The Jakarta Declaration

                                               on

                                       Health Promotion

                                     into the 21st Century





Background:

The 4th International conference on Health Promotion - New Players for a New
Era: Leading Health Promotion into the 21st Century - comes at a critical moment
in the development of international strategies for health. It is almost 20 years
after the World Health Organisation member states made an ambitious commitment
to a global strategy of Health for All, and to the principles of primary health
care through the Alma-Ata Declaration. It is ten years after the 1st
International Conference on Health Promotion was held in Ottawa, Canada. That
conference resulted in publication of the Ottawa Charter for Health Promotion
which has been a source of guidance and inspiration for health promotion since
that time. Subsequent international conferences and meetings have further
clarified the relevance and meaning of key strategies in health promotion
including healthy public policy (In Adelaide, 1988), and supportive environments
for health (in Sundsvall, 1991).

The 4th International Conference on Health promotion in Jakarta is the first to
be held in a developing country, and the first to involve the private sector in
supporting health promotion. It provides an opportunity to reflect on what has
been learned about effective health promotion, to re-examine determinants of
health, and to identify the directions and strategies which are required to
address the challenges of promoting health in the 21st Century.



Health promotion is a valuable investment

Health is a basic human right and essential for social and economic development.


Increasingly, health promotion is being recognised as an essential element of
health development. It is a process of enabling people to increase control over
and to improve their health. Health promotion, through investments and actions,
acts on the determinants of health to create the greatest health gain for
people, to contribute significantly to the reduction of inequities in health, to
ensure human rights, and to build social capital. The ultimate goal is to
increase health expectancy, and to narrow the gap in health expectancy between
countries and groups.

The Jakarta Declaration on health promotion offers a vision and focus for health
promotion into the next century. It reflects the firm commitment of participants
at the 4th International Conference on Health Promotion to draw upon the widest
range of resources to tackle health determinants in the 21st century.



Determinants of health: new challenges

Pre-requisites for health are peace, shelter, education, social security, social
relations, food, income, empowerment of women, a stable eco-system, sustainable
resource use, social justice, respect for human rights and equity. Above all,
poverty is the greatest threat to health.

Demographic trends such as urbanisation, an increase in the number of older
people and the prevalence of chronic diseases, increased sedentary behaviour,
resistance to antibiotics and other commonly available drugs, increased drug
abuse and civil and domestic violence, threaten the health and well-being of
hundreds of millions of people.

New and re-emerging infectious diseases, and greater recognition of mental
health problems require an urgent response. It is vital that health promotion
evolve to meet changes in the determinants of health.

Transnational factors also have a significant impact on health. These include
the integration of the global economy, financial markets and trade, access to
media and communication technology, as well as environmental degradation due to
the irresponsible use of resources.

These changes shape values, lifestyles throughout the lifespan, and living
conditions across the world. Some have great potential for health, such as the
development of communications technology, others such as international trade in
tobacco, have a major negative impact.



Health promotion makes a difference

Research and case studies from around the world provide convincing evidence that
health promotion works. Health promotion strategies can develop and change
lifestyles, and the social, economic and environmental conditions which
determine health. Health promotion is a practical approach to achieving greater
equity in health.

The five Ottawa Charter strategies are essential for success:

     build healthy public policy

     create supportive environments

     strengthen community action

     develop personal skills

     re-orient health services.

There is now clear evidence that:

     comprehensive approaches to health development are the most effective.
     Those which use combinations of the five strategies are more effective than
     single track approaches

     settings offer practical opportunities for the implementation of
     comprehensive strategies. These include mega-cities, islands, cities,
     municipalities, and local communities, their markets, schools, workplace,
     and health care facilities

     participation is essential to sustain efforts. People have to be at the
     centre of health promotion action and decision-making processes for it to
     be effective

     health learning fosters participation. Access to education and information
     is essential to achieving effective participation and the empowerment of
     people and communities

These strategies are core elements of health promotion and are relevant for all
countries.



New responses are needed

To address emerging threats to health, new forms of action are needed. The
challenge for the coming years will be to unlock the potential for health
promotion inherent in many sectors of society, among local communities and
within families.

There is a clear need to break through traditional boundaries within government
sectors, between government and non-government organisations, and between the
public and private sector. Co-operation is essential. Specifically, this
requires the creation of new partnerships for health on equal ground between the
different sectors at all levels of governance in societies.



