Ottawa Charters Lecture Notes

Announcements and Assignment 2

• Deadline extended to April 14, 11:59 PM.
• Extension given because marking and feedback are not yet released; will be available tomorrow.
• Feedback includes suggestions, recommendations, and marking tied to the rubric.
• Tutorial last week covered assignment structuring, referencing, and general structure.
• Assignment instructions on Canvas will be modified to reflect this structure.
• The structure is a recommendation, other structures will not be penalized but it is the one the teaching team felt might be most helpful.
• Tutorials are helpful for understanding lectures, readings, and assignments.

Module 3 and the Ottawa Charter

• Focus of Module 3: Understanding the Ottawa Charter. Module 1 covered health, health promotion theories/models and social determinants of health, and Module 2 covered ethics, power, empowerment and risk communication.
• Next three lectures (including today) will cover the Ottawa Charter.
• Today's focus: Healthy public policy (first action area).
• Second half of the semester might include guest lecturers to show practical application of concepts.

Learning Objectives

• Understand the Ottawa Charter, its strategies, and significance in contemporary health promotion.
• Explore what healthy public policy involves and why it's critical.

Alma Ata Declaration (1978)

• Conference on primary care.
• Shift from medical/clinical model to a social view on health.
• Considered a formal beginning of health promotion as a discipline.
• Emphasis on human rights, equity, and community participation.
• Governments have a responsibility to provide adequate health and social services.
• People have the right and duty to participate in planning and implementation of their healthcare.
• Equal emphasis on health and social measures, citizen duty, and individual/collective participation.

World Health Assembly Debate

• Response to growing expectation of a paradigm shift in public health.
• Calls on member states to integrate health objectives into sectoral policies (agriculture, education, water, housing, sanitation).
• Includes equity-oriented targets for improving health outcomes for disadvantaged people (women, rural poor, urban slum dwellers, those in hazardous occupations).
• Taking health out of clinics and into communities and society.

First International Union of Health Promotion and Education Conference (1986) in Ottawa

• Led by WHO regional office, with Professor Ilona Kickbusch as a key figure.
• Series of events and publications preceded the conference.
• Document "Concepts and Principles of Health Promotion" consolidated health promotion as a new discipline.
• Acknowledged limitations of lifestyle and behavioral approaches.
• Recognized the need for a system-based approach rather than singling out individuals.
• Built on feminist theories, public health principles, and green/consumer movements.
• Radical shift providing cohesive direction for population health approach.

Relevance of the Ottawa Charter

• Developed to respond to health gaps within and between societies.
• Tackles inequities in health produced by societal rules and practices (social determinants).
• Served as a catalyst for the formal establishment of health promotion.
• Provided clarity and wider applicability.
• Based on comprehensive set of values, strategies, and goals related to health.

Emblem of the Ottawa Charter

• Big red circle symbolizes building healthy public policy:
  • Policy is constantly shifting and responsive to community needs.
• Other elements include:
  • Creating supportive environments
  • Reorienting health services (away from clinical, preventive, sickness-oriented model to population health).

Three Guiding Principles

• Advocate:
  • Gaining political commitment, support, or social acceptance for health.
  • Actions that lead to better health outcomes.
  • Good health is a major resource for social, economic, and personal development.
  • Political, economic, social, cultural, environmental, behavioral, and biological factors influence health.
• Enable:
  • Taking action in partnership with individuals/groups to empower them.
  • Mobilizing resources to promote and protect health.
  • Creating an enabling environment where people are empowered to ask for resources.
  • Achieving equity in health by reducing differences in health status.
  • Providing access to information, life skills, and opportunities for healthy choices.
  • Participation is meaningless if people are not enabled to participate properly.
• Mediation:
  • Reconciling differing interests (communities vs. industry, profits vs. health outcomes).
  • Navigating difficult conversations with different community groups.
  • Ensuring prerequisites for health like peace, stable ecosystem, social justice, and equity.
  • Involving all stakeholders (families, communities, organizations) in decisions.
  • Adapting strategies to local needs (culture, geography, religion).

Five Action Areas

• Building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills, and reorienting health systems.
• These areas are interactive and reinforce each other.
• Strategies should ideally incorporate multiple action areas for better outcomes.

Building Healthy Public Policy

• Health and equity should be the cornerstone of all policies.
• Aims to create supportive environments for healthy lives.
• Extends beyond healthcare, influencing policies across all sectors.
• Requires coordinated action between ministries.
• Identifies and eliminates barriers to healthy public policies.
• Policies should make healthier choices the easier option.

Creating Supportive Environments

• Aligned with socio-ecological approach.
• Considers living, working, and recreational environments.
• Encourages reciprocal maintenance (looking after each other and the ecosystem).
• Adapts to changing living and working conditions (agricultural, industrial, IT sectors).
• Systematic assessment of the health impact of the environment.
• Identifies personal support networks.

Strengthening Community Actions

• Empowering the community.
• Ensuring community collaboration in setting health priorities, planning, and implementing strategies.
• Capitalizing on resources within the community.
• Enhancing self-dependence and social support.
• Developing flexible systems for strengthening public participation.

