This is the Canadian Public health Association Action
Statement on Health Promotion
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If not, read and think about what "Public health is".
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Preamble
This Action Statement is the product of a two-year
consultation process
involving more than 1,000 people. Participants in the
process were mainly
health professionals and volunteers who work to promote
health. Other
participants came from areas such as social services,
research, education,
recreation, environment and law enforcement. These people
share the values
and ways of working that define health promotion, even
though they may not
call themselves health promoters. Together, we represent a
community of
shared purpose. The purpose of this document is to provide
strategic
direction to this community.
Canada has a rich legacy in health promotion. A New
Perspective on the
Health of Canadians (1974) demonstrated the wide array of
influences on
health. The Ottawa Charter for Health Promotion (1986) and
Achieving Health
for All: A Framework for Health Promotion (1986) articulated
the principles
of health promotion and proposed strategic frameworks for
action. This
document is not intended to replace or update the Ottawa
Charter for Health
Promotion. We believe the Ottawa Charter should continue to
be used as the
framework that defines health promotion as an approach and
concept all of
us can use. Rather, this statement is intended to focus our
efforts in the
current climate so different from the optimistic days when
the Ottawa
Charter was first written.
Today, poverty is increasing and the income gap between rich
and poor is
widening. Unemployment persists in spite of economic growth.
Communities
are under increasing pressure from global economic practices
that imperil
the environment and consolidate wealth and power in private
corporations
with few legal responsibilities to the common good. Cuts in
government
spending threaten the social safety net and health system
that have served
us well and have defined us as a caring people.
In light of these realities, promoting health requires that
we focus our
efforts and prioritize our actions by:
* affirming and sharing the vision and values of health
promotion;
* emphasizing the creation of alliances across and
between sectors;
* honing our knowledge, skills and capacity to improve
health;
* emphasizing political commitment and the development of
healthy public
policies;
* strengthening our communities; and
* ensuring that health systems reform promotes health
both inside and
outside the health care system.
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Vision and Values
Health promotion's commitment is derived from a vision of
how the world
could be if it was based on an understanding of the
determinants of health.
The Ottawa Charter for Health Promotion identified the
prerequisites for
health as peace, shelter, education, food, income, stable
ecosystem,
sustainable resources, social justice and equity. Today,
with additional
knowledge from population health research, we recognize that
additional
critical health determinants include healthy child
development; adequate
incomes; a small gap between rich and poor; the absence of
discrimination
based on gender, culture, race and sexual orientation;
life-long learning
opportunities; healthy lifestyles; meaningful work
opportunities with some
control over decision-making; social relationships that
respect diversity;
freedom from violence or its threat; freedom from exposure
to infectious
disease; protection of humans from environmental hazards and
protection of
the environment from human hazards. In short, improving
health is a vital
component of human development.
Health promotion draws on an explicit values base.
* Individuals are treated with dignity and their innate
self-worth,
intelligence and capacity of choice are respected.
* Individual liberties are respected, but priority is
given to the
common good when conflict arises.
* Participation is supported in policy decision-making to
identify what
constitutes the common good.
* Priority is given to people whose living conditions,
especially a lack
of wealth and power, place them at greater risk.
* Social justice is pursued to prevent systemic
discrimination and to
reduce health inequities.
* Health of the present generation is not purchased at
the expense of
future generations.
Health promotion is guided by seven strategic principles.
1. Health promotion addresses health issues in context. It
recognizes
that many individual, social and environmental factors
interact to
influence health. It searches for ways to explain how
these factors
interact in order to plan and act for the greatest
health gain.
2. Health promotion supports a holistic approach that
recognizes and
includes the physical, mental, social, ecological,
cultural and
spiritual aspects of health.
3. Health promotion requires a long-term perspective. It
takes time to
create awareness and build understanding of health
determinants. This
is true for organizations as well as for individuals.
4. Health promotion supports a balance between centralized
and
decentralized decision-making on policies that affect
people where we
live, work and play.
