at the University of Toronto and Suzanne Schwenger, health promotion consultant at OPC. The session analyzed the history of the World Health Organization international health promotion conferences and commitments beginning with the Ottawa Charter of 1986 right up to the recent Bangkok Charter of 2005. Suzanne Jackson identified the strengthening of the healthy settings movement, and some global themes that have emerged in this period, including community involvement, expanding partnerships, investing in health, social equity and global accountability. Interesting discussions ensued, particularly focusing on the increasingly smaller world we live in as a result of globalization, mass media and other forces, and how these changes impact on the work of health promoters.

Participants brought forward the dilemma of feeling constrained by job assignments, organizational structures and funding parameters, and the importance of being active in the arena of public policy to bring about lasting change. Following this session, Charles Pascal[5], in a keynote address, championed the Canadian Index of Well-being (CIW) now in development, which will measure societal well-being and complement measures such as the Gross Domestic Product (GDP) used to measure the economic outputs of a society. A growing number of organizations and public figures in Canada, including Roy Romanow, are working collaboratively towards this index that would meaningfully measure what impacts the quality of life of people.

The release of OPC’s position paper by Connie Clement, Executive Director, set the tone for the second day of the conference. Entitled The Case for Prevention[6], the report succinctly marshals powerful arguments and data to urge policy makers to take a long-term perspective and create strong social and policy commitments for prevention and health promotion initiatives.

The concurrent sessions addressed key issues for the future of Health promotion. For example, during the session entitled “Where are the determinants of health?”, conference participants discussed the opportunities and barriers faced by organizations that address determinants of health. One of the lessons emphasized was that it is hard work to tackle all the determinants of health at the same time and that organizations should focus on a few and work in collaboration with others to cover the  whole spectrum of determinants. The challenge for all organizations is to find ways to integrate the determinants into their work.  During the “Breaking out of silos” session, to counterbalance divisions between sectors that result from political structures and funding, participants explored building more effective partnerships. It was suggested that silos could be infiltrated through influence in addition to trying to break out of them. In order to build bridges across sectors, we have to make a conscious effort to change the dialogue, change the language, and change the paradigm. For instance, when creating partnerships with the private sector, we need to communicate in language understandable to them and emphasize what unites us. Sessions were also led in French as participants tackled complex issues relating to francophone services. In the session: “Access alone is not enough – solutions for francophone communities”, participants stressed the importance of flexibility and innovation in our services, and the necessity to get francophone communities involved when identifying their needs[7].

Afternoon sessions on the second day were in “roundtable” format. Hosts at each of the nearly 20 concurrent tables set the discussion rolling by outlining concrete examples of successful health promotion initiatives. Using the conversation café format, the discussion helped highlight specific points for shared learning such as – What worked? What did not work? What would have helped?  Would you do anything differently in hindsight? Participants brainstormed on a wide range of issues, such as gender identity, partnerships with schools, culturally appropriate services, or social housing, and each roundtable generated upstream ideas and solutions to address the issue. Some of the conclusions included: sexual orientation is not often made explicit as a social determinant of health and there is much work to do to make it a safe issue to talk about; we can move towards healthy partnerships with schools by supporting student driven projects; children are often a good way to reach immigrants when English is not the parents’ first language; social housing is an issue in which the focus should be on community building rather than housing building. The conference succeeded in generating rich insights, forging new connections and renewing old ones.

The conference reaffirmed the importance of maintaining and building health promotion impact by moving upstream and addressing issues before they overwhelm us. The discussions confirmed the need to learn from our successes; innovate and create novel partnerships; integrate inclusion and reduce health disparities; and even more essentially, act NOW in order to promote better health. 

