R HEALTH PROMOTION MEETINGSEPORTS OF
Item
- Title
- R HEALTH PROMOTION MEETINGSEPORTS OF
- extracted text
-
ix)/Z
REPORTS OF HEALTH PROMOTION MEETINGS
Contents
Sl.No.
1.
Name of the Meeting (Place)
Ottawa Declaration on Health Promotion
Sundsvall Statement on Supportive Environments for Health
- 3rd International Conference on Health Promotion,
Sweden, 9-15 June 1991
2.
3.
Adelaide Recommendations on Healthy Public Policy,
Adelaide, South Australia, 5-9 April 1998
4.
4th International Conference on Health Promotion, Jakartha
21-25 July 1997
4a
4th International Conference on Health Promotion, Jakartha
21-25 July 1997-Report 2
4b
NGOs response to - 4th International Conference on Health
Promotion, Jakartha 21-25 July 1997 - Report 3
5.
The Fift^Global Conference on Health Promotion, 5-9th
June 2000, Mexico City
6.
The dynamics of health promotion: from Ottawa to Bangkok
L
Page Nos
T
7.
8.
9.
10.
11.
12.
13.
14.
The Bangkok charter for health Promotion in a Globalized
World, 7-llth August 2005____________________________
The 7th WHO Global conference on Health Promotion towards integration of oral health (Nairobi, kenya2009)._____
The 8th Global conference on Health promotion, Helsinki,
Finland, 10-14 June 2013. The Helsinki Statement on Health in
All Policies_________________________________________
9th Global Conference on Health Promotion Shanghai, 21-24
November, 2016. Shanghai Declaration on promoting health
in the 2030 Agenda for Sustainable Development
I
I
Sundsvall Statement on Supportive
Environments for Health
Third International Conference on Health Promotion, Sundsvall,
Sweden, 9-15 June 1991
The Third International Conference on Health Promotion: Supportive
Environments for Health - the Sundsvall Conference - fits into a sequence of
events which began with the commitment of WHO to the goals of Health For
All (1977). This was followed by the UNICEF/WHO International Conference
on Primary Health Care, in Alma-Ata (1978), and the First International
Conference on Health Promotion in Industrialized Countries (Ottawa 1986).
Subsequent meetings on Healthy Public Policy, (Adelaide 1988) and a Call for
Action: Health Promotion in Developing countries, (Geneva 1989) have
further clarified the relevance and meaning of health promotion. In parallel
with these developments in the health arena, public concern over threats to
the global environment has grown dramatically. This was clearly expressed
by the World Commission on Environment and Development in its report Our
Common Future, which provided a new understanding of the imperative of
sustainable development.
Third International Conference on Health
Promotion: Supportive Environments for Health the first global conference on health promotion, with participants from 81
countries - calls upon people in all parts of the world to actively engage in
making environments more supportive to health. Examining today's health
and environmental issues together, the Conference points out that millions of
people are living in extreme poverty and deprivation in an increasingly
degraded environment that threatens their health, making the goal of Health
For All by the Year 2000 extremely hard to achieve. The way forward lies in
making the environment - the physical environment, the social and economic
environment, and the political environment - supportive to health rather than
damaging to it.
This call for action is directed towards policy-makers and decision- makers in
all relevant sectors and at all levels. Advocates and activists for health,
environment and social justice are urged to form a broad alliance towards the
common goal of Health for All. We Conference participants have pledged to
take this message back to our communities, countries and governments to
initiate action. We also call upon the organizations of the United Nations
system to strengthen their cooperation and to challenge each other to be
truly committed to sustainable development and equity.
A Call for Action
i
I
I
1
A supportive environment is of paramount importance for health. The two are
interdependent and inseparable. We urge that the achievement of both be
made central objectives in the setting of priorities for development, and be
given precedence in resolving competing interests in the everyday
management of government policies. Inequities are reflected in a widening
gap in health both within our nations and between rich and poor countries.
This is unacceptable. Action to achieve social justice in health is urgently
needed. Millions of people are living in extreme poverty and deprivation in an
increasingly degraded environment in both urban and rural areas. An
unforeseen and alarming number of people suffer from the tragic
consequences for health and well-being of armed conflicts.
Rapid population growth is a major threat to sustainable development.
People must survive without clean water, adequate food, shelter or
sanitation.
Poverty frustrates people's ambitions and their dreams of building a better
future, while limited access to political structures undermines the basis for
self-determination. For many, education is unavailable or insufficient, or, in
its present forms, fails to enable and empower.
Millions of children lack access to basic education and have little hope for a
better future. Women, the majority of the world's population, are still
oppressed. They are sexually exploited and suffer from discrimination in the
labour market and many other areas, preventing them from playing a full
role in creating supportive environments. More than a billion people
worldwide have inadequate access to essential health care. Health care
systems undoubtedly need to be strengthened. The solution to these massive
problems lies in social action for health and the resources and creativity of
individuals and their communities. Releasing this potential requires a
fundamental change in the way we view our health and our environment, and
a clear, strong political commitment to sustainable health and environmental
policies. The solutions lie beyond the traditional health system.
Initiatives have to come from all sectors that can contribute to the creation of
supportive environments for health, and must be acted upon by people in
local communities, nationally by government and nongovernmental
organizations, and globally through international organizations. Action will
predominantly involve such sectors as education, transport, housing and
urban development, industrial production and agriculture.
The Sundsvall Conference identified many examples and approaches for
creating supportive environments that can be used by policy-makers,
decision-makers and community activists in the health and environment
sectors. The Conference recognized that everyone has a role in creating
supportive environments for health.
2
r
Dimensions of Action on Supportive Environments for
Health
)
In a health context the term supportive
environments refers to both the physical and the
social aspects of our surroundings. It encompasses where people live, their
local community, their home, where they work and play. It also embraces
the framework which determines access to resources for living, and
opportunities for empowerment. Thus action to create supportive
environments has many dimensions: physical, social, spiritual, economic and
political. Each of these dimensions is inextricably linked to the others in a
dynamic interaction. Action must be coordinated at local, regional, national
and global levels to achieve solutions that are truly sustainable.
The Conference highlighted four aspects of supportive environments:
•
)
•
•
•
The social dimension, which includes the ways in which norms,
customs and social processes affect health. In many societies
traditional social relationships are changing in ways that threaten
health, for example, by increasing social isolation, by depriving life of a
meaningful coherence and purpose, or by challenging traditional
values and cultural heritage.
The political dimension, which requires governments to guarantee
democratic participation in decision-making and the decentralization of
responsibilities and resources. It also requires a commitment to human
rights, peace, and a shifting of resources from the arms race.
The economic dimension, which requires a re-channelling of resources
for the achievement of Health for All and sustainable development,
including the transfer of safe and reliable technology.
The need to recognize and use women's skills and knowledge in all
sectors - including policy-making, and the economy - in order to
develop a more positive infrastructure for supportive environments.
The burden of the workload of women should be recognized and
shared between men and women. Women's community-based
organizations must have a stronger voice in the development of health
promotion policies and structures.
Proposals for Action
The Sundsvall Conference believes that proposals
to implement the Health for All strategies must
reflect two basic principles:
i.
1. Equity must be a basic priority in creating supportive environments for
health, releasing energy and creative power by including all human
beings in this unique endeavour. All policies that aim at sustainable
development must be subjected to new types of accountability
3
■h
It
A
J
)
procedures in order to achieve an equitable distribution of
responsibilities and resources. All action and resource allocation must
be based on a clear priority and commitment to the very poorest,
alleviating the extra hardship borne by the marginalized, minority
groups, and people with disabilities. The industrialized world needs to
pay the environmental and human debt that has accumulated through
exploitation of the developing world.
2. Public action for supportive environments for health must recognize
the interdependence of all living beings, and must manage all natural
resources, taking into account the needs of future generations.
Indigenous peoples have a unique spiritual and cultural relationship
with the physical environment that can provide valuable lessons for
the rest of the world. It is essential, therefore, that indigenous peoples
be involved in sustainable development activities, and negotiations be
conducted about their rights to land and cultural heritage.
It Can be Done: Strenghthening
Social Action
A call for the creation of supportive environments
is a practical proposal for public health action at the local level, with a focus
on settings for health that allow for broad community involvement and
control. Examples from all parts of the world were presented at the
Conference in relation to education, food, housing, social support and care,
work and transport. They clearly showed that supportive environments
enable people to expand their capabilities and develop self-reliance. Further
details of these practical proposals are available in the Conference report and
handbook.
Using the examples presented, the Conference identified four key public
health action strategies to promote the creation of supportive environments
at community level.
1. Strengthening advocacy through community action, particularly
I
through groups organized by women.
2. Enabling communities and individuals to take control over their health
and environment through education and empowerment.
3. Building alliances for health and supportive environments in order to
strengthen the cooperation between health and environmental
campaigns and strategies.
4. Mediating between conflicting interests in society in order to ensure
equitable access to supportive environments for health. In summary,
empowerment of people and community participation were seen as
essential factors in a democratic health promotion approach and the
driving force for self-reliance and development.
4
Participants in the Conference recognized, in particular, that education is a
basic human right and a key element in bringing about the political,
economic and social changes needed to make health a possibility for all.
Education should be accessible throughout life and be built on the principle of
equity, particularly with respect to culture, social class and gender.
The Global Perspective
People form an integral part of the earth's
ecosystem. Their health is fundamentally
interlinked with the total environment. All available information indicates that
it will not be possible to sustain the quality of life, for human beings and all
living species, without drastic changes in attitudes and behaviour at all levels
with regard to the management and preservation of the environment.
Concerted action to achieve a sustainable, supportive environment for health
is the challenge of our times.
At the international level, large differences in per capita income lead to
inequalities not only in access to health but also in the capacity of societies to
improve their situation and sustain a decent quality of life for future
generations. Migration from rural to urban areas drastically increases the
number of people living in slums, with accompanying problems - including
lack of clean water and sanitation.
Political decision-making and industrial development are too often based on
short-term planning and economic gains which do not take into account the
true costs to people's health and the environment. International debt is
seriously draining the scarce resources of the poor countries. Military
expenditure is increasing, and war, in addition to causing deaths and
disability, is now introducing new forms of ecological vandalism.
Exploitation of the labour force, the exportation and dumping of hazardous
substances, particularly in the weaker and poorer nations, and the wasteful
consumption of world resources all demonstrate that the present approach to
development is in crisis. There is an urgent need to advance towards new
ethics and global agreement based on peaceful coexistence to allow for a
more equitable distribution and utilization of the earth's limited resources.
Achieving Global Accountability
The Sundsvall Conference calls upon the
i.
international community to establish nw
mechanisms of health and ecological
accountability that build upon the principles of sustainable health
development. In practice this requires health and environmental impact
statements for major policy and programme initiatives. WHO and UNEP are
5
f
r
urged to strengthen their efforts to develop codes of conduct on the trade
and marketing of substances and products harmful to health and the
environment.
WHO and UNEP are urged to develop guidelines based on the principle of
sustainable development for use by Member States. All multilateral and
bilateral donor and funding agencies such as the World Bank and
International Monetary Fund are urged to use such guidelines in planning,
implementing and assessing development projects. Urgent action needs to be
taken to support developing countries in identifying and applying their own
solutions. Close collaboration with nongovernmental organizations should be
ensured throughout the process.
1
The Sundsvall Conference has again demonstrated that the issues of health,
environment and human development cannot be separated. Development
must imply improvement in the quality of life and health while preserving the
sustainability of the environment. Only worldwide action based on global
partnership will ensure the future of our planet.
)
Document resulting from the Third International Conference on Health
Promotion* 9-15 June 1991, Sundsvall, Sweden
!
