Is the Ottawa Charter Still Relevant?

The Ottawa Charter for Health Promotion (the Ottawa Charter) (World Health Organization, 1986) is often seen as a landmark document for health promotion, primarily through the lens of health equity. It outlines five actions to create health promotion with three strategy arenas (see Figure 1). The Ottawa Charter revolutionized our approach to health (Thompson et al., 2018). Instead of directing efforts to improve health for individuals with disease, it altered our perception to extend beyond the absence of disease and instead, to facilitate health promotion by creating favourable environments and self-determination.

Figure 1.

Note: The five actions include building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services. The three focus areas include advocating, mediating, and enabling. From “Ottawa Charter for Health Promotion, 1986,” by the World Health Organization, 1986 (https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf )

As the Ottawa Charter approaches its 40th anniversary, does it remain relevant as a document mandated to “achieve Health for All” (World Health Organization, 1986, para 1)? To answer this, we need to consider the lens through which we view this question, especially when discussing a document that aims to achieve health equity. The Coin Model of Privilege and Critical Allyship framework by Stephanie Nixon (2019) helps to visualize the privileges and disadvantages that parallel societal structures (see Figure 2). When examining societal structures within healthcare, it is understood that those who aim to correct inequities (albeit often experts in their field) come from a place of privilege drafting a document for those who are disadvantaged. The conundrum is that the true experts exist at the bottom of the coin: the disadvantaged (Nixon, 2019). Nixon describes this practice as typical in health equity practices and, unfortunately, reinforces inequities.

Figure 2.

Note: From “The Coin Model of Privilege and Critical Allyship: Implications for Health,” by S. A. Nixon, 2019, BMC Public Health, 19(1), p. 4 (https://doi.org/10.1186/s12889-019-7884-9)

In the context of colonialism, the Ottawa Charter is critiqued as an ideologically Western-centric approach to health promotion (Ratima, 2024). Colonialism extends beyond the theft and exploitation of traditional Indigenous People’s land and resources to include the suppression and disregard for Indigenous knowledge and traditions (Ratima, 2024). This disregard of Indigenous knowledge ultimately restricts the number of possible solutions to problems experienced by both local and global communities. The view of Indigenous health promoters has vastly been underappreciated (Tiohtià:ke Statement, 2022). Indigenous health promotion expresses Indigenous world views while “sustaining biodiversity, food sovereignty, and ecological integration, with millennia of experiences adapting to a changing environment through close connections with the land amidst waves of adversity” (Tiohtià:ke Statement, 2022, p. 4).

As health promotion seeks to dismantle social structures that create barriers to health equity, all those involved in health promotion need not only to strive to decolonize the health promotion strategies as put forth in the Ottawa Charter, but it is essential also to support Indigenous self-determination (Ratima, 2024; Tiohtià:ke Statement, 2022). Individuals working in health promotion should familiarize themselves and answer the calls for action while supporting Indigenous self-determination through documents such as

• Tiohtià:ke Statement: Catalysing Policies for Health, Well-being and Equity (2022),

• Truth and Reconciliation Commission of Canada: Calls to Action (2015),

• United Nations Declaration on the Rights of Indigenous Peoples (2007).

  
  

While acquainting oneself with the world views of Indigenous Peoples and the depth of colonization, it is integral that we engage in deep self-reflection while acknowledging our own bias and privilege (Nixon, 2019; Ratima, 2024). In my personal experience, I was fortunate to enroll in the San’Yas Indigenous Cultural training which discussed colonialism and the effects of racism as experienced in the healthcare setting. This reflection enables individuals to identify societal practices in their daily lives that consciously or unconsciously reinforce inequality (Nixon, 2019). It also provides opportunities to take a stand against colonialism and its consequential effects that exist within society (Ramita, 2024). Ramita (2024) suggests that these gestures do not always need to be grand and can be as simple as listening to Indigenous perspectives or voicing concern when inequities are being experienced.

Circling back to the question asked, is the Ottawa Charter still relevant? Yes. However, we cannot, with good conscience, disregard the fact that colonialism is embedded within it. Forty years following its inauguration and in the context of an ever-increasingly conscious society, perhaps now is the time for an updated health promotion charter: the Ottawa Charter 2.0.

References

Nixon., S. A. (2019). The coin model of privilege and critical allyship: implications for health. BMC Public Health, 19(1), 1–13. https://doi.org/10.1186/s12889-019-7884-9

Ratima, M. (2024). Realising the promise of health promotion through decolonization. Global Health Promotion, 31(2), 3-6. https://doi.org/10.1177/17579759241252382

Thompson, S. R., Watson, M. C., & Tilford, S. (2018). The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education, 56(2), 73–84. https://doi.org/10.1080/14635240.2017.1415765

Tiohtià:ke Statement: Catalysing policies for health, well-being and equity. (2022). Global Health Promotion, 29(4), 3–7. https://doi.org/10.1177/17579759221134772

Truth and Reconciliation Commission of Canada. (2015). Truth and Reconciliation Commission of Canada calls to action. http://trc.ca/assets/pdf/Calls_to_Action_English2.pdf

United Nations. (2007). United Nations declaration on the rights of Indigenous Peoples. https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf

World Health Organization. (1986). Ottawa charter for health promotion, 1986 (No. WHO/EURO: 1986-4044-43803-61677). World Health Organization. Regional Office for Europe.  https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf