Certainly the Ottawa Charter included strong equity principles. However,
while the 1978 Declaration of Alma Ata resulted from the participation of
developing nations, only industrialised countries attended the First
International Conference on Health Promotion in 1986, which resulted in the
Ottawa Charter.

In the interim, the idea of ‘lifestyle’ and its impact on health became
prominent and ‘lifestyle’ took distinctly different forms in Anglophone and
non-Anglophone countries. A WHO European publication in 1985 devoted a
chapter to lifestyle but emphasised ‘structural influences on behaviour’, …
where Anglophone countries tended to emphasise individuals. (Canada?) . So,
where in Alma Ata there is a framework called Primary Health Care, this is
replaced by Health Promotion in 1986. By 1997 the Jakarta Declaration
refers to lifestyle as a characteristic of the person and the conference
was attended by a health promotion workforce which is overwhelmingly
individualist in practice, if not in ideals.

I think the drift to an individualist orientation of ‘health promotion’ in
Anglophone countries was assisted by the separation of developed countries
from developing countries, in international health conferences. In
retrospect, Ottawa marks the point. Separating from developing countries
assumes a threshold model of material circumstances' impact on health that
developed countries have passed, which is contradicted by familiar evidence
from states/ countries like Kerala, Cuba etc. This underlying assumption is
at odds with the evidence of a social gradient in health in all countries.

Brian Fleming
Adelaide

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