5. Health promotion is multisectoral. While program
initiatives often
originate in the health sector, little can be done to
change unhealthy
living conditions and improve lifestyles without the
support of other
people, organizations and policy sectors.
6. Health promotion draws on knowledge from a variety of
sources. It
depends on formal knowledge from the social, economic,
political,
medical and environmental sciences. It also depends on
the
experiential knowledge of people.
7. Health promotion emphasizes public accountability.
Those providing
health promotion activities need to be accountable and
to expect the
same commitment from other individuals and
organizations.
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Priority Areas for Action
The Ottawa Charter has set the strategic course for the past
decade; its
direction is as important today as it was ten years ago. A
renewed health
promotion thrust will focus on three of the Charter's
strategies ­p;
advocating healthy public policy, strengthening communities
and reforming
health systems. To improve action in each area, the focus of
practice needs
to be sharpened and some infrastructures need to be
strengthened or
developed.
Governments at all levels, non-governmental and voluntary
organizations,
private sector organizations, community groups and
individuals all have key
roles in transforming this statement from words to action.
But assuming
that the Action Statement is everybody's business can lead
to it becoming
nobody's business.
We commit ourselves to ensuring that the public, private and
not-for-profit
sectors take action on the priority areas outlined in this
statement. It is
essential that each and all of the key players take a
leadership or
partnership role in the particular actions that best fit
with their
mandate, interest, ability, obligations and sphere of
influence.
Advocate Healthy Public Policies
Policies shape how money, power and material resources flow
through society
and therefore affect the determinants of health. Advocating
healthy public
policies is the most important strategy we can use to act on
the
determinants of health. Current policies that emphasize
deficit reduction
and private sector economic growth can be unhealthy for
people. These
policies may increase economic inequalities, environmental
degradation,
social intolerance and violence.
Healthy public policies are required to:
* reduce inequalities in income and wealth;
* ensure that economic activity contributes to human
development and is
environmentally and socially sustainable;
* protect people and the earth from toxic pollution,
resource depletion
and systemic global effects;
* create safe, secure and meaningful work opportunities;
* create opportunities for meaningful activities beyond
the workplace
(i.e., at home and in the community);
* create safe, supportive environments in schools,
workplaces and the
community;
* support the active participation of people
significantly affected by a
particular policy in discussing, choosing and
implementing the best
option;
* ensure that individuals and families have access to the
recreation
opportunities and other programs we need to stay
healthy; and
* ensure that individuals and families have access to the
resources we
need to choose and sustain healthy lifestyles.
To date, most policies in the area of health promotion have
supported
healthy lifestyles. Now we need to give more emphasis to
policies that
create healthy living conditions and work to ensure that the
voices of
society's least powerful express their concerns in these
policy issues.
Advocating healthy public policy involves:
* working with others to identify the most important
areas where policy
can make a difference;
* finding partners with whom to develop policy options;
* encouraging public dialogue on policy options;
* persuading decision-makers to adopt the healthiest
policy option; and
* following up to make sure the policy is implemented.
Healthy Public Policies: Priorities for Action
1. Focus health promotion practice more on developing and
implementing
policies that create healthy living conditions and less
on policies
that influence personal lifestyle behaviours.
2. Participate in alliances to deal with critical issues
such as growing
income disparities, child and family poverty,
environmental
degradation, support for the caregiving role of family
members, job
security, unemployment and under-employment,
independent living in old
age and Aboriginal rights.
3. Provide training in healthy public policy "how-to's"
including:
* analysis of health information;
* policy development;
* community participation;
* advocacy strategies; and
* evaluation of advocacy work in public policy.
1. 4. Conduct research into healthy public policy options
including:
* case studies of their implementation (process,
infrastructure,
effects); and
* evidence of their effectiveness
1. Undertake health impact assessments at all levels on
public and
private sector policies that are likely to have a
significant effect
on people's health.
2. Build the policy and resource capacity within local and
regional
health authorities to:
* act on the determinants of health;
* support health workers and community groups who
advocate healthy
public policies; and
* advocate healthy public policies with appropriate
government levels
and private sector organizations.