Priorities for Health Promotion in the 21st Century

1. Promote social responsibility for health

Decision makers must be firmly committed to social responsibility. Both the
public and private sectors should promote health by pursuing policies and
practices that:

          avoid harming the health of other individuals

          protect the environment and ensure sustainable use of resources

          restrict production and trade in inherently harmful goods and
          substances such as tobacco and armaments, as well as unhealthy
          marketing practices

          safeguard both the citizen in the marketplace and the individual in
          the workplace

          include equity-focussed health impact assessments as an integral part
          of policy development

  2.Increase investments for health development

In many countries, current investment in health is inadequate and often
ineffective. Increasing investment for health development requires a truly
multi-sectoral approach, including additional resources to education, housing as
well as the health sector. Greater investment for health, and re-orientation of
existing investments - both within and between countries - has the potential to
significantly advance human development, health and quality of life.

Investments in health should reflect the needs of certain groups such as women,
children, older people, indigenous, poor and marginalised populations.

3. Consolidate and expand partnerships for health

Health promotion requires partnerships for health and social development between
the different sectors at all levels of governance and society. Existing
partnerships need to be strengthened and the potential for new partnerships must
be explored.

Partnerships offer mutual benefit for health through the sharing of expertise,
skills, and resources. Each partnership must be transparent and accountable and
be based on agreed ethical principles, mutual understanding and respect. WHO
guidelines should be adhered to.

4. Increase community capacity and empower the individual

Health promotion is carried out by and with people, not on or to people. It
improves both the ability of individuals to take action, and the capacity of
groups, organisations or communities to influence the determinants of health.

Improving the capacity of communities for health promotion requires practical
education, leadership training, and access to resources. Empowering individuals
demands more consistent, reliable access to the decision making process and the
skills and knowledge essential to effect change.

Both traditional communication and the new information media support this
process. Social, cultural and spiritual resources need to be harnessed in
innovative ways.

5. Secure an infrastructure for health promotion

To secure an infrastructure for health promotion, new mechanisms of funding it
locally, nationally and globally must be found. Incentives should be developed
to influence the actions of governments, nongovernmental organizations,
educational institutions and the private sector to make sure that resource
mobilization for health promotion is maximised.

"Settings for health" represent the organisational base of the infrastructure
required for health promotion. New health challenges mean that new and diverse
networks need to be created to achieve intersectoral collaboration. Such
networks should provide mutual assistance within and between countries and
facilitate exchange of information on which strategies are effective in which
settings.

Training and practice of local leadership skills should be encouraged to support
health promotion activities. Documentation of experiences in health promotion
through research and project reporting should be enhanced to improve planning,
implementation and evaluation.

All countries should develop the appropriate political, legal, educational,
social and economic environments required to support health promotion.



Call for Action

Participants are committed to sharing the key messages of the Declaration with
their governments, institutions and communities, to put into practice the
actions proposed, and report back to the 5th International Conference on Health
Promotion.

In order to speed progress towards global health promotion, participants endorse
the formation of a global health promotion alliance. The goal of this alliance
is to advance the action priorities for health promotion expressed in this
declaration.

Priorities for the alliance include:

     raising awareness about the changing determinants of health

     supporting the development of collaboration and networks for health
     development

     mobilisation of resources for health promotion

     accumulating knowledge on best practice

     enabling shared learning

     promoting solidarity in action
     fostering transparency and public accoutability in health promotion

National governments are called to take initiative in fostering and sponsoring
networks for health promotion both within and between their countries.

Participants in Jakarta '97 called on WHO to take the lead in building a global
health promotion alliance and enabling its member states to implement the
results of the Jakarta Conference. A key part of this role is for WHO to engage
governments, nongovernmental organisations, development banks, UN agencies,
interregional bodies, bilateral agencies, the labour movement and co-operatives,
as well as the private sector in advancing the action priorities for health
promotion.

************************
Eberhard Wenzel MA PhD
Griffith University
Australian School of Environmental Studies
Nathan, Qld. 4111
Australia
Tel.: 61-7-3875 7103
Fax:  61-7-3875 7459
e-mail: [log in to unmask]
http://www.ens.gu.edu.au/eberhard/welcome.htm

Nothing is so dangerous as being too modern.
One is apt to grow old-fashioned quite suddenly.
Oscar Wilde