*Co-sponsored by the United Nations Environment Programme, the Nordic
Council of Ministers, and the World Health Organization
1
1
6
1
■
■>
Adelaide Recommendations on Healthy Public
Policy
Second International Conference on Health Promotion,
Adelaide, South Australia, 5-9 April 1998
The adoption of the Declaration of Alma-Ata a decade ago was a major
milestone in the Health for All movement which the World Health Assembly
launched in 1977. Building on the recognition of health as a fundamental
social goal, the Declaration set a new direction for health policy by
emphasizing people's involvement, cooperation between sectors of society
and primary health care as its foundation.
The Spirit of Alma-Ata
The spirit of Alma-Ata was carried forward in the Charter for Health
Promotion which was adopted in Ottawa in 1986. The Charter set the
challenge for a move towards the new public health by reaffirming social
justice and equity as prerequisites for health, and advocacy and mediation as
the processes for their achievement.
The Charter identified five health promotion action areas:
■» Op
•
•
•
•
•
build Healthy Public Policy,'
create supportive environments,
develop personal skills,
strengthen community action, and
reorient health services.
<$
QjQ_O-
f
V
These actions are interdependent, but healthy public policy establishes the
environment that makes the other four possible.
The Adelaide Conference on Healthy Public Policy continued in the direction
set at Alma-Ata and Ottawa, and built on their momentum. Two hundred and
twenty participants from forty^two countries shared experiences in
formulating and implementing healthy public policy. The following
recommended strategies for healthy public policy action reflect the consensus
achieved at the Conference.
Healthy Public Policy
Healthy public policy is characterized by an
1.
explicit concern for health and equity in all areas
of policy and by an accountability for health
impact. The main aim of health public policy is to create a supportive
environment to enable people to lead healthy lives. Such a policy makes
I'
u
y
health choices possible or easier for citizens. It makes social and physical
environments health-enhancing. In the pursuit of healthy public policy,
government sectors concerned with agriculture, trade, education, industry,
and communications need to take into account health as an essential factor
when formulating policy. These sectors should be accountable for the health
consequences of their policy decisions. They should pay as much attention to
health as to economic considerations.
The value of health
Health is both a fundamental human right and a sound social investment.
Governments need to invest resources in healthy public policy and health
promotion in order to raise the health status of all their citizens. A basic
principle of social justice is to ensure that people have access to the
essentials for a healthy and satisfying life. At the same time, this raises
overall societal productivity in both social and economic terms. Healthy public
policy in the short term will lead to long-term economic benefits as shown by
the case studies presented a this Conference. New efforts must be made to
link economic, social, and health policies into integrated action.
Equity, access and development
J
Inequalities in health are rooted in inequities in society. Closing the health
gap between socially and educationally disadvantaged people and more
advantaged people requires a policy that will improve access to health
enhancing goods and services, and create supportive environments. Such a
policy would assign high priority to underprivileged and vulnerable groups.
Furthermore, a healthy public policy recognizes the unique culture of
indigenous peoples, ethnic minorities, and immigrants. Equal access to health
services, particularly community health care, is a vital aspect of equity in
health.
New inequalities in health may follow rapid structural change caused by
emerging technologies. The first target of the European Region of the World
Health Organization, in moving towards Health for All is that:
”by the year 2000 the actual differences in health status between countries
and between groups within countries should be reduced by at least 25% by
improving the level of health of disadvantaged nations and groups.”
i
'I
In view of the large health gaps between countries, which this Conference
has examined, the developed countries have an obligation to ensure that
their own policies have a positive health impact on developing nations. The
Conference recommends that all countries develop healthy public policies
that explicitly address this issue.
Accountability for Health
-1
r
The recommendations of this Conference will be
realized only if governments at national, regional
—
-__ and local levels take action. The development of healthy public policy is as
as
important at the local levels of government as it is nationally. Governments
should set explicit health goals that emphasize health promotion.
Public accountability for health is an essential nutrient for the growth of
healthy public policy. Governments and all other controllers of resources are
ultimately accountable to their people for the health consequences of their
policies, or lack of policies. A commitment to healthy public policy means that
governments must measure and report the health impact of their policies in
language that all groups in society readily understand. Community action is
central to the fostering of healthy public policy. Taking education and literacy
into account, special efforts must be made to communicate with those groups
most affected by the policy concerned.
The Conference emphasizes the need to evaluate the impact of policy. Health
information systems that support this process need to be developed. This will
encourage informed decision-making over the future allocation of resources
for the implementation of healthy public policy.
Moving beyond health care
Healthy public policy responds to the challenges in health set by an
increasingly dynamic and technologically changing world, with is complex
ecological interactions and growing international interdependencies. Many of
the health consequences of these challenges cannot be remedied by present
and foreseeable health care. Health promotion efforts are essential, and
these require an integrated approach to social and economic development
which will reestablish the links between health and social reform, which the
World Health Organization policies of the past decade have addressed as a
basic principle.
Partners in the policy process
Government plays an important role in health, but health is also influenced
greatly by corporate and business interests, nongovernmental bodies and
community organizations. Their potential for preserving and promoting
people's health should be encouraged. Trade unions, commerce and industry,
academic associations and religious leaders have many opportunities to act in
the health interests of the whole community. New alliances must be forged to
provide the impetus for health action.
i
Action Areas
The Conference identified four key areas as
priorities for health public policy for immediate
1.
action:
Supporting the health of women
Women are the primary health promoters all over the world, and most of
their work is performed without pay or for a minimal wage. Women's
networks and organizations are models for the process of health promotion
organization, planning and implementation. Women's networks should
receive more recognition and support from policy-makers and established
institutions. Otherwise, this investment of women's labour increases inequity.
For their effective participation in health promotion women require access to
information, networks and funds. All women, especially those from ethnic^
indigenous, and minority groups, have the right to self-determination of their
health, and should be full partners in the formulation of healthy public policy
to ensure its cultural relevance.
This Conference proposes that countries start developing a national women's
healthy public policy in which women's own health agendas are central and
which includes proposals for:
•
•
•
•
equal sharing of caring work performed in society;
birthing practices based on women's preferences and needs;
supportive mechanisms for caring work, such as support for mothers
with children,
parental leave, and dependent health-care leave.
Food and nutrition
The elimination of hunger and malnutrition is a fundamental objective of
healthy public policy. Such policy should guarantee universal access to
adequate amounts of healthy food in culturally acceptable ways. Food and
nutrition policies need to integrate methods of food production and
distribution, both private and public, to achieve equitable prices. A food and
nutrition policy that integrates agricultural, economic, and environmental
factors to ensure a positive national and international health impact should
be a priority for all governments. The first stage of such a policy would be
the establishment of goals for nutrition and diet. Taxation and subsidies
should discriminate in favour of easy access for all to healthy food and an
improved diet.
The Conference recommends that governments take immediate and direct
action at all levels to use their purchasing power in the food market to
ensure that the food-supply under their specific control (such as catering in
hospitals, schools, day-care centres, welfare services and workplaces) gives
consumers ready access to nutritious food.
Tobacco and alcohol
fl
The use of tobacco and the abuse of alcohol are two major health hazards
that deserve immediate action through the development of healthy public
policies. Not only is tobacco directly injurious to the health of the smoker but
the health consequences of passive smoking, especially to infants, are now
more clearly recognized than in the past. Alcohol contributes to social
discord, and physical and mental trauma. Additionally, the serious ecological
consequences of the use of tobacco as a cash crop in impoverished
economies have contributed to the current world crises in food production
and distribution.
The production and marketing of tobacco and alcohol are highly profitable
activities - especially to governments through taxation. Governments often
consider that the economic consequences of reducing the production and
consumption of tobacco and alcohol by altering policy would be too heavy a
price to pay for the health gains involved.
This Conference calls on all governments to consider the price they are
paying in lost human potential by abetting the loss of life and illness that
tobacco smoking and alcohol abuse cause.
Governments should commit themselves to the development of healthy
public policy by setting nationally-determined targets to reduce tobacco
growing and alcohol production, marketing and consumption significantly by
Creating supportive environments
Many people live and work in conditions that are hazardous to their health
and are exposed to potentially hazardous products. Such problems often
transcend national frontiers.
Environmental management must protect human health from the direct and
indirect adverse effects of biological, chemical, and physical factors, and
should recognize that women and men are part of a complex ecosystem. The
extremely diverse but limited natural resources that enrich life are essential
to the human race. Policies promoting health can be achieved only in an
environment that conserves resources through global, regional, and local
ecological strategies.
A commitment by all levels of government is required. Coordinated
intersectoral efforts are needed to ensure that health considerations are
regarded as integral prerequisites for industrial and agricultural development.
At an international level, the World Health Organization should play a major
role in achieving acceptance of such principles and should support the
concept of sustainable development.
This Conference advocates that, as a priority, the public health and ecological
movements join together to develop strategies in pursuit of socioeconomic
development and the conservation of our planet's limited resources.
Developing New Health Alliances
The commitment to healthy public policy demands
an approach that emphasizes consultation and
------------------------------- -----negotiation. Healthy public policy requires strong advocates who put health
high on the agenda of policy-makers. This means fostering the work of
advocacy groups and helping the media to interpret complex policy issues.
Educational institutions must respond to the emerging needs of the new
public health by reorienting existing curricula to include enabling, mediating,
and advocating skills. There must be a power shift from control to technical
support in policy development. In addition, forums for the exchange of
experiences at local, national and international levels are needed.
The Conference recommends that local, national and international bodies:
•
•
establish clearing-houses to promote good practice in developing
healthy public policy;
develop networks of research workers, training personnel, and
programme managers to help analyse and implement healthy public
policy.
Commitment to Global Public
Health
Prerequisites for health and social development
are peace and social justice; nutritious food and clean water; education and
decent housing; a useful role in society and an adequate income;
conservation of resources and the protection of the ecosystem. The vision of
healthy public policy is the achievement of these fundamental conditions for
healthy living. The achievement of global health rests on recognizing and
accepting interdependence both within and between countries. Commitment
to global public health will depend on finding strong means of international
cooperation to act on the issues that cross national boundaries.
Second International Conference on Health Promotion,
Adelaide, South Australia, 5-9 April 1998
The adoption of the Declaration of Alma-Ata a decade ago was a major
milestone in the Health for All movement which the World Health Assembly
launched in 1977. Building on the recognition of health as a fundamental
social goal, the Declaration set a new direction for health policy by
emphasizing people's involvement, cooperation between sectors of society
and primary health care as its foundation.
The Spirit of Alma-Ata
The spirit of Alma-Ata was carried forward in the Charter for Health
Promotion which was adopted in Ottawa in 1986. The Charter set the
challenge for a move towards the new public health by reaffirming social
justice and equity as prerequisites for health, and advocacy and mediation as
the processes for their achievement.
The Charter identified five health promotion action areas:
•
•
•
•
•
build Healthy Public Policy,
create supportive environments,
develop personal skills,
strengthen community action, and
reorient health services.
These actions are interdependent, but healthy public policy establishes the
environment that makes the other four possible.
The Adelaide Conference on Healthy Public Policy continued in the direction
set at Alma-Ata and Ottawa, and built on their momentum. Two hundred and
twenty participants from forty-two countries shared experiences in
formulating and implementing healthy public policy. The following
recommended strategies for healthy public policy action reflect the consensus
achieved at the Conference.
Adelaide Recommendations on Healthy Public Policy : Previous page |
1,2,3,4,5,6, Z
Healthy Public Policy
Healthy public policy is characterized by an
explicit concern for health and equity in all areas —-——-------- ----of policy and by an accountability for health impact. The main aim of health
public policy is to create a supportive environment to enable people to lead
healthy lives. Such a policy makes health choices possible or easier for
citizens. It makes social and physical environments health-enhancing. In the
d
pursuit of healthy public policy, government sectors concerned with
agriculture, trade, education, industry, and communications need to take into
account health as an essential factor when formulating policy. These sectors
should be accountable for the health consequences of their policy decisions.
They should pay as much attention to health as to economic considerations.
The value of health
Health is both a fundamental human right and a sound social investment.