1. Issue periodic report cards on local, regional,
provincial,
territorial and national progress toward goals and
objectives that
address the determinants of health.
2. Create and maintain provincial and territorial health
councils to
advise on and monitor public policies that affect
health. These
multidisciplinary and multisectoral councils would be
charged with
generating action on health goals and objectives, and
would be
resourced sufficiently by government grants to perform
their tasks,
without interference in their day-to-day work.
3. Create intersectoral committees of provincial and
territorial cabinets
and within local governments to consider health impacts
when approving
policy and allocating resources.
4. Create an intersectoral committee of the federal
cabinet to consider
health impacts when approving policy and allocating
resources.
5. Create a multidisciplinary focal point (organization or
network) that
has the capacity to undertake policy research and
advocacy, support
the development of alliances for health promotion and
monitor key
public and private sector policy initiatives.
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Strengthen Communities
Communities are the dynamic groups that people form when
they share common
space, identities, interests and concerns. People experience
community
through close family and friendship ties and through
relationships where
they work, worship, study, volunteer, play and carry out
their civic rights
and responsibilities. Our health is created and sustained in
these
community relationships. Individuals belong to many
different communities,
not all of which embody the quality of sharing and caring
which
characterizes health promoting communities. There is
abundant evidence that
as sharing and caring disappear, health deteriorates.
Health promotion strengthens communities by supporting
community groups
that strive to create healthy living conditions and healthy
lifestyles.
Initiatives such as the healthy communities' movement have
been
particularly helpful in this work. Some communities do not
have all of the
resources necessary to ensure their own health. This may be
particularly
true for some poor families with young children, people with
disabilities,
Aboriginal communities, new immigrants and refugees, and
older people.
Efforts to promote health need to give priority to these
communities.
Strengthen Communities: Priorities for Action
1. Participate in local alliances working to change
unhealthy living
conditions and support environments that promote
healthy lifestyles.
2. Support a settings approach to practice (e.g., healthy
communities,
schools, workplaces and health care facilities).
3. Make community development a priority with people whose
living and
working conditions (especially the lack of wealth and
power) place
them at greatest risk for poor health.
4. Help strengthen the capacity of community members to
identify issues
and persuade politicians to implement change.
5. Share power more widely within health organizations.
Many health care
and community workers feel powerless in their own
organizations.
Before we can share power, we first must have power to
share.
6. Provide multidisciplinary training opportunities in how
to undertake
community development, work with vulnerable groups and
multicultural
diversity, analyze and synthesize knowledge-based
practice, and
develop and use appropriate evaluation methods.
7. Provide funding that supports:
* mutual aid and self-help networks;
* community groups acting to nurture citizenship,
maintain a sense of
community, sustain the environment and foster healthy
living
conditions; and
* national, provincial, territorial and local efforts to
use health
information technology to strengthen communities,
foster self-help and
break down inequities.
1. Support networks for healthy communities. Secure
sufficient funding to
allow networks to share experiences, translate local
lessons and
concerns into provincial, territorial, national and
international
policies, and, advocate these policies to appropriate
provincial,
territorial, national and international governments and
non-governmental organizations.
2. Develop appropriate evaluation methods for
community-based health
promotion work, community development and healthy
communities
projects.
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Reform Health Systems
Health systems reform has two objectives: to shift the
emphasis from
treating disease to improving health, and to increase the
effectiveness and
efficiency of the health care system. These objectives are
expressed in
most provincial and territorial policy documents concerning
health services
restructuring and goals for population health.
The reality of the reform process, however, is quite
different from its
rhetoric. The broad determinants of health have not been
addressed and
political and public debate continues to focus on insured
medical
treatments and reducing the number of hospital beds.
Provincial health
councils, which brought a determinants of health perspective
to health
reform, have largely been disbanded. In some cases,
devolution of power to
local and regional health authorities has become a
downloading of
responsibility without sufficient money, staff, authority
and training to
do the job.
