The 6^th World Conference on Health Promotion was held in Bangkok, Thailand in August 2005. Almost 20 years after the historic launch of the Ottawa Charter in 1986, the Bangkok Charter held promise for a renewal of commitment to health promotion and for addressing the challenges encountered in implementing the Ottawa charter in the broader context within which health promotion occurs. However, the Bangkok Charter was met with mixed reactions, particularly by those who were concerned that it may undermine or supersede the Ottawa Charter.[i] Perhaps on account of this, or simply because the Bangkok Charter was released immediately prior to the 20^th anniversary of the Ottawa Charter, there has been less focus than one might have expected on the Bangkok Charter in the two years since its launch. In contrast, there has been more attention than ever on the Ottawa Charter – as demonstrated by the special one-day workshop on the Ottawa Charter at the 10^th Journées Annuelles de Santé Publique (JASP) conference held in Montreal in October 2006 (http://www.inspq.qc.ca/jasp), as well as by the programme of the upcoming International Union of Health Promotion and Education (IUHPE) conference to be held in Vancouver in June 2007, where each day of the conference is devoted to one of the 5 axes of the Ottawa Charter (http://www.iuhpeconference.org/). However, it is still early days for the Bangkok Charter, and the process of implementing the 4 commitments and 5 action strategies is gradually gaining momentum: There have been meetings to develop country plans (a synthesis of which will be presented at the  upcoming IUHPE conference), a benchmarking working group has been established, a meeting of experts is planned which will integrate the Charter recommendations into a global framework for health promotion, the Bangkok Charter has been cited in several key documents,[ii] and a growing number of publications are appearing in relation to the Charter in academic journals (e.g. Health Promotion International, WHO Bulletin, etc.). 

A tale of two Charters

The Ottawa Charter has certainly made an enormous contribution over the last 20 years, and deserves to be widely celebrated, promoted and continued to be used. However, this should not preclude drawing upon useful concepts and recommendations contained within the more recent Bangkok Charter. In my view, the Bangkok Charter does not threaten to replace the Ottawa Charter, but rather to elaborate further the tools needed to adequately apply the Ottawa Charter within a constantly evolving context. Nonetheless, the road leading up to the Bangkok Charter required a great deal of groundwork, both in terms of justifying the need for another Charter and of the logistics of making a new Charter a reality.

Addressing new challenges and closing the “implementation gap”

The 6^th World Conference on Health Promotion represented a significant departure from earlier conferences which focused on specific axes of the Ottawa Charter (i.e. the 2^nd World Conference in 1988 focused on healthy public policy and the 3^rd World Conference in 1991 focused on supportive environments for health). However, it followed on from more recent World Conferences which looked at the challenges of implementing the Ottawa Charter and how to overcome these (i.e. the 4^th World Conference in 1997 led to the Jakarta Declaration on Leading Health Promotion into the 21^st Century and the 5^th World Conference in 2001 produced the Mexico Ministerial Statement on the Promotion of Health: From Ideas to Action). The official conference page on the WHO website stated:

Almost 20 years [since the launch of the Ottawa charter], many things have changed in the world, including the impact of globalization, the internet, greater moves towards private sector involvement in public health, emphasis on a sound evidence-based approach and cost-effectiveness. The 6th Global Conference has been convened to meet these challenges and to better exploit the opportunities presented for health promotion in the 21st Century.[iii]

Focusing on policies and partnerships

The title of the 6^th World Conference on Health Promotion, “Policy and Partnership for Action: Addressing the Determinants of Health,” highlights the growing realization that healthy public policy has been one of the most successful strategies of the Ottawa Charter, and yet, there needs to be a greater emphasis on building partnerships, since many of the most important determinants of health (such as poverty, education, employment and social support) lie outside of the formal domain of the health sector.[iv] Thus the main goal of the conference was to produce a Charter that would set out a strategic vision for sustainable and integrated health promotion that can successfully tackle the social, economic and environmental determinants of health through policy development and partnerships building.

Constructing the Bangkok Charter

Over 700 participants attended the 5-day meeting representing governments, academic circles, industry, non-governmental organizations and civil society groups from around the world. The selection of participants was a subject of great deliberation to ensure a balanced representation according to region and gender. The conference was structured in such a way as to maximize the contribution of a large number of stakeholders with diverse backgrounds and interests. This involved the use of 29 technical sessions which were categorized according to 4 tracks: new context, health-friendly globalization, partners, and sustainability. Technical papers were prepared in advance for each of the sessions to review the main issues. During the meeting, each technical session had a designated Chair and a Next Generation Rapporteur, who synthesized the main conclusions from the session and submitted these to the charter drafting committee. Several iterations of the charter were distributed and discussed during plenary sessions, before the final version was agreed upon.

Another milestone in a long process

Although the Bangkok charter, in my view, does not replace the Ottawa charter, it does make several important contributions (e.g. making even more explicit the different partners central to promoting health including: strong civil society organizations and a private sector that embraces its responsibility through good corporate citizenship; going further to emphasize the importance of policy coherence and a whole of government approach for addressing the determinants of health and correcting inequities; reinforcing the need for capacity building and greater investment for health, etc.).

However, the 6^th World Conference on Health Promotion was merely another step, albeit an important one, in a much longer process. Following on from the conference, the strategic vision set out in the Bangkok Charter still needs to be operationalized into interventions, strategies, models and methods (which incorporate and build upon the tried and tested elements of the Ottawa Charter) and are then implemented and evaluated based on specific indicators and targets. Only then will it be possible to judge the added contribution of the Bangkok Charter, to the undisputed contribution of the Ottawa Charter, in promoting population health.