Governments need to invest resources in healthy public policy and health
promotion in order to raise the health status of all their citizens. A basic
principle of social justice is to ensure that people have access to the
essentials for a healthy and satisfying life. At the same time, this raises
overall societal productivity in both social and economic terms. Healthy public
policy in the short term will lead to long-term economic benefits as shown by
the case studies presented a this Conference. New efforts must be made to
link economic, social, and health policies into integrated action.
Equity, access and development
Inequalities in health are rooted in inequities in society. Closing the health
gap between socially and educationally disadvantaged people and more
advantaged people requires a policy that will improve access to health
enhancing goods and services, and create supportive environments. Such a
policy would assign high priority to underprivileged and vulnerable groups.
Furthermore, a healthy public policy recognizes the unique culture of
indigenous peoples, ethnic minorities, and immigrants. Equal access to health
services, particularly community health care, is a vital aspect of equity in
health.
New inequalities in health may follow rapid structural change caused by
emerging technologies. The first target of the European Region of the World
Health Organization, in moving towards Health for All is that:
"by the year 2000 the actual differences in health status between countries
and between groups within countries should be reduced by at least 25% by
improving the level of health of disadvantaged nations and groups."
In view of the large health gaps between countries, which this Conference
has examined, the developed countries have an obligation to ensure that
their own policies have a positive health impact on developing nations. The
Conference recommends that all countries develop healthy public policies
that explicitly address this issue.
Accountability for Health
(I
The recommendations of this Conference will be
1.
realized only if governments at national, regional
and local levels take action. The development of
healthy public policy is as important at the local levels of government as it is
nationally. Governments should set explicit health goals that emphasize
health promotion.
Public accountability for health is an essential nutrient for the growth of
healthy public policy. Governments and all other controllers of resources are
ultimately accountable to their people for the health consequences of their
policies, or lack of policies. A commitment to healthy public policy means that
governments must measure and report the health impact of their policies in
language that all groups in society readily understand. Community action is
central to the fostering of healthy public policy. Taking education and literacy
into account, special efforts must be made to communicate with those groups
most affected by the policy concerned.
The Conference emphasizes the need to evaluate the impact of policy. Health
information systems that support this process need to be developed. This will
encourage informed decision-making over the future allocation of resources
for the implementation of healthy public policy.
Moving beyond health care
Healthy public policy responds to the challenges in health set by an
increasingly dynamic and technologically changing world, with is complex
ecological interactions and growing international interdependencies. Many of
the health consequences of these challenges cannot be remedied by present
and foreseeable health care. Health promotion efforts are essential, and
these require an integrated approach to social and economic development
which will reestablish the links between health and social reform, which the
World Health Organization policies of the past decade have addressed as a
basic principle.
Partners in the policy process
Government plays an important role in health, but health is also influenced
greatly by corporate and business interests, nongovernmental bodies and
community organizations. Their potential for preserving and promoting
people's health should be encouraged. Trade unions, commerce and industry,
academic associations and religious leaders have many opportunities to act in
the health interests of the whole community. New alliances must be forged to
provide the impetus for health action.
Action Areas
The Conference identified four key areas as
Supporting the health of women
Women are the primary health promoters all over the world, and most of
their work is performed without pay or for a minimal wage. Women's
networks and organizations are models for the process of health promotion
organization, planning and implementation. Women's networks should
receive more recognition and support from policy-makers and established
institutions. Otherwise, this investment of women's labour increases inequity.
For their effective participation in health promotion women require access to
information, networks and funds. All women, especially those from ethnic,
indigenous, and minority groups, have the right to self-determination of their
health, and should be full partners in the formulation of healthy public policy
to ensure its cultural relevance.
1
This Conference proposes that countries start developing a national women's
healthy public policy in which women's own health agendas are central and
which includes proposals for:
•
•
•
•
equal sharing of caring work performed in society;
birthing practices based on women's preferences and needs;
supportive mechanisms for caring work, such as support for mothers
with children,
parental leave, and dependent health-care leave.
Food and nutrition
The elimination of hunger and malnutrition is a fundamental objective of
healthy public policy. Such policy should guarantee universal access to
adequate amounts of healthy food in culturally acceptable ways. Food and
nutrition policies need to integrate methods of food production and
distribution, both private and public, to achieve equitable prices. A food and
nutrition policy that integrates agricultural, economic, and environmental
factors to ensure a positive national and international health impact should
be a priority for all governments. The first stage of such a policy would be
the establishment of goals for nutrition and diet. Taxation and subsidies
should discriminate in favour of easy access for all to healthy food and an
improved diet.
The Conference recommends that governments take immediate and direct
action at all levels to use their purchasing power in the food market to
ensure that the food-supply under their specific control (such as catering in
hospitals, schools, day-care centres, welfare services and workplaces) gives
consumers ready access to nutritious food.
Tobacco and alcohol
)
»
The use of tobacco and the abuse of alcohol are two major health hazards
that deserve immediate action through the development of healthy public
policies. Not only is tobacco directly injurious to the health of the smoker but
the health consequences of passive smoking, especially to infants, are now
more clearly recognized than in the past. Alcohol contributes to social
discord, and physical and mental trauma. Additionally, the serious ecological
consequences of the use of tobacco as a cash crop in impoverished
economies have contributed to the current world crises in food production
and distribution.
The production and marketing of tobacco and alcohol are highly profitable
activities - especially to governments through taxation. Governments often
consider that the economic consequences of reducing the production and
consumption of tobacco and alcohol by altering policy would be too heavy a
price to pay for the health gains involved.
This Conference calls on all governments to consider the price they are
paying in lost human potential by abetting the loss of life and illness that
tobacco smoking and alcohol abuse cause.
Governments should commit themselves to the development of healthy
public policy by setting nationally-determined targets to reduce tobacco
growing and alcohol production, marketing and consumption significantly by
the year 2000.
Creating supportive environments
Many people live and work in conditions that are hazardous to their health
and are exposed to potentially hazardous products. Such problems often
transcend national frontiers.
Environmental management must protect human health from the direct and
indirect adverse effects of biological, chemical, and physical factors, and
should recognize that women and men are part of a complex ecosystem. The
extremely diverse but limited natural resources that enrich life are essential
to the human race. Policies promoting health can be achieved only in an
environment that conserves resources through global, regional, and local
ecological strategies.
A commitment by all levels of government is required. Coordinated
intersectoral efforts are needed to ensure that health considerations are
regarded as integral prerequisites for industrial and agricultural development.
At an international level, the World Health Organization should play a major
role in achieving acceptance of such principles and should support the
concept of sustainable development.
!
This Conference advocates that, as a priority, the public health and ecological
movements join together to develop strategies in pursuit of socioeconomic
development and the conservation of our planet's limited resources.
Developing New Health Alliances
The commitment to healthy public policy demands
an approach that emphasizes consultation and
—------------------negotiation. Healthy public policy requires strong advocates who put health
high on the agenda of policy-makers. This means fostering the work of
advocacy groups and helping the media to interpret complex policy issues.
Educational institutions must respond to the emerging needs of the new
public health by reorienting existing curricula to include enabling, mediating,
and advocating skills. There must be a power shift from control to technical
support in policy development. In addition, forums for the exchange of
experiences at local, national and international levels are needed.
The Conference recommends that local, national and international bodies:
•
•
establish clearing-houses to promote good practice in developing
healthy public policy;
develop networks of research workers, training personnel, and
programme managers to help analyse and implement healthy public
policy.
Commitment to Global Public
Health
Prerequisites for health and social development
are peace and social justice; nutritious food and clean water; education and
decent housing; a useful role in society and an adequate income;
conservation of resources and the protection of the ecosystem. The vision of
healthy public policy is the achievement of these fundamental conditions for
healthy living. The achievement of global health rests on recognizing and
accepting interdependence both within and between countries. Commitment
to global public health will depend on finding strong means of international
cooperation to act on the issues that cross national boundaries.
Future Challenges
i
)
1. Ensuring an equitable distribution of
resources even in adverse economic
-——------------------------circumstances is a challenge for all nations.
Health for All will be achieved only if the creation and preservation of
healthy living and working conditions become a central concern in all
'<)I
1
>
!
public policy decisions. Work in all its dimensions - caring work,
opportunities for employment, quality of working life - dramatically
affects people's health and happiness. The impact of work on health
and equity needs to be explored.
3. The most fundamental challenge for individual nations and
international agencies in achieving healthy public policy is to
encourage collaboration (or developing partnerships) in peace, human
rights and social justice, ecology, and sustainable development around
the globe.
4. In most countries, health is the responsibility of bodies at different
political levels. In the pursuit of better health it is desirable to find new
ways for collaboration within and between these levels.
5. Healthy public policy must ensure that advances in health-care
technology help, rather than hinder, the process of achieving
improvements in equity.
The Conference strongly recommends that the World Health Organization
continue the dynamic development of health promotion through the five
strategies described in the Ottawa Charter. It urges the World Health
Organization to expand this initiative throughout all its regions as an
integrated part of its work. Support for developing countries is at the heart of
this process.
Renewal of Commitment
In the interests of global health, the participants at the Adelaide Conference
urge all concerned to reaffirm the commitment to a strong public health
alliance that the Ottawa Charter called for.
EXTRACT FROM THE REPORT ON THE ADELAIDE CONFERENCE * HEALTHY
PUBLIC POLICY, 2nd International Conference on Health Promotion April 5-9,
1988 Adelaide South Australia
* Co-sponsored by the Department of Community Services & Health,
Canberra, Australia and the World Health Organization Regional Office for
Europe, Copenhagen, Denmark.
ll
1
)
New Players for a New Era
Leading Health Promotion
into the 21st Centurn
4th International Conference on Health Promotion
Jakarta, Indonesia 21 -25 July 1997
Conference Report
Ar
QA
} 2 1 DEC ’'Wft i!
MH
Table of Content
Foreword
Fourth International Conference on Health Promotion Report
Conference Format ..............................................
Structure of the Report.................. ’
..................
The Road to Jakarta ........................................................
Where Are We Now?........
. 1
Healthy Cities/villages/islands/communities
Health Promoting Schools .......................................................
Healthy Workplaces........................................................
Healthy Ageing
.................................................
Active Living/Physical Activity .................................................
Sexual Health.....................................................................
Tobacco free societies...............................................
Promoting women's health.......................................................
Health promoting health care settings
Healthy homes/families ...........................................................
.. 4
.. 4
.. 5
.. 5
.. 6
.. 6
.. 7
.. 7
.. 8
.. 8
The Road Ahead ......................................................
Healthy Cities/villages/islands/communities ...........................
Health Promoting Schools ...................................................
Healthy Workplaces.......................................................
Active Living/Physical Activity ...................................
Sexual Health.............................................................
Tobacco free societies...............................................................
Promoting women's health.........................................................
Health promoting health care settings .......................................
With Whom Do We Travel?
A Global Commitment
Partnerships and Alliances
The Global Healthy Cities Network
Global School Health Initiative
Healthy Work Initiative
Healthy Ageing Initiative
Active Living Initiative
Mega-Country Initiative
Health Promotion Foundations Initiative
Health Promotion for Chronic Health Conditions
Health Promoting Hospitals Initiative
Health Promoting Media Settings
)
Conference Conclusions
..........................
Tradition.........................................................................
Future
Evidence........................................................................
Partnerships
...........................................
The beginning of the future
The Jakarta Declaration on Leading Health Promotion into the 21st Century
Special Statements
Statement on healthy ageing
Statement on health promoting schools
Statement on healthy workplaces ................
Statement on partnerships for healthy cities .
Statement of member companies and groups
. 1
. 2
. 2
. 4
. 8
. 11
. 12
. 12
. 13
. 13
. 14
. 14
. 15
16
17
19
19
19
20
21
21
22
23
23
23
24
26
26
26
26
27
27
28
34
35
36
37
38
Annexes
Annex 1 - Conference Programme ....................................................
Annex 2 - Conference Secretariat........................................................
Annex 3 - Conference Advisory Group ................................................