Health promotion infrastructures have been weakened and in
some areas they
have been dismantled. Power imbalances within the system and
between health
professionals and their clients have been slow to change. In
many areas,
supports for client-centred primary health care,
community-based services,
family care-givers and community action have been cut,
rather than
increased. Mass layoffs in the health care sector (which
employs a
significant percentage of the working population) will only
worsen the
health consequences associated with forced retirement and
unemployment.
There are now fewer professionals to work with vulnerable
Canadians at the
very time they are most needed. Families, especially women,
are expected to
pick up the slack.
Shifting the emphasis from treating disease to improving
health requires:
* improved access to client-centred primary health care
services;
* increased support for community development work;
* improved community-based care services;
* increased support for family-based care;
* stronger health protection programs;
* increased support for informed community participation;
and
* increased priority given to the promotion of health in
the public,
not-for-profit and private sectors.
The actions that follow are designed to ensure that the
reality of reform
is true to the stated values and strategic principles of
health promotion.
Reform Health Systems: Priorities for Action
1. Provide local and regional health authorities with the
mandate and
resources they need to support families, strengthen
primary health
care, improve community-based services and work in
multidisciplinary
teams.
2. Provide mechanisms for increasing representative
community
participation in decision-making in local and regional
health
authorities. Ensure that board membership includes
people with
knowledge of health promotion and the broad
determinants of health.
(Consider becoming a member of local or regional health
boards
yourself.)
3. Develop and maintain appropriate infrastructure support
for health
promotion within the health system and assign dedicated
resources to
the promotion of health.
4. Collect consistent baseline data on the determinants of
health and
develop regional health profiles that measure health
status. The
information must be accessible, comprehensive and free.
5. Ensure that evidence on the effectiveness of curative
and preventive
interventions is considered when resources and
priorities are
allocated within the health system.
6. Present health promotion research results in a manner
that is readily
understood and usable by health professionals, the
public and the
media. State-of-the-art technology, such as the
Internet, should be
used to further disseminate this information.
7. Capitalize on lifestyle programs and issues as entry
points for
actions on the broader determinants of health and
provide resources
for this work.
8. Advocate the preservation of universal health care as
set out in the
Canada Health Act. Vigorously oppose user fees, since
they
discriminate against people with low income and protest
federal
decreases in transfer payments.
9. Empower health professionals to support the self-care
efforts of their
clients.
10. Address the power imbalances between health
professionals within the
health system.
11. Improve multidisciplinary practice for health promotion
by:
* increasing understanding of the strategic relationship
between primary
health care, disease and injury prevention, health
protection and
health promotion;
* documenting case studies of multidisciplinary health
programs that
integrate efforts in primary health care, disease and
injury
prevention, health protection and health promotion; and
* strengthening training in health promotion theory and
strategies in
post-secondary curricula for various health
disciplines.
1. Build stronger alliances among those who are working in
health
promotion, population health, community social services
and primary
health care in order to:
* share different perspectives on how to promote health;
* strengthen disease and injury prevention efforts;
* encourage multidisciplinary action on the determinants
of health; and
* strengthen the collective voice for advocating healthy
public
policies.
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Supporting Effective Action
While there are many factors that contribute to effective
action, at this
time the two most urgent factors are enhancing our knowledge
base and
building stronger alliances.
Enhance Knowledge and Skills
Considerable knowledge of effective health promotion action
exists. Some of
this knowledge has been generated through formal research
and some through
the experiences of community-based initiatives. Indeed, this
accumulated
wisdom is the basis of this Action Statement. However,
certain skills need
to be enhanced to shift the focus of practice. These skills
include
utilizing community development, working with vulnerable
groups, developing
healthy public policies, working in multidisciplinary
settings, doing
social marketing and using health impact assessment tools
and appropriate
evaluation methods.
A better understanding of the interaction of the
determinants of health is
needed in order to focus priorities for healthy public
policies and health
promotion actions, and to determine the best methods to
evaluate their
impacts. Several university-based Centres for Health
Promotion Research now
exist and are contributing to this understanding. But,
health promotion
research and training remains underfunded, especially when
contrasted to
funding for medical research. More support is needed for
participatory
research.