Developing Personal Skills

• Supporting personal and social development of individuals.
• Empowerment to increase options and exercise discretion.
• Modifying personal behaviors and increasing access to information and support.

Reorienting Health Services

• Creating a healthcare system that contributes to the pursuit of health.
• Focusing on prevention rather than just the illness model.
• Ensuring sensitivity to community needs and cultural respect.
• Opening channels between the health sector and other areas.

Key Achievements of the Ottawa Charter

• Legitimized the vision of health promotion by clarifying key concepts.
• Provided a foundation for steering population health.
• Helps in understanding the history of health promotion and its evolution to better understand current practices and future directions.

Drawbacks of the Charter

• Less of a planning tool, more of a strategic framework.
• Seen as too complex or unattainable.
• Doesn't provide specific guidance for planning.

Subsequent Developments After Ottawa Charter

• Adelaide (1988): Focus on healthy public policy.
• Sundsvall (1991): Focus on supportive environments.
• Jakarta (1997): Promotion of health as a fundamental priority.
• Bangkok (2005): Health in all policies.
• Commission on Social Determinants of Health (2008).
• Closing the Gap (2009).
• Helsinki Declaration on Health in All Policies (2013).
• Sustainable Development Goals.
• Core concepts have remained the same despite newer models and goals.

Building Healthy Public Policy (Detailed)

• Virtually all public policies affect population health.
• Need for collective effort across sectors to improve health and attain equity.
• Lifestyle choices are influenced by social, economic, and political environments.
• Broad-scale policies addressing structural drivers are more effective long-term.
• Policies:
  • Decisions, goals, and ways to achieve them.
  • Guide change, allocate resources, and set priorities.
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Healthy Public Policy Defined

• Health and equity front and center in all areas of policy.
• Accountability for health impact.
• Distinct from health policy (health services).
• Creates environments for healthy lives and easy choices.
• Implemented at various levels of government and non-government sectors.

Six Features of Healthy Public Policy

1. Multisectoral and involves a range of groups (e.g., drink driving, climate change policies).
2. Local and international.
3. Mostly educational and persuasive, but sometimes legislative (e.g., seat belts, COVID lockdowns).
4. Intrinsically a political activity.
5. Impact of political decisions on issues.
6. Helsinki statement: Systematic approach across sectors, taking into account health implications, seeking synergies, and avoiding harmful health impacts.

Who Makes Public Policy?

• Matters who is involved (perspectives, opinions).
• Political parties, leaders, community/public expectations.
• Need for diverse representation to feed into the policy-making process.

How is Policy Made?

• Identification of a problem with evidence.
• Mapping stakeholders from different sectors.
• Consultative process involving legal and technical teams.
• Public consultations to ensure community voice.
• Simplified example highlighting community engagement.

Changing Public Policies as a Health Promotion Activity

• Addresses structural drivers, social determinants, commercial determinants, and ecological determinants.
• Helps ensure causes of the causes are addressed.
• Improves health outcomes and equity.

Phases in Policy Making

1. Problem Identification and Issue Recognition:
   • Important to focus on what is triggering the policy making.
   • Problems of minority communities need to be recognized.
2. Policy Formulation:
   • Decide what initiatives will be taken.
3. Policy Implementation:
   • Framework, resources, timeline.
4. Policy Evaluation:
   • Outcomes (process vs. distant outcomes).
   • Premise for saying that the program is successful.

Real-World Policy Making

• Iterative, subjective, and affected by the social and political environment.
• Involvement of industry, lobbyists, and people with different ideologies.
• Requires enabling communities and mediating different expectations.
• Influence of power (power over, power with, power within).

Health Promotion Perspective

• Providing opportunities for engagement and control of circumstances.
• What policy and legislation is required to expedite that.
• Facilitating an environment where people can bring about a policy and a legislative change that empowers them and gets them to the health outcomes that they're seeking about?
• Coalition building, mobilizing public opinion, lobbying.
• Influencing political and ideological values.
• Access to determinants of health is affected by policy choices (income, education, housing).
• Focusing on changes at a social and structural level.

Examples of Healthy Public Policy

• Free public education system
• Childcare support
• Water and sewage services
• Policies and programs:
  • Healthy homes standards help ensure housing conditions prevent disease and mental harm.
  • The graduated driver licensing system helps minimize road accidents.
  • The health school lunches program helps students learn and attend.
  • Alcohol consumption regulations help minimize death and harm due to drinking.

Key Factors for Adopting Healthy Public Policy

• Issue with clear evidence of adverse effects.
• Effective lobbying groups.
• Support from key opinion leaders.
• Supportive bureaucratic players.
• Conducive policy environment.
• Wins for health and other services.

Key Takeaway Points

• Potential for public policy/legislation as a public health tool.
• Consider public health impact of ongoing policy debates.
• Policies can restrict individual behaviors for gains at a population level.
• Success depends on acceptance and compliance.
• Community values should be reflected in policies.