Annex 4 - List of Background Papers ..................................................
Review and evaluation of health promotion...................................................
Health promotion futures ........................................... ...................................
Partnerships for health promotion .................................................................
Other publications/ sources...........................................................................
Annex 5 - Follow-up Activities ..............................................................
Annex 6 - World Health Assembly 51 Resolution on Health Promotion .
Acknowledgments
. 39
. 66
. 67
. 71
. . 71
. . 72
. . 73
. . 74
. 75
. 76
78
il
1
Foreword
The Fourth International Conference on Health Promotion: ‘New Players fora New
Era - Leading Health Promotion into the Twenty-first Century’,
Jakarta, 21-25 July 1997
The spirit of Alma-Ata was carried forward in the Ottawa Charter developed at the First
International Conference on Health Promotion (1986) in Ottawa, Canada. The Ottawa Charter,
with its five independent action areas, has since served as the blue print for health promotion
worldwide. The subsequent Second and Third International Conferences on Health Promotion
in Adelaide, Australia (1988) and in Sundsvall, Sweden (1991), examined two major action
strategies of health promotion, resulting in the adoption of the Adelaide Recommendations on
Healthy Public Policy and the Sundsvall Statement on Supportive Environments.
The Fourth International Conference on Health Promotion was the first to be held in a
developing region. It provided the opportunity to exchange experiences, for developing and
developed countries to share and to learn from each other. In view of the major changes which
have taken place since the Ottawa Conference in 1986, it provided the opportunity to evaluate
the impact of health promotion globally and its priorities in today’s world.
It is essential to review and evaluate the impact of health promotion globally, to take
stock, to provide vision as to the most desirable future scenarios for world health and to try and
identify the approaches, partnerships and alliances which will be required to achieve the desired
goal.
Consequently, the Jakarta Conference had three objectives:
a)
b)
c)
>
to review and evaluate the impact of health promotion;
to identify innovative strategies to achieve success in health promotion; and
to facilitate the development of partnerships in health promotion to meet the global
health challenges.
Preparations for the Conference, which formed the central focus in 1997 of the WHO
Five-Year Plan for health promotion, served as a catalyst to stimulate action in capacity build
capacity for health promotion at local, national and international levels in both developing and
developed countries. A series of planned preparatory activities were carried out jointly with the
WHO Regional Offices and/or through WHO Collaborating Centers and NGOs in all regions,
including intercountry meetings, workshops, and consultations.
These preparations contributed to three major inputs, each addressing one of the
specific Conference objectives, namely: I) review and evaluation track; II) scenario/futures
track; III) partnership track.
I)
The review and evaluation track was developed following a global literature analysis of
all evaluated health promotion and education projects. Case studies, published or
unpublished, on successful health education and health promotion action were collected
and analyzed on a region by region basis through specially appointed focal points. The
overall state of health promotion research was reviewed. A number of WHO
Collaborating Centers held symposia on the effectiveness of health promotion and
prepared papers on health promotion evaluation and research. The results of these
efforts provided convincing evidence that health promotion strategies can develop and
change lifestyles, and have an impact on the social, economic and environmental
conditions, that determine health (a book with selected papers is available as part of
proceedings).
II)
The scenario/futures track provided a set of health promotion futures papers and
practical guidelines in scenario development. Guidelines for developing scenarios and a
global scenario for health promotion in 2020 were specially prepared. Detailed review
for health promotion futures in selected topics areas were also prepared, including health
promoting schools, workplace health promotion, tobacco free society, ageing and health
sexual health, women’s health, healthy cities, and food and nutrition.
III)
The third input was on building partnerships for which a series of five papers were
prepared outlining the possible way forward, including one on partnerships for health in
the 21 st Century, and a working paper on partnerships for health promotion. Also, a
series of six specific issue papers were prepared for review at the conference as part of
the health promoting school global initiative.
The Jakarta Declaration confirmed the five action areas of the Ottawa Charter:
•
build healthy public policy;
•
create supportive environments;
•
strengthen community action;
•
develop personal skills;
•
reorient health services.
Research and case studies from around the world provided convincing evidence that health
promotion is effective and confirmed its continuing validity and relevance. It placed health
promotion at the centre of health development. In calling for a global alliance it widened the
emphasis to include all sectors of society to work together for the health and well-being of all
peoples and societies. The Jakarta Declaration set out the global priorities for health promotion
as we enter the new century - health promotion is a key investment.
The success of the 4 ICHP is due to the active contribution of many, the host country, WHO,
HQ and the Regional Offices, WR Country Offices, WHO CCs, UN, IGOs and NGOs.
Special gratitude is extended to all; to the countries, institutions and bodies whose support
enabled the Conference to take place and assistance to be given to many participants who
would otherwise have been able to attend. We are most grateful to all who have contributed to
this collective global effort.
Since the Jakarta Conference there has been active follow-up. In May 1998 the World Health
Assembly (WHA) has passed the first ever Resolution on Health Promotion confirming the
priorities as identified in the Jakarta Declaration and to report back to the WHA in two years
time on the progress achieved. This challenge has now to be met.
Dr Desmond O’Byrne
Chief, Health Education and
Health Promotion Unit (HEP)
World Health Organization
Dr Ilona Kickbusch
Director, Division of Health Promotion,
Education and Communication (HPR)
World Health Organization
!
Fourth International Conference
on Health Promotion
Report
Conference Format
J
The Fourth International Conference on Health Promotion (4ICHP) took place in Jakarta,
it was the first in the series to be hosted by a country from the South, with a majority of
participants coming from the South. But this was not the only thing that made 'Jakarta'
unique. It was the first conference of the four to deal with three different but intricately
connected themes:
•
The Conference was to review critically the
achievements in the area of health promotion
First Truly Global
since the adoption of the Ottawa Charter;
•
The meeting was to explore possibilities and
Health Promotion
commitments towards the involvement of new
players in partnerships and alliances for
health promotion;
•
It was to formulate the challenges that are ahead of us, as well as the responses and
strategies which health promoters in their partnerships and alliances could employ.
These objectives made the conference very much a working
Achievements
meeting. Plenaries provided food for thought, to be
expressed in a daily symposia series. Morning plenary
Partnerships
sessions were followed by 'Leading Change' symposia in
which insights on new work styles, health promotion skills,
Strategies
the economics of health promotion, ethical conduct, new
technologies and much more were shared. In this report, 'Leading Change’symposia will
not be reported on, as they were conceived to be training-like sessions; information on
sessions can be obtained through their facilitators. Further, networking time was scheduled
every day in order to facilitate further exchange around themes felt important to participants;
every late afternoon participants were found all over the conference venue, involved in
debates. The core of the conference process was found
in ‘Partnership in Action’ symposia, which will be
reported on below.
Indonesia Day on
The centre of the programme was constituted by
Health Promotion
Indonesia Day, during which the host country’s health
promotion policy was unveiled and national and local health promotion programmes were
presented. Indonesia has committed itself formally to the theme of the conference, and
presented an overview of the most innovative health programmes in the country.
The commitments formulated around the above-mentioned themes were ultimately reflected
in the Jakarta Declaration, the development of which was a continuous participatory process
throughout the conference.
1
d
1
Structure of the Report
Rather than following the structure of the conference, this part of the report takes a more
evolutionary perspective. The next section describes developments that made a 4ICHP on
/Vew Players for a New Era' timely. It contains a review of political and scientific advances
in the field.
.
The 'Where are We /Vow?'section takes stock of the current state of health promotion in
settings, contexts and stages of life. 'The Road Ahead' takes an overall view of health
promotion challenges in the new era, supplemented by findings of a second set of Symposia
on contexts and settings. Partnerships are dealt with in the subsequent section. ‘With Whom
do we Travel?’. The ‘Conclusion’ deals with health promotion tradition, future challenges
evidence of health promotion working, and partnership issues.
Throughout the report, the global commitment to health promotion in the next millennium
will become obvious. In ‘A Global Commitment’ representatives of some of the major
political global constellations will be presented.
The Road to Jakarta
‘Jakarta’ should be viewed in the context of a health promotion development process that
was started with the adoption of the Ottawa Charter in 1986. This conference was followed
in 1989 by a conference in Adelaide dealing with Healthy Public Policy. The third
international conference on health promotion dealt with Supportive Environments for Health
and was organised in Sundsvall, 1991.
The Fourth Conference is not only
significant because we are on the brink of
Dynamic forward-looking
the next millennium (a symbolic threshold
j
.
.
which stimulates the imagination), but
development
also because the world seems to be changing at an ever increasing pace.
Neither of the above developments can be separated from the context of Primary Health
Care (Alma Ata, 1978) and the rejuvenated strategy Health for All by the Year 2000. These
major initiatives constitute a strong global commitment to public health.
Particularly globalization of communication, trade, and norms and values was referred to
by many as being the most recent challenges. The WHO/SEARO Regional Director (Dr
Uton Muchtar Rafei) said during the very
first plenary session that ‘the New Era has
already begun. ’
Two leading policy makers also took stock
of the advances of health promotion in the
changing context of their countries. Mr I
Potter (Assistant Deputy Minister for Health) demonstrated the Canadian commitment to
working on prerequisites for health (particularly the distribution of wealth), and the need for
intersectoral collaboration in the development of healthy public policy. And even though
economically adverse conditions abound, health promotion has been growing. Hungarian
Minister for Health Dr M. Kokeny also dealt with economic and political changes He
explained that the launch of the Ottawa Charter, in 1986, came both too early and too late
for his country. Because of a deteriorating economy, health promotion at that time was not
Globalization of
communication, trade 9
norms and values
2
perceived to be feasible; once the former socialist block (1990) had disappeared, it seemed
that health promotion could no longer claim a place on the political agenda. Yet, in spite of
a decrease in GDP and the actions driven by market forces, health promotion is back on the
agenda. Health Promoting Schools and Healthy Cities are very much integrated in the
Hungarian health domain.
Mr J. Mullen, of the 'Private Sector for Health Promotion', suggested that indeed the
conference was a landmark, acknowledging the important contributions that the private
sector has already made and will make in the future. He showed that the private sector is
already collaborating intensively with the health sector in a number of regions. Further
global partnerships can be developed, he asserted.
A review of the effectiveness of alliances and partnerships for health promotion presented
by Prof P. Gillies (Health Education Authority, London) examined evidence of the success
of health promotion. Two approaches to the study were chosen: a literature review using
.
bibliographies of peer-reviewed
Significant behaviour change. journals, and snowball sampling
through a network of global focal
Yet: more emphasis on
point consultants who were asked to
provide further case studies.
‘Social Capita!’\n studies
Following a validated search
protocol, 16 randomised controlled
trials, 15 comparison studies, and 12 pre-post test evaluations were found. They generally
reflected a narrow focus on behaviour change alone, although some highlighted process
and policy development outcomes. The focal point consultants provided a further 46
examples of health promotion alliances and partnership programmes. These were
predominantly from developing regions in the world.
Significant health behaviour change has been reported. The concept of 'social capital' would
potentially add a crucial dimension to the understanding of social influences on health, and
would take into account the broader contexts in which health is produced. The approach
would focus attention on the mechanisms connecting people with public'institutions and with
power at local level. The idea of social capital may therefore have much to offer to health
promotion research in future, particularly those studies that aim to understand and evaluate
the impact of alliances or partnerships for health promotion.
3
J
Where Are We Now?
The Monday series of Symposia was to take stock of health promotion developments in a
number of settings, contexts and stages of life,
important for the further development of the
Settings, contexts and
realm. In this section these developments are
being summarised; a conclusion will lead into
stages of life
responses to future challenges in these areas.
1
)
J
1
Healthy Cities/villages/islands/communities
Being started as a health promotion demonstration project in the European Region of WHO
in 1986, the Healthy Cities initiative is now an established global movement. Three case
studies were presented, from Kuching (Malaysia), Queensland (Australia), and Samoa.