Contemporary research agendas need to focus on:
* demonstrating the effectiveness of health promotion;
* increasing the role of community in research;
* translating lessons from research into practice and
practice into
research; and
* investigating conceptual and methodological issues
(e.g., qualitative,
quantitative and participatory research).
Build Alliances
Alliances are coalitions or partnerships among different
organizations that
share a common goal. Through joint planning, resource
sharing and increased
political strength, alliances can accomplish more than
groups acting alone.
Health promotion has a long history of coalition and
partnership work. Most
of this work, however, has tended to involve only those
concerned about
specific disease or lifestyle issues. A concerted effort is
required to
form alliances across sectors that can advocate and affect
change on the
broad determinants of health. These alliances need to be
formed at local,
regional, provincial, territorial, national and
international levels.
Building alliances for action on health determinants
necessarily involves
people and organizations with different goals and
priorities. Developing a
common strategic goal around which all member groups can
mobilize requires
patience, persistence and flexibility. Within the framework
of our visions
and values, we need to negotiate a common agenda with our
partners, rather
than imposing our agenda on them.
Alliances for action on health determinants need to give
more attention to
working with the private sector, non-governmental
organizations, and with
members of vulnerable groups who often require resources and
support in
order to participate.
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Conclusion
This Action Statement for Health Promotion in Canada is
directed toward all
who share the values of health promotion. But, Canada exists
within a
global community. Political, economic and environmental
conditions around
the world determine the health of Canadians, just as
conditions in Canada
determine the health of many people beyond our borders.
Health promotion
works within political boundaries but is not confined by
them. We believe
this Action Statement is important for health promoters
around the world
and hope that it will inspire action elsewhere. We commit
ourselves
individually and collectively, locally and globally, to
demonstrate these
actions in our lives, our families, our work, our
communities, our
organizations and our public policies.
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Follow-up
The Canadian Public Health Association is committed to
working with a
variety of organizational and community partners to:
* facilitate action on the ideas presented in this
statement; and
* monitor and report on our progress.
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Copyright © 1996 by the Canadian Public Health Association.
Permission granted for non-commercial reproduction only.
ISBN 0-919245-80-3
The financial support provided to the Perspectives on Health
Promotion
project by the Health Promotion and Programs Branch,
Population Health
Directorate, Health Canada is greatly appreicated.
Mission Statement
The Canadian Public Health Association (CPHA) is a national,
independent,
not-for-profit, voluntary association representing public
health in Canada
with links to the international public health community.
CPHA's members
believe in universal and equitable access to the basic
conditions which are
necessary to achieve health for all Canadians.
CPHA's mission is to constitute a special national resource
in Canada that
advocates for the improvement and maintenance of personal
and community
health according to the public health principles of disease
prevention,
health promotion and protection and healthy public policy.
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Canadian Public Health Association
400-1565 Carling Avenue
Ottawa, Ontario, Canada K1Z 8R1
Telephone: (613) 725-3769
Fax: (613) 725-9826
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The views expressed in this document do not necessarily
represent the
official policy of Health Canada.
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Cover Design:
The design on the cover has as its core a focus on the
vision and values of
health promotion. All of the elements of the Action
Statement for Health
Promotion in Canada are based on this foundation. The three
priority
areas-advocate healthy public policy, strengthen communities
and reform
health systems-intertwine with the two most urgent factors
that will
contribute to effective action-enhancing knowledge and
skills and building
alliances.
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| last updated January 13, 1997 | mise à jour le 13
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***********************************
That which is sure is not sure.
As things are, they shall not remain.
-Bertolt Brecht
***********************************
Dennis Raphael, Ph.D., C.Psych.
Associate Professor
University of Toronto
Division of Community Health
Faculty of Medicine
Department of Behavioural Science
McMurrich Building, Room 101
Toronto, Ontario M5S 1A8
Tel: (416) 978-7567
Fax: (416) 978-2087
E-Mail: [log in to unmask]
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