Building on the Conference results: articles, discussions, presentations

In the months following the conference, OPC built on the strategic insights gained from the workshops and discussions and continued the reflection on the Ottawa and Bangkok charters. One of our health promotion consultants, Sylvie Boulet, wrote an article published in Le Bloc-Notes and then in the Ontario Health Promotion Electronic bulletin, two of OPC’s electronic newsletters,[8] on the Bangkok Charter and its relevance for community health promoters (Boulet, 2005, 2006). The article argues that the Bangkok Charter reinforces the Ottawa Charter by stressing the importance of health promotion theory and practice; it also takes health promotion strategies to another level by extending their scope to developing countries. According to Boulet, the Bangkok Charter argues for the need for global level initiatives and foresees a central role for health promotion within the global development agenda. It calls for the development of significant intergovernmental agreements to increase population health and to reduce health inequities between rich and poor. Boulet pursues this argument by suggesting that while the Ottawa Charter focused on community action, the Bangkok Charter calls for building capacity by means of policy development, legislation and partnerships with various sectors (public and private) at a global level. The Bangkok Charter raises questions about the impact of community action beyond the limits of our local and affinity communities. How does our local work, as health promoters, influence what occurs at the global level? Through our various actions – training, support to minority groups, or encouragement to change lifestyles – we influence the health of individuals and also families, communities, and potentially, nations. Unfortunately, even though this new framework for health promotion raises our awareness of global issues, many health promotion practitioners in local communities do not have the mandate, time, energy or tools to apply this new framework. However, we all can work in the spirit of the Bangkok Charter by making clients aware of their economic power.

According to Boulet then, the Bangkok Charter greatly complements the Ottawa Charter. The Ottawa Charter, with its concrete language and well-defined structure encourages health promoters to use multifaceted actions. It validates the determinants of health as objectives, as well as indicators of success. The Bangkok Charter, on the other hand, stimulates our reflection, questions our global commitment and evaluates our social justice actions. It forces us to reflect on our personal actions and community interventions and consider the international significance of local initiatives. 

This article generated interest internally amongst OPC staff as well as externally amongst health promotion practitioners. OPC organized an all staff meeting during which the article and the two Charters were discussed. Sylvie Boulet went on to present these reflections at the Journées annuelles de Santé Publique 2006 (JASP) Conference in Montreal. She is scheduled to present her conclusions at the International Union of Health Promotion and Education (IUHPE) in Vancouver in June 2007.

The Ottawa Charter for Health Promotion continues to guide the work of health promotion around the world. OPC is no exception. Be it in day to day programme planning, strategic thinking, policy positions, staffing or resource development, the philosophy and comprehensive approach of the Ottawa Charter is still a point of reference for us. OPC has used it to develop a health promotion “Subject Areas Framework” that is the foundation of Canada’s most comprehensive health promotion bulletin and searchable database – the Ontario Health Promotion E-Bulletin. A younger, sister publication, le Bloc-Notes, follows the same framework. OPC has used this same framework in our work with the Canadian Health Network (CHN) Health Promotion Affiliate, to build a tool for all CHN Affiliates that will help ensure comprehensive coverage in health promotion resources. This will also be featured in an oral presentation by Alison Stirling at Vancouver in June.

The Bangkok Charter is being used to deepen this basic approach in many ways. The acknowledgement of health disparities is one example. Within Canada, Aboriginal communities face highly adverse health outcomes. Moreover, one way in which globalization has affected Canada is through immigration. The reduction of health disparities particularly among immigrant and ethno-racial community groups is one area where research and action are needed.

The response to the Moving Upstream conference and Boulet’s reflections on the Bangkok charter of health promotion shows that the Ottawa and Bangkok charters for health promotion continue to resonate with health promotion practitioners.  Yet, as we learned during the conference, the appeal of the two charters goes far beyond health promotion practitioners. The pre-conference session focusing on the charters generated much more interest than we expected. It had been planned for health promotion specialists, and we were surprised when 85% of our conference participants coming from diverse sectors signed up for the pre-conference to learn about the charters. This interesting fact reinforces the idea that the charters have great potential and remain effective tools to bring about far reaching social transformation in our move towards health for all.

Acknowledgements:

This article is a joint effort of staff at OPC. Contributors: Subha Sankaran, Health Promotion Consultant, Sylvie Boulet, Health Promotion Consultant, Connie Clement, Executive Director, and Eliane Nguyen, Communications and Policy Specialist.