One of the very first agreements the participants established was that 'Healthy City' is the
catch phrase for a wide variety of health promotion programmes related to larger scale
contained living arrangements. Therefore, healthy islands, communities, and villages -in
spite of their unique social and geographic set-ups- would all fall under the one slogan.
The approach has become an umbrella for many other setting approaches, e.g. in schools,
hospitals and market places. It
Link ideas, visions, political contributes to the establishment of high
quality
physical
infrastructures,
commitment and social
psychosocial
environment,
and
sustainability
of
health
action.
It
entrepreneurship to health
effectively combines the 'art' and
'science' dimensions of public health, linking ideas, visions, political commitment and social
entrepreneurship to the management of resources, methods for infrastructure development,
and the establishment of procedures to respond to community needs. Intersectoral work is
an integral part of the movement, with many partnerships already in place.
Nevertheless, further strategic considerations and evaluations on capacity building
(including political commitment), process development and implementation and outcome
measures will be as crucial in the future as they are now.
Whatever the size of the target population (be they inhabitants of mega-cities or of small
islands), the importance of action at the local level is identified as essential.
V
Health Promoting Schools
Schooling is of course one of the best investments in the future. National and international
experiences now show that schools provide also the best opportunities for investment in
health. Examples from China, India, Russia, USA, Indonesia, Bangladesh, Pakistan, most
European countries including
Romania, Zimbabwe, Thailand,
The best investment in the
Samoa, Australia, Brazil, and Sri
Lanka showed the immense
future
potential that schools have in
comprehensive health promotion. Collaboration between schools and local health services,
with parents and local communities, with teachers also becoming aware of health issues,
4
!
with pupils, through intergenerational activities, and with professional sports associations
or the food industry shows that the concept is easy to apply, stirs the imagination in and
beyond schools, and has both direct benefits as well as longer-term health benefits. Some
direct benefits are improvement of the overall curriculum and active student participation in
both curricular and extra-curricular activities. Also, Health Promoting Schools offer a
comprehensive package of behavioural and structural interventions that is most appropriate
for children in school-ages. Even children not in school, as evidence from Samoa and India
demonstrates, could well be reached through the programme.
The major strength of, Networks of Health Promoting Schools, is its network building, the
designation of national focal points, involvement of experts in the field of school health, and
the mobilisation of resources at a regional level.
Healthy Workplaces
Workplace health promotion until quite recently seems to have been a largely European and
North-American approach. The Conference created an excellent opportunity to take stock
of experiences elsewhere in the world.
Two models were considered innovative. A German example was used in more than
seventy organisations, nationally and internationally. This 'Health Circle Approach' is based
on the availability of problem-solving tools
6 If you can’t manage
at the management level, but employees
- 4
,
decide on need and feasibility of
SaTety, you can t manage interventions during eight work-time
anything ’
sessions. The approach connects with
J
.
future-oriented management, is flexible and
yet broad in its scope, and is easily implemented on the work floor as it is precisely there
where the programme is designed in operational terms.
Another model was that of accident prevention in Scandinavia, starting at the workplace,
but extending to every setting of everyday life. The assumptions were that
•
if a company cannot manage safety, it cannot manage anything;
•
all accidents can be prevented.
The approach involved industry, the municipality, and the community.
Several other examples were presented during the session, demonstrating that workplace
health promotion is a global effort. A notable programme was presented from Shanghai,
where a number of factories engaged in innovative approaches to enhance the health and
well-being of workers and their communities.
Successful workplace health promotion requires the following:
The support for programmes by company leadership and top management is
essential;
•
'Investment in workers' health is a good investment' is a message that has to be
communicated to businesses more unequivocally.
•
The community around the workplace must be involved in a coalition with an interest
in workplace health promotion; incentives are part of the coalition formation.
•
Mental health and stress prevention among workers merits special attention.
Healthy Ageing
Ageing has become a development issue: An ageing population should not be considered
a burden on society, but as a challenge and an opportunity. The vast majority of old people
5
are independent and in good health. They are productive
(though not only in economic terms) and contribute to their
Ageing is a
communities in a variety of ways.
The healthy ageing message can best be heard by
development
establishing networks. Such networks are interdisciplinary,
issue
flexible, informed, and dynamic. Synergy creates an
enhanced approach, much better than isolated projects by individual organisations.
Evidence now shows that health promotion action could lead to, e.g. sustained or increased
levels of physical activity leading to decreased levels of cholesterol and morbidity.
Active Living/Physical Activity
Accumulated scientific evidence shows that daily moderate activity enhances health
Physical activity contributes to mental health, and to the reduction of risks related to e g'
obesity. Modern lifestyles, however, make it increasingly difficult and provide less and less
incentive for people to remain physically active.
Active living should start at an early age, and schools offer in that respect more effective
efficient and equal opportunities than any
other setting to get young people interested in Activity good for mental
physical activity, and enjoy it.
.
Experiences so far suggest three pathways to
health
successful development and implementation of active living programmes;
•
A sound scientific base, providing valid assessment tools, social and clinical
diagnoses, and trends in active living;
•
Development and evaluation of community interventions, including the joint
development of behavioural components, policy development, and the creation of
appropriate facilities;
•
Effective dissemination and communication of information both to professionals and
the general public.
Sexual Health
Sexual health has increasingly become a key public health issue. The HIV/AIDS epidemic
has spurred this attention. Recent experiences show that foci on sexual health can build
upon the worldwide investments in HIV/AIDS prevention programmes, in order to build a
broader sexual health approach. Scandinavian experiences also showed that embeddinq
sexual health issues in social development (e.g. taking into account changing roles of
families and women,
and
«
ur
and migration of sexual
Respectful of va.ues
Such an approach would include the following:
Sa^hSh henSiVe’ inte9rated' cultural|y sPecific Ponies and programmes for
A range of partners will be involved in the establishment and implementation of these
policies and programmes;
Openness' (and yet respectful of cultural and religious values of the community)
towards sexual health;
Professional education to avoid judgmental attitudes towards sexuality among health
6
if
service providers.
1
J
Tobacco free societies
Tobacco use is one of the major threats to health. It is on the increase in most countries
from the South, and in Western countries there are
The major threat to
examples of youth smoking more, in spite of
intensive health education.
health
A number of approaches were suggested to deal
with the tobacco issue:
•
Legislation is of essential importance, but needs to be complemented with
Public awareness. This can be accomplished by conveying a positive message
about tobacco free societies, the marketing of legislation, the formulation and
implementation of legislation with a wide range of stakeholders, the need for a
phased implementation of smoke-free environments (as people not to adjust), and
eliciting support from the mass media;
Involvement of prime movers (role models, prominent people, etc.);
•
Incentives are important in the establishment of behaviour change;
Community involvement, and mobilisation of a range of partners are essential to the
sustainability of programmes;
Education on a tobacco free society should start at an early stage of life, involving
peer pressure and parental support, and;
•
Financing of health promotion through tobacco taxes.
Promoting women's health
Women's health remains an issue of considerable concern. Discrimination, unequal
opportunities, rape, violence, social taboos and unnecessary medicalization of the female
body all create barriers to health.
Stock was taken of a number of projects dealing with training, education and empowerment
of women, as well as support of women's health workers. An example from India suggested
that empowerment of women,
including opportunities for credit and
.
.
saving and freedom of movement
Industry:
significantly contribute to health Outstanding Midwives Award
siaius.
Support of midwives, and gender-specific services, was provided through a number of
schemes. They included industry support that recognised the importance of these
overworked and underpaid women. The industry established an ’Outstanding Midwives
Award, establishing the image of midwifery in the community; two award-winners have now
been elected to public office.
A strong need is felt to advocate women's health interests at key international meetings.
The Global Alliance on Women's Health is among many organisations doing just that, by
producing and dissemination of a compendium containing women's health concerns.
1
Healthcare:
unhealthful conditions
Health promoting healthcare settings
Healthcare settings are not necessarily
conducive to health. Waiting lists, occupational
stress among staff, and inadequate integration of
U8997
C1
health promotion and public health in service delivery create unhealthful conditions.
In order to enhance the health promoting capacities of healthcare settings it is important to
involve the community in needs assessments and the quality of service delivery.
A number of initiatives are underway to review and improve conditions conducive to health
in healthcare settings, for example the “health promoting hospital-project” not only focussing
on patients, but also on health of healthcare staff, patients’ families and communities.
)
Healthy homes/families
Nutrition and safety are among the issues which could be addressed through families and
homes. Much has already been learnt from experiences in the past. Health promotion in
these settings turns out to be successful if the following considerations are brought together
in a comprehensive package:
•
a behavioural component through which parents as
well as children are reached. Examples are manuals
on food, environment and health in Indonesia, and FOCUS OH homes
audio-visual materials in the field of mother and child
health in Africa. Behavioural components need to be
supplemented and supported by
•
implementation of programmes through intersectoral work, in which education and
training are further enhanced by the provision of facilities, and access to relevant
services. Examples include the provision of impregnated mosquito bednets in Africa,
in addition to information on the transmission of malaria. However, both health
education and facilities need to be
culture-specific and technologically simple. Boiling of water over wood fires may be
appropriate in Indonesia, whereas a country with a critical fuel situation (like Nepal)
may follow a different solution to that condition.
The Road Ahead
)
The conference clearly stated that the New Era has already begun. Both Dr Sujudi
(Indonesian Minister for Health) and Dr Uton Muchtar Rafei (WHO/SEARO Regional
Director) demonstrated that socio-political changes in Indonesia and the region have
stimulated new ways of dealing with health. All should be mobilised for health, and respect
for and humility in regard to the potential of community action and involvement of new
partners for health have become an essential concern.
Dr Boladuadua (Director of Primary & Preventive Health Services of Fiji) described the vast
variety of Pacific nations. In spite of a generally perceived emptiness in the Pacific, some
countries are facing population pressures. Inequities in health exist within countries and
between countries. Most significant, though, is the diversity in health problems. On the one
hand, health problems associated with poverty and socioeconomic deprivation are putting
a burden on the health care system, whereas in the very same countries diseases of
affluence are dominant. The goal of health promotion, therefore, must be to curb both noncommunicable disease as well as infectious disease. The development of healthy public
policy and the establishment of adequate infrastructures for health promotion is a crucial
challenge for the future.
8
The situation was affirmed by Dr F. Manguyu (President, Medical Women's International
Association); diversity is as large in Africa as it is in the Pacific. However, large social
unrest, wars, and ethnic and population pressures create complex situations for
partnerships between government, NGOs, and the private sector. Particularly NGOs play
an essential role in the development of health
‘No responsibility
promotion and health services; they are often the
voice of the voiceless. Government should
without authority#
recognise their role, and create conditions for
effective partnerships: "No responsibility without
good governance
authority," as Dr F. Manguyu phrased it. Within
is essential
such more relevant partnerships NGOs can take
on roles of health promotion advocacy, resource development, and creation of policies
through a commitment to the public dimension of health.
On Tuesday, these issues were particularly affirmed by Dr A. Mukhopadyay (Director of
Voluntary Health Association India), who saw an immense role for grassroots organisations
that should be respectful of local technologies for health, and not only rely on the immense
technological advances of the recent decade; in some cases, puppeteering could be a more
powerful communication tool than the Internet.
A
The Tuesday tune was set by Dr I. Kickbusch (Director,
Division Health Promotion, Education and Communication). In
Think Health
her keynote she stressed the inextricable link between health
and human development. Although much has been
accomplished, there are considerable imbalances in, among
others, health spending, rates of growth, and consumerism.
Dr I. Kickbusch introduced some concepts to describe and operationalise the achievements
and challenges presented throughout the conference. They are in many ways paradoxical
The idea of 'socially toxic environments' would indicate that those that are to benefit from
sustainable development in the next generation are deeply hurt socially as they grow up.
Similarly, many countries are now suffering from a double burden of disease (conditions of
poverty as well as communicable and non-communicable diseases), whereas at the same
time 84% of the global population lives in countries where together only 11% of qlobal
health budgets are spent.
