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From Ottawa to Helsinki: A Charter for Health Promotion

Social welfare and health care workers work at the boundary between the public and the health
system. These workers are the ones who can communicate and influence the needs of the
public to the health care implementers and in return inform communities and individuals about
various aspects of social health. Health promotion is a concept which incorporates various
definitions of health and seeks to provide a framework for this type of health work. The Ottawa
Charter for Health Promotion signalled a change in thinking of how health was viewed
worldwide. It defined prerequisites for health and laid the foundations of health public policy.
One area of health that the principles of the Ottawa Charter are put into practice is mental
health. Mental health impacts on all other areas of health and for successful health promotion
a healthy state of mind maximises the potential impact of various promotional activities.
Health promotion is a term with many varied definitions and is used in any situations from
education, to nursing, to preventative medicine (Naidoo and Wills, 2009). The term arose from
a change in the perceptions of what defined health and the recognition that supplying health
care services was not the way forward to improving health and that instead, the social
determinants of health must be addressed (Naidoo and Wills, 2009). This focused on making
changes in the way that people lived by improving living conditions and developing a strategy of
living in which the basic resources of health income, shelter, and food are built on with
various social opportunities and services, to create a healthier future for everyone (WHO,
2009). In Ottawa, the World Health Organisation defined health promotion as the process of
enabling people to increase control over, and to improve their health. To reach a state of
complete physical, mental and social well-being, an individual or group must be able to identify
and to realise aspirations, to satisfy, needs, and to change or cope with the environment
(WHO, 1986). This definition laid the foundation for the Ottawa Charter for health promotion.
The Ottawa Charter identified eight prerequisites for health. These were: peace, shelter,
education, food, income, a stable ecosystem, sustainable resources, and social justice and
equity (WHO, 1986). These prerequisites were seen as essential foundations for improving
health and without them one could not easily become healthier. To ensure these prerequisites
could be achieved, the processes of advocacy, mediation and enablement were set as a
challenge for the new public health (WHO, 1986). The processes would be integrated through
five different action areas which would aim to: build healthy public policy, creative supportive
environments, develop personal skills, strengthen community action, and reorient health
services (WHO, 1986). These action areas and prerequisites form the platform for the Ottawa
Charter and provide a practical framework for effective health promotion.
Health can be categorised into a number of different dimensions, one of which is mental health.
Mental health, as defined by Naidoo and Wills (2009), refers to a positive sense of purpose and

an underlying belief in ones own worth. They give the example of feeling good and feeling
able to cope. Mental health and physical health share many of the same determinants but
mental health is often overlooked in terms of health promotion (Sturgeon, 2007). The Ottawa
charter and its five areas of action provide a framework for mental health promotion that is
relevant to todays society. Sturgeon (2007) emphasises the importance of focusing on the
positive concepts of mental health as the target for mental health promotion and to promote it
in a way that mental health may complement other areas of health while keeping within the
principles off the Ottawa Charter.
The first of the key action areas of the Ottawa Charter is to build health public policy (WHO,
1986). This concept recognises the scope of health promotion beyond the care services but also
recognises that primary health care has a part to play in promoting health. It shares the
responsibility of health promotion with policy makers from all sectors, a change from what was
once perceived to be an exclusive responsibility of the medical sector (WHO, 2009). The
Universal Declaration of Human Rights states that everyone has a right to a standard of living
adequate for the health and wellbeing of himself and of his family (Universal Declaration of
Human Rights, Article 25 in Niadoo and Wills, 2009). In order for this right to stand true,
governments must take responsibility for ensuring policies around employment, education,
transport, and health and social services, promote healthy public principles (Niadoo and Wills,
2009). The aim should be to make the healthier choice the easier choice (WHO, 2009), in
terms of policy making. When healthy public policies are supported by policy makers the
benefits can be seen through mental health. Communities with lower socioeconomic
backgrounds are often the ones that benefit the most from healthy public policies. Policies that
aim to increase access to nutrition, education and housing, have been shown to lead to
improved levels of safety and participation in communities (Jan-Llopis, Barry, Hosman and
Patel, 2005).
Creating supportive environments is about recognising that both nature and the environment
play a part in human health at local and global levels (Parker 2009). The environment refers to
the physical landscape , the social and economic environments and the political environment
(WHO, 2009) The World Health organisation identified in 1991 that making these environments
supportive of health was the way forward (WHO, 2009) A key point from this action area is that
health and the environment are inextricably linked. Creating supportive environments starts
from an early age. One of the ways in which mental health can be supported is through home
based interventions aimed at providing information for families about newborn health and to
enhance responsible and sensitive parenting styles and to facilitate the development of healthy
parent/child relationships (Jan-Llopis et al, 2005). Jan-Llopis et al, describe how initiatives
such as family support programmes for families under stress can provide support the mental
health of parents and their children by creating supportive environments where the health