The foremost challenge would therefore be to combine strategies for social capital with
strategies that build intellectual capital for health. The notion of 'health literacy' becomes
important: understanding individual, social, societal and global health conditions and their
impact. Of course these conditions are intricately interdependent. Another challenge is to
deal with them in a coherent way. One way of describing the complexity is using indices like
social capital', the 'human development index', or a measure called the 'ecological footprint'.
Dealing with the global paradox in health and development would require:
harnessing some of the new driving forces that have emerged more clearly since
Ottawa to support health;
advocacy to make health promotion as much part of the social and human health
agenda as part of the health agenda;
to position health promotion as a key element of good governance - thus opening
avenues for health governance, financing and accountability; and
to fully understand the changes in the global system of health production and work
towards a more systematic global response.
. 9
1
"The future is something you build as you move into it," Dr O. Shisana (Director-General of
Ministry of Health in South-Africa) added in her presentation. Indeed, although the future
is unavoidable, it can be shaped. Dr r Hancock found that the future is only useful and
interesting when it affects what we do and how we live today. For that reason, out of the
distinction between possible, plausible, probable and preferable futures, the latter is driving
the Conference debate.
Although wild scenarios around preferable health promotion futures can be imagined, the
futures presented were realistic. They were illustrated by Dr R. Vaithinathan (Ministry of
Health, Singapore). She envisaged futures in which new alliances were forged between
authorities, communities and social sectors (such as
industry), jointly working towards health.
People Central, not
Dr S.T. Han (Regional Director, WHO/WPRO) saw a
future for the Western Pacific region in which people
disease
were at the centre of activity, and no longer Disease. Stages of life, and living
arrangements, thereby will become essential focal points of policy and action. Specifically,
a focus on early years would emphasise Health Promoting Schools, but also the shaping
of lifestyles. The middle years of life would be linked, in action and policy terms, to healthy
cities, workplaces, markets and islands. The later years, finally, will become the main priority
of the region. Vast numbers of people will be over the age of 65; although they are an
essential source of wisdom and experience, their health needs will have to be dealt with as
well. The family has a crucial position in that respect.
The same future, but from a family planning perspective, was foreseen by Dr Suyowo
(Deputy-Minister of Population, Indonesia). In his policy view, population activities will
become owned by families which are empowered towards healthy choices.
Literacy and volunteer action were mentioned as two more issues on which a preferable
future vision could be formulated. Dr E.
Jouen (Education International) once more
The future: literacy and
illustrated the link between literacy and
health.
As 25% of the world's working
volunteer action
population is illiterate, the health problem
becomes dramatic too. Stronger political will
to link schools, families, and government in combatting illiteracy is a preferable, if not
essential, future. Voluntarism can play a major role in health promotion, according to Dr R.
Scott (Rotary, Canada). Rotary assistance to health projects is the glue of partnerships.
With a solid foundation in both business and professional communities, as well as
connections with populations in need, voluntarism will be able to play a proactive role in
finding sustainable solutions to local problems, which in turn contribute to global solutions.
The 'Leading Change' Symposia during the second half of Tuesday, Wednesday and
Thursday mornings provided valuable insights into future challenges and responses.
Conference participants valued these sessions particularly because of their action oriented
nature. Questions like ‘How to finance health promotion’, or 'What kind of evaluation
methodologies can be applied to a variety of health promotion issues, settings and
questions'were explored, and on many occasions answered. Part II of this publication lists
all conveners and papers prepared for the various symposia.
Tuesday
and
Action’ Symposia on
Skills and action
10
Thursday ‘Partnerships in
healthy settings, stages
<l
1
of life, and health conditions were exploring different ways of moving ahead, and operating
modes of strengthening and broadening partnerships with a range of both old and new
partners; again, a list of facilitators and presentations can be found in Part II of the current
volume. Findings are presented below.
Healthy Cities/villages/islands/communities
As participants in this Symposium came from Healthy Cities from all over the world, a
debate started on common values and approaches. It soon turned out that, where
industrialised nations structure their ideas in terms of 'plans' and 'strategies', countries from
South-East Asia, for instance, would speak of 'hope' and 'tradition'. The overriding
characteristics of these complementary world views, though, are its interconnectedness and
integral vision.
The group built a 'Healthy City Tree of Successful Strategies' which is rooted in political
commitment, a connection with the past and traditions, community engagement, inspired
leadership, allocation of resources, work on the
Island
determinants of health, and establishing relations
Village
with key partners. The trunk of the tree is made The Healthy
Tree of Successful Strategies
T own
City
up by the formal process, in which good gov
ernance and good management are reflected.
Both the art and science of running a programme
come together in the trunk. The canopy of the
tree is constituted by enhanced health, spirituality,
quality of life, psycho-social environment, access
•j
to determinants of health, and physical
‘O
environment. Naturally, the canopy is an
A
umbrella; the umbrella approach of healthy cities
EiLvir A m®m),
facilitating other settings-based health promotion
activities was therefore reaffirmed.
Partners
The following future challenges lay ahead of
Partners
Healthy Cities:
Partners
•
Most important is the community
agreement on the shape of the future.
People will agree on a vision, then move
ahead ready to share, adapt and change.
•
Healthy Cities were affirmed to be the
Ir’®
hope for reaching high quality of life; the
o
role of health promotion cannot be one of T
'instruction'. Health promotion is to
encourage, facilitate, and network with
other
movements
towards
the
establishment of one preferred future.
Invest in school
environment
Give & Take
Innovation
Give & Take
!WU@0T)ti
®<rslh)B[p)
[R!(a£s©MU'®;fe©
Health Promoting Schools
Already operational in many countries, Health Promoting
Schools (HPS) could be further enhanced through the
establishment of local, national and international
networks between schools, and health and education
11
<1
sectors, as well as through the development of partnerships and alliances with appropriate
other sectors.
Participants in the Symposium identified the following priorities for the further success of
HPS:
•
Community involvement, and the facilitation of involvement by students in the
development of education and health;
'•
Health sector support for the education sector's efforts to improve quality and
substance of education;
•
Collaboration among ministries of health and education, as well as international
bodies, to create enhanced conditions for health promoting schools;
•
An integrated approach to policy processes, curriculum development and evaluationand
•
Maintaining a very practical focus in the key in successful development of HPS.
J
Healthy Workplaces
Workplaces are the natural environments for effective partnerships. In order to guide such
partnerships, the discussions around scenarios and strategies came up with the following
priorities:
•
Given the great disparity of working
conditions and health of workers, there is a
Global Unity and
need to advocate for global unity and
f
partnership to promote and protect the Partnership TOF WOFk
health of working populations. To this end,
health
international coalitions must be built in order
to share values, resources, and responsibilities;
•
Policies and action plans in relation to workers health must be future-oriented, taking
into account foreseeable population trends and other issues of the working life, e.g.
high rate of unemployment, ageing, work patterns, social, economic and
technological changes and their impact on health, including mental health;
There is an urgent need to promote awareness of the benefits of workplace health
promotion, as a healthy workforce is vital for the success of global, national and local
economies.
•
Alliances must be built between various stakeholders and organisations involved in
the promotion and protection of workers' health, especially health promotion,
occupational health and safety, environmental health and human resources
management;
Finally, there is no shortage of work, only of jobs. We have to reconsider our values,
and combine economic development with human development, taking full account
of the various trends in the working world.
Active Living/Physical Activity
Participants in the Symposium reviewed a number of large-scale physical activity promotion
programmes. The experiences are in line with findings from numerous scientific studies and
practical projects and point out several important issues in physical activity promotion:
12
I
Begin today: there is a need,
and there are possibilities for
Begin today
success;
Act locally, even in national ,
Tailor programme
projects; then you can tailor
the
programme
to •
Commit partners
correspond to real needs,
Simple sophistication
expectations,
and *
opportunities;
Find responsible committed partners, and make use of the local culture, traditions,
attitudes, and values;
Make the realisation simple even if the foundation is sophisticated. This is possible
when you use the vast range of knowledge and experience that has been gathered.
If you can afford to direct the effort to only part of the population, consider children
as a first priority group. They need physical activity and they like it;
Strengthen existing opportunities such as physical activity in schools in and outside
school hours;
Another priority area would be women, as they are often underserved in terms of
motivation and needs;
Document anything you do and account for what you did. This serves our own
learning process and that of others.
Sexual Health
UNAIDS, brings together six UN Agencies (WHO, UNFPA, UNICEF, UNDP, UNESCO,
World Bank) on sexual health. The presentation, and subsequent discussions with
Symposia participants, brought up a range of issues that seem determinants of future
success in the realm.
First of all, the HIV/AIDS epidemic has major
Social and economic
social and economic implications. Although
implications of sexual
prevention works, there remains some
indolence
regarding political commitment,
health
leadership, and a global view on the issue. In
those cases where HIV/AIDS prevention has proven to be cost-effective, it was because of
the following factors. These constitute the context in which sexual health programmes will
have to further develop in the future:
•
Recognition of the socio-economic impact of sexual health problems, including
HIV/AIDS, will have to lead to a political position in which investments in health
become a priority;
•
Subsequently, openness and transparency in public health functions has been, and
will continue to be, critical to the success of countries in the prevention of the spread
of HIV/AIDS;
•
The global determinants of the spread of HIV/AIDS and other STDs are travel,
tourism (particularly sex tourism), transportation and trade, 'transcultural sexual
liberation', and illicit drug trading. Industries and agencies involved in these sectors
can be involved in dealing with the spread of the epidemic;
•
Increasingly, the business sector is becoming involved in HIV prevention
programmes, notably in countries where government fails to act. A global cosmetics
chain, e.g., is marketing is some countries the cheapest available condom plus
13
public education on its use. In collaboration between health and private sectors,
though, it is found that only philanthropy is not enough. Work health promotion would
be a further road to travel;
A sector that has also a role in the realm is that of religious leaders. Involvement of
key leaders can make or break programmes in this field.
Yet, a code of (ethical) conduct is required to legitimise and structure partnerships.
Tobacco free societies
Tobacco use may be the one single most addressed issue in public health and health
promotion. Therefore, Symposium participants could focus more unequivocally on the
future.
In addition to the already existing range of interventions, the following recommendations
would guide future action on tobacco use:
•
Legislation should always be complemented by
other interventions and activities;
•
Adoption and implementation of legislation requires
Complement
a^ phased approach in order to effect gradual
’
•
’
1
interventions
Public awareness of the smoking problem and available legislative opportunities is
of crucial importance;
Popular support and further availability of data enables a second round of more
stringent legislation;
Partners, such as the media and employers' organisations, need to be involved in
the legislative process and be mobilised to that end.
Sustainability of programmes, interfacing with community participation;
There is a definite need to take into account global developments; a country may
ban smoking, but not ban export of tobacco products. This is inconsequential. Part
of this perspective would also be to provide viable alternatives to tobacco production
and processing; the economic impact of a reduction of agricultural output and shifts
in industrial processing may not facilitate moves towards tobacco-free societies.
Promoting women's health
Participants in the women's health Symposium reviewed presentations by Education
International (a World Trade Union organisation representing 23 million teachers) and BBC
Intemational
(British public radio and television). The first agency reviewed progress on health literacy
among women and girls since the Jomtien education
Men sensitive to
(1990) and Beijing women's (1996) international meetings.
In spite of recommendations and declarations very little
women’s health
seems to have happened. Yet, education is a basic human
right; by 2000, 148 million children (among which 86 girls) will still have no access to
primary education. BBC ran a multimedia programme over a week on men's health, making
men more sensitive to women's health issues. The programme was a success, both in
terms of ratings as well as responses. A consequence was that new partnerships between
BBC and other actors need to be established for effective follow-up. Television turns out to
be not the only medium: drum, dance and music can be vehicles for subtle passing on of
information.
14
Participants discussed Action Steps for further enhancement of global women's health:
A new concept of women's health for all stages of a woman's life cycle from maternal
and child health;
•
Adult education and Health Education covering the lifespan should be promoted;
•
There should be specific and measurable objectives for implementation of women's
health from WHO on education, budget and other issues;
•
It is important to emphasise positive values, empowering elderly women (such as
TBA's, aunts, grandmothers), giving them the opportunity to teach young women;
•
WHO should create partnerships, including with the media, other UN Agencies,
NGO's, etc. to increase the dissemination of knowledge and information about
women's issues, rights and recommendations from international conventions, like
Beijing, Jomtien, etc.;
We need to have mutually reinforcing programmes with WHO resulting in sustained
partnerships with NGO's;
•
Governments should treat women's NGOs as real partners, providing support and
opportunities and including them in policy and decision making;
In promoting the health of women and girls, WHO needs to take a strong role in
encouraging Governments, Foundations and others to allocate resources, and
muster the political will needed for implementation;
WHO needs to expand its involvement with civil society, creating more partnerships
with NGO’s;
Health promoting healthcare settings
Healthcare settings are at the core of health care and development. In order to continue to
play this role, they must broaden its horizons. Symposium participants generally agreed that
there is considerable potential in forging new partnership between relevant actors and
healthcare settings. Instruments and perspectives to deal with that challenge are:
To mobilise patient and consumer organisations to play an active joint role in health
promotion;
•
Share information and data with the partnership;
•
Build an infrastructure, within and beyond the healthcare setting, for health
promotion;
•
Reorient resource allocation towards
health promotion;
Infrastructure toward
•
Open up a dialogue and establish joint
commitments with health insurance commitment between
companies and businesses, all health
industry, patients,
professionals including traditional and
alternative healers as well as allied
healthcare
health
professionals
(nurses,
technicians), social and business entrepreneurs, and religious leaders; and
•
To argue strongly for healthcare dedicated tax on health-damaging industries, most
notably tobacco and alcohol industries.
With Whom Do We Travel?
15
<
1
)
)
No single sector can meet the challenges of health promotion in splendid isolation. Success
will come through an alliance between the private, public and non-governmental sectors.
The conference demonstrated through many examples of good practice that health
M
.
promotion already thrives on joint working. Of
No single sector can course, such joint working can materialize in
meet challenaes
many different shapes. Alliances, partnerships
“
and collaborative actions are just a few ways of
indicating work done together. Work can be governed through contracts, memoranda of
understanding, or rather simple mutual recognition. Working together can be done on a
bilateral basis, or with the involvement of many different constituencies and legal bodies
The conference demonstrated the wide range of possibilities. Dr A. Malaspina discussed
the work of ILSI, the International Life Sciences Institute. ILSI is a public, non-profit
foundation sponsored by industry, private foundations, and government funding. Its goal is
to sponsor and carry out research in food safety and nutrition. The Institute has a
membership of over 350 companies, with a global network of 3000 scientists working for
ILSI’s 12 branches around the world. To facilitate collaboration, ILSI acquired NGO status
with WHO. An ILSI scientist is located in WHO Headquarters to facilitate speedy and
effective exchange of work.
The contribution of the private sector proved to be a major focus for debate at the
conference. Representatives of commercial and industrial companies identified a number
of issues which would assist in their involvement. At the international level, for example,
facilitation is essential in bringing together these two sectors which have traditionally had
little contact. WHO, and other United Nations organisations, could play a valuable role in
this process, and in actively managing and monitoring the developing relationship. WHO
should also provide a clearing house for examples of successful private/public sector
partnerships.
.
.
A genuine desire for joint
In addition to the obvious potential for
sponsorship, private sector organisations
expressed a genuine desire for joint,
community-based
programmes.
They
programmes
acknowledged that such an involvement
would not only be in the interests of
improved public health, but would also be good for their companies. They stressed that
solid, ethical business was also successful business, and that such an involvement would
present a positive company image. Moreover, workplace health programmes not only
benefited employees, they also contributed to better productivity and positive industrial
relations. Private sector colleagues argued strongly, however, for an involvement in
partnership programmes right from the outset as this would develop a joint sense of
ownership and cement the process of collaboration.
There are also many examples of health promotion contributing to safer commercial and
industrial practices which ultimately were of benefit to consumers. The development of
increasingly comprehensive food hygiene and nutrition programmes in the food industry was
but one example cited at the conference.
NGOs also have a growing desire to work more closely with private sector partners, not only
out of a desire for commercial sponsorship, but also on issues such as training and
management development. Conference participants agreed to establish a joint database of
interested NGOs and commercial organisations, through the auspices of the International
community-based
16
1
)
Union for Health Promotion and Education (IUHPE), as the basis for fostering future
partnerships.
All parties acknowledged that such partnerships were not without potential pitfalls. A clear
statement of ethical principles would be essential as a basis for growing trust and co
operation. This would help to protect the interests of the public, and provide a sound basis
for joint development. The road towards healthful alliances and partnerships will not be an
entirely smooth one. Participants raised concerns as to matters of control and industrial
(hidden) agendas. It was agreed that any networking for health would have to recognize
interdependencies and unique expertise of each partner. Openness and mutual respect are
essential ingredients of successful collaboration.
A Global Commitment
1
)
1
As stated in the introduction to this report, the conference was very much a working
meeting. This characteristic did not just apply to health promotion professionals. There was
substantial political commitment to health promotion in its many dimensions.
Representatives from many countries described the achievements already accomplished.
High-level professionals and politicians also pledged their commitment to the road ahead.
Prof Sujudi, Minister of Health of Indonesia, presented the conference with the strong
commitment to health promotion of the 13,000 island nation stretched along the Equator like
an emerald string. Mr I. Potter (Canadian Assistant Deputy Minister for Health) and
Hungarian Minister for Health Dr M. Kdkeny were already mentioned earlier.
Other significant presentations were formulated by strong players in international health
promotion development. Prof Lu Rushan (Minister of Health of the People’s Republic of
China) described both the accomplishments of his country as well as the double face of
challenges that lay ahead of China. Whereas the country is sharing many of the problems
of other countries (such as globalization, ageing, urbanization, etc.), the most populous
nation of the world is still having to deal
with a large rural population and its more
traditional health problems. 'In China,
health care services cannot be dealt with
in a way developed countries have done
in the past - with too high costs. Nor
should they be treated the way China did
in the past - not appropriate to the
current socio-economic development’,
Prof Lu stated. The country regards
health promotion as a major contributing
instrument to solving its problems. Pilot
projects involving a network of health
promoting schools,. workplace health
promotion,
and
healthy
cities
demonstrated that health promotion will
be the future point of reference.
Partnerships are crucial to its success.
Prof Lu described a partnership between
four ministries (Health, Agriculture,
1*1
17
Broadcasting, Television and Cinema and the National Committee of Patriotic Health
Campaign) and further NGOs and academia in the implementation of the Health Education
for the 900 Million Peasants programme.
DrM. Rajala of the European Union described the increased efforts of the Union in public
health and health promotion. The Maastricht Treaty opened up new venues and
opportunities in European health promotion. In addition to substantial and longer-term
programmes such as Europe Against Cancer and Europe Against AIDS, health promotion
development is acquiring a prominent position on European political agendas. Naturally, the
Union operates in a strong partnership with the World Health Organization, and
constitutionally has to work with numerous other partners from its member states. Such
collaboration only strengthens the scope and vision of health promotion.
Prof D. McQueen, on behalf of Dr D. Satcher the Director of the Centers for Disease Control
and Prevention (United States of America), described CDC’s perspective on health
promotion. ‘CDC’s vision of a “Healthy People in a Healthy World - Through Prevention"
conveys the agency’s global perspective. The concept of the global village has traditionally
guided CDC activities in global health,' he stated. CDC is an esteemed inhabitant of that
village. The organization is committed to improving global health by strengthening and
facilitating efforts of other international health organizations, by provision of consultancies,
by conducting capacity development programmes (e.g. in response to infectious disease
outbreaks, an important staple of its international work), and by the application of its global
mission which is the promotion of health and quality of life by preventing and controlling
disease, injury and disability. Prof McQueen emphasised that the United States itself is
benefiting from international collaborative activities as well; its understanding of global
health issues is enhanced and would led to further improvements in domestic and global
activities. It is also for this reason that CDC is involved in the Mega Country Health
Promotion Network (cf. below).
I
18
il
Partnerships and Alliances
Thursday symposia were to take stock of existing partnerships and alliances, and explore
the potential for new such collaborative efforts. The following reflects the debate.
The Globa! Healthy Cities Network
The group has worked collaboratively during this with week; discussion offered an
opportunity to initiate new dialogues and partnerships among themselves and thereby
reached to state a Declaration on Partnerships For Healthy Cities.
I
-“The global Healthy Cities movement, which now incorporates
Declaration on islands, villages, communities, towns, municipalities, cities,
1
!
i
partnershins for and me9acit,es around the world, has been a very successful
K
. .
application of the Ottawa Charter’s strategies. Healthy Cities
Healthy Cities
embodies healthy schools, workplaces, health care facilities,
markets and other settings. Healthy Cities is on the balance of
people's spirit and technologies. The process of creating healthier cities is a practical
example of the effectiveness of partnerships between local governments involving different
departments, residents, NGOs, private sectors, community organisations, and academics.
Commitment to build successful partnerships for Healthy Cities rests on action at local level.
Partnerships at several levels with various partners widen diversity in alliance. They include
partnerships within the health sector, within the public sector, between cities, and across
sectors. This requires participation from health, environment, economy, ecology, education,
urban planning fields. Decentralisation expedites influential partnerships.
There is no single standard formula to build up effective partnerships for Healthy Cities. The
leadership and managerial skills affect its outcome. Social pressure is a key to stimulate
leaders to make partnerships with the concerned organisations and people to enhance the
health promotion in places where people live. Health plans developed through partnerships
contribute to health gain.
Mechanisms to constitute influential partnerships are to tackle hot local issues, to build on
cultural and historical backgrounds, to employ holistic approach, to build on mutual success,
to work step by step, to keep conscious in generating additional financial resources to
sustain good partnerships, and to involve decision makers of communities.
We need to enable people of various sectors to build partnerships at the local level. People
need skills to find partners, work with different partner, mediate, create participatory
platform, and work towards the same goal. We need to increase partnership literacy.
This commitment to building Healthy Cities movement is for the health of the people".
Global School Health Initiative
The WHO Global School Health Initiative is a concerted effort by international organisations
to help schools improve the health of students, staff, parents and community members. The
network is a consolidating initiative,
gathering knowledge and understanding
Six international HPS
about health promotion in the school
setting.
Networks
Prior to Jakarta four regional HPS networks
19
were in place and moving forward strongly: Latin America, Europe, South Africa, and West
Pacific. The development of two new networks has been reinforced in Jakarta, and will be
formally started in the months following, namely: Central Africa, and South-East Asia In
1998, two more regional networks are also planned in West Africa and the Middle East. In
the USA, CDC in Atlanta is a WHO Collaborating Centre for Health Promotion and
Education for School-aged Children. CDC provides technical support to WHO on school
matters.
Participants from the above-mentioned networks met in Jakarta with 'New Players', in
particular from the private sector, private voluntary agencies, Ministries of Health
international networks of schools, and NGOs.
After debating priority areas the Jakarta participants agreed to elaborate networking modes
to enhance further collaboration.
1
)
i
Healthy Work Initiative
The third Symposium on the theme examined the possibility for different organisations and
agencies to meet and negotiate with various health promotion initiatives and networks on
potential joint health promotion action.