prerequisites of peace, justice and equity are met. This type of action is one way mental health
promotion can be approached.
The third area of health promotion action involves communities. Strengthening their
involvement in decisions and planning around health matters gives them ownership and
control of their own endeavours and destinies (WHO, 2009). Community development aims to
provide self help services and social support that is unique to the strengths and needs of
individual communities. It takes away the sole reliance on public health services freeing them
up for issues that cannot otherwise be dealt with by communities (WHO, 2009). Health care
professionals must act as educators to provide information and resources for communities to
work with working with them rather than on them (Parker, 2009). Mental health promotion
projects Australia and Ireland provide good examples of how this principle of the Ottawa
Charter can be applied to mental health. Strengthening the networks in the community, both
projects drew on people from the community to help plan the events and participation was the
key to their success (Jan-Llopis et al, 2005). Rahman et al (1998 in Jan-Llopis et al, 2005)
gives another example of mental health promotion in a Pakistani school where children
educated their families and communities about mental health. It was seen to have improved
school childrens awareness of and attitudes towards mental health problems (Jan-Llopis et
al, 2005).
Developing personal skills is the fourth action area of the Ottawa Charter. The WHO (2009)
explanation for this is: health promotion can provide support by providing information around
health; educating people to make healthy decisions; and helping them enhance their life skills,
to develop personally and socially. This extends the aims of the strengthening communities to
the individual. It leads them to make educated decisions around their personal health by
developing the skills required for this. The advantages for later life include the ability to cope
with disease and illness more adequately and ultimately prevent this occurring further (Parker,
2009). Parker points out that the school, home, work and community environments can be the
setting for personal skill development.
The last of the five health promotion action areas, for the Ottawa Charter, is about
reorientation of health services. The role of the health service is often seen to be treatment
focused. The goal of the Ottawa Charter is to refocus this role to be one of health promotion
beyond that of providing clinical and curative service (WHO, 1986). WHO calls Health services
to work with individuals and communities to support their needs for a healthier life and to
recognise the shared responsibility of health promotion beyond the clinical setting. Research
and professional education around health and its promotion with the aim of this information
and training leading the way for attitude change for health services, to focus on the whole
needs of individuals (WHO 1986).

The Ottawa Charter for health promotion is a framework of action settings and health
prerequisites that can have a practical impact on the way health is viewed. The same concepts
that were originally developed in Ottawa in 1986 can still be applied to health today. Mental
health is an area of health where health promotion can be successful and success in this area of
health is a foundation for future health promotion in mental health and other areas of health.
The role of health care services has been shared among governments communities and
individuals to lead the way for a new public health focussed on prevention and promotion
rather than illness and cure.
References:
Jan-Llopis, E., Barry, M., Hosman, C., & Patel, V. (2005). Mental health promotion works: a
review. Promotion & Education, 12(S2), 9-25.
Naidoo, J., Wills, J. (2009). Foundations for Health Promotion (3rd ed). China: Elsevier
Parker, E. (2009). Health Promotion. In M.L. Flemming and E. Parker (Eds.), Introduction to
Public Health (pp. 280-303). Elsevier: Chatswood.
Sturgeon, S. (2006). Promoting mental health as an essential aspect of health promotion.
Health Promotion International, 21(suppl 1), 36-41.
World health Organization. (2009). Milestones in health promotion. Geneva: Author.
World health Organization. (1986). The Ottawa Charter for health promotion. Retrieved from
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index1.html