The first presentation drew attention to the need for a healthy work initiative, which included
the identification of resources, development of marketing strategies, establishment of a
system for the co-ordination of activities, and the reinforcement of information support and
research. The second presentation highlighted the UNAIDS workplace AIDS Programme
as an example of a partnership initiative in response to the AIDS epidemic The UNAIDS
sen/ed as a catalyst for partnerships among NGOs, governments and private sector through
public awareness, HIV prevention and resource mobilisation.
pointsUbSeqUent discussions and resP°nses to the presentations highlighted the following
•
•
collect and disseminate data concerning the workers' health so that workers can
formulate their demands;
conduct workshops to create awareness among partnerships on the importance (in
economic as well as in health terms) of workplace health promotion;
involve top decision makers in the public and private sectors;
encourage corporate involvement in the community;
equal partnership is important;
social marketing is a mechanism to engage
Catalysts for
corporate partnership;
partnership is complex. Be aware of the different
workplace
levels for partnership dialogues, from the work floor
health
to national level. As a consequence, partnership
negotiation takes different shapes at different levels;
strategic partnership can be established on the basis of holistic issue-based
programmes;
partnerships thrive within stable social and political contexts;
partnerships on a micro-level are built on the joint establishment of basic values
development of criteria, methods and tools for the development and implementation
of action, and establishment of a system of co-ordination and information support
and research;
global partnership and alliance building will be based on equity and mutual trust.
20
i
Healthy Ageing Initiative
Healthy older persons are resources for their families, their communities and for society.
Rapid population ageing worldwide requires investments on healthy ageing at all levels. The
return to economy will be immediate.
Embracing these principles, a multisectoral
healthy ageing initiative has been launched Old age should not be
under WHO leadership. Partners include NGOs,
compartmentalised
academic and governmental agencies. It
emphasises the unprecedently rapid ageing of but is an integral part
developing countries populations.
of the life cycle
The framework of this initiative is based on a life
course perspective: old age should not be compartmentalised but is an integral part of the
life cycle. The emphasis is on the adoption of Health Promotion principles applied to the
ageing process. Complementary dimensions include gender specificity, promotion of
intergenerational cohesion, establishment of community-based programmes and
consideration of cultural values as well as ethical issues.
The initiative comprises a cycle consisting of information-base strengthening and
dissemination of the information through multiple means. This re-enforces the initiative’s key
advocacy role leading to an “informed” research agenda and redefinition of training needs.
All this is ultimately translated into the development of policies and interventions to be
appropriately evaluated.
The launching of a world-wide movement to celebrate the International Day of Older
Persons with a strong “active ageing” message is an example of the actions triggered by
this initiative. Partnerships coalitions in this movement include NGOs, local government,
academic institutions, the International Olympic Committee, the media and the private
sector. This movement followed another outcome of this initiative: the Guidelines for
Promoting Physical Activity in Older Age developed by WHO in collaboration with the
scientific community and NGOs in 1996. Altogether these examples illustrate the
importance being given to physical activity as a key contributor to physical, social and
mental well-being. Action on this is strong in the USA where the manufacturers of sports’
equipment and clothing have launched a nation-wide campaign targeting ageing individuals.
Active Living Initiative
The WHO Active Living Global Initiative was presented as an illustration of a global
intersectoral and multidisciplinary activity which requires a broad partnership including both
traditional and new partners to give sufficient
.
«
momentum for this initiative.
Active Living:
The challenge of this Initiative is to promote healthenhancing physical activity as an outstanding public
health issue. Its objectives are the following :
•
To strengthen the world-wide advocacy of the
outstandina nublic
**
health iSStie
health benefits of Physical Activity for all, and in various life settings.
•
•
To foster the development of national policies and programmes on Physical Activity
as part of social and health for all policies.
To promote/stimulate actions directed to the community, with particular attention to
activities in favour of children, youth, older persons, and persons with disabilities and
21
•
belonging to economically vulnerable groups.
To develop international support to Physical Activity and health.
The strategy to attain these objectives and the targets based on them relies on a broad
network of committed partners. These include organisations and institutions from
governmental, and non governmental sectors, national public health, educational social
sport, transport and environment agencies/institutions, and relevant private companies. ’
It is necessary to include among the partners organisations and groups which are interested
in fostering the possibilities for increased participation of all girls and women.
The realisation of the activities will be implemented and carried out by community networks
of promotional, health, and sociocultural services and associations. This approach is
necessary to appreciate the need for culturally appropriate actions and to combine
traditional and innovative activities that meet the needs and motivations of the people.
Mega-Country Initiative
The Mega Country Health Promotion Network is a component of the WHO 5-year action
plan on health promotion. The goal of the network is to mobilise the world's most populated
Mnhilicck a# laact
lUDiiise ai least
countries to promote health in a concerted,
collaborative effort. There are ten countries with
a P°Pulation of at least 100 million. Together,
these countries make up approximately 60% of
for health the world's population. They are: Bangladesh,
n ,. .
_
Brazil, China, India, Indonesia, Japan, Nigeria,
Pakistan, Russian Federation, United States of America. By the year 2000 Mexico will also
have a population of 100 million.
The objectives of the Mega Country Health Promotion Network include:
•
Improving each country's own national capacity to promote health;
•
Identifying priority areas on which the Network can focus, which can be centred
around health issues (e.g. chronic and infectious diseases, mental health, and
environmental health), population groups (e.g., youth/ children, women/mothers, and
the ageing population) and settings (e.g. communities, schools, and worksites);
•
Selecting action areas and activities to work on together;
•
Providing support to the nations in the region or world; and
•
Building partnerships with governmental and non-governmental agencies,
universities, and private industry.
•
Criteria for participation in the Mega Country Health Promotion Network include:
•
Demonstrating a government commitment to health promotion;
•
Providing adequate communication technology;
•
Identifying country focal points to facilitate communication and ensure continuity.
1,000,000,000 people
i
!
1
Health Promotion Foundations Initiative
The Symposium addressed the dire need to
Hrnanicoti/tHnl
organisational
establish organisational structures for health
promotion. Such structures have been developed,
a.o., in Australia. Similar initiatives are to be
structures crucial for
launched shortly in Bangkok and Vietnam.
promotion
22
1
financing health
<1
Organisational structures for health promotion are important for financing the domain;
analysis and dissemination of health and health findings are to be important tasks of such
structures.
Dedicated tobacco-taxation is an important and effective way of establishing a financial
basis for health promotion structures. Integrated health promotion programmes should be
the result.
Health Promotion for Chronic Health Conditions
Patient Groups need to be an integral part of WHO as policy influencers because chronic
diseases are increasing and many chronic diseases are hereditary. They have a crucial role
to play in improving health care, and the health of individuals with chronic disease by
encouraging and supporting self help and personal responsibility for life style.
Patient Groups strongly believe that partnerships are the future and can be sooner achieved
by using patients at a political level. Patient Groups can educate and advocate.
Patient/Doctor partnerships are critical to good health management. Many people with
chronic disease are now living longer (
Patient - Doctor
thanks to new drugs and new
developments) - many into middle age,
partnership critical for
hence the need for education, support,
coping
skills and life style information to
health management
maintain quality of life.
The group were concerned about the marginalisation of people with chronic disease,
especially those with diseases that carry stigma, and were also concerned that the move
towards self responsibility may lead to a blaming culture, and an abdication of responsibility
by health services for providing support and treatment.
The dynamism, commitment, skills and experience demonstrate by the achievements of
patient groups in the 20 ,h century can be built on to support new initiatives in the 21 st
century.
Patient Groups were also concerned that existing negative attitudes towards the
pharmaceutical industry were detrimental to patients, who are often dependent on the drugs
which industry produce for their quality of life, and sometimes life itself. They feel they have
a duty to their members to have good relations with industry to ensure the continued
availability of their treatments, as well as pressing for new and improved drugs. They can
also work together to produce better information and develop understandings about the non
medical issues of living with chronic disease:
*
Health Promoting Hospitals Initiative
The group looked at:
- Project Hope work, giving management training of health care practices in Eastern Europe.
This was the examination of a project in Poland initially funded by a partnership of corporate
giving and routed via a charity, US state aid, and local government departmental funding.
Now requested by and extended into the Czechoslovakia republic and taught in the Czech
language.
- A Community based approach Initiative in Africa, where there was a change from the more
centralised specialist services to a basic community based approach again with multi sector
funding including the private sector.
- Health 2020. An approach in Thailand which looked at scenarios in health situations and
23
<
future trends, so as to inform policy makers and planners and facilitate long term
development planning.
- A strategic project which considered
important aspects of the prevention of
chronic non communicable disease. This
Healthcare settings
project argued for a reversal of the process
require health policy
of marginalisation of the medical staff in
health development, suggesting that a
stronger lead was necessary .
- The WHO healthy hospital project in Europe.
The main outcomes and action steps are as follows :
Existing health care settings could benefit from an integration across other sectors
This could also involve multiple partnering with both existing and new partners to a
greater extent.
In some cases, the sector could probably also be extended both horizontally into
similar areas and also vertically up and down the process into related areas. More
integration with other projects could also occur, e.g. hospitals have not only "in
patients", but also
"
Staff ( mainly female) - so there are women's health
Staff and ancillary workers - so its a workplace
Visitors and Out patients - so it could reach out into a community setting
•
More emphasis could be given to :
Staff professional development and training - so it needs to become a
learning organisation
Extension of the Healthy hospital concept into existing hospitals who are not
members of the healthy hospitals network, including related organisation's in
the community.
New Partners with specialist skills could be involved in this sector in providing
expertise for:
a
Training and professional development improve quality standards.
Management training - Improving staffs skills and competencies in
management practices
Infrastructure and organisational development, re engineering internal
processes and stronger project management.
Health Policy development at both local and national levels.
Health Promoting Media Settings
The technologies and delivery systems of the media have changed dramatically it is no
longer a case of distributing bits of information. To be effective we need to encourage
informed dialogue in order to change behaviour to create health and well-being This is a
much harder job.
Two reports were cited by Warren Peek (UNICEF) to illustrate this more complex SituationDemographic and Health Survey Report (UNICEF) and the Soul City Evaluation.
The first assessed the impact of mass media on sexual health. It demonstrated a clear
relationship between expose to various media and positive choices.
Access makes the difference especially if health issues are discussed by a wide range of
24
(I
1
media news media, soaps and DJ’s On radio. The Soul City Evaluation also revealed the
importance of a positive cycle of reinforcement i.e. a number of media reinforcing each other
resulted in a dialogue amongst friends and family much more effectively than when a person
was exposed to only one media.
To be effective Health Promotion should have PUBLIC APPEAL and be presented to media
professionals in a user friendly form.
Sherrie Connelly emphasised the importance of selecting appropriate technology. For
example there is no point choosing television shows if children’s improvisation in school
work as well. It is important to ask the following questions:
• What are the communication assets
Communication assets;
• What works
• What can you learn from other countries
what works; what can be
Attitudes of health promoters are
important. It should not be co-opting the
learned?
media but getting to know the media.
Alliance building need not be so hard if you begin with those that are already involved in
doing good things.
She outlined the following approach based on problem solving:
Scan the media for media professions and business leaders for those people who are
already doing ‘good things’
•
Get the media professionals to teach WHO how to apply attitude change
•
Encourage communications leaders to learn more about WHO.
•
Prepare a strategy to get everybody on line.
Sonny Fox disagreed with only contacting those already converted. It is important to contact
many people simply because of the pressures of media business they may not have given
the topic much thought. As well as understanding the media it is important not to be
adversarial. The approach should be “we need your help” which empowers the media
professionals. Soaps send out messages everyday sometimes carelessly, but by
understanding and respecting what programme makers tend to be more willing to act
responsibly.
The issues of soap operas (US, UK, Australian, Mexican and Brazilian) being important was
raised. A participant from Kenya said this cultural imperialism could be overcome by
encouraging local talent. The result may not be as sophisticated as Hollywood but it could
have a bigger impact.
Other issues which were raised by the group were the need not just to concentrate on soap
but seek to build partnerships in other entertainment areas such as interactive games. The
need to maintain a comprehensive list of resources as a service to the media. The need to
maintain a topical outlook and new messages to keep alive long running issues such as
anti-smoking campaigns.
25
<1
Conference Conclusions
the ^onferenc9 th®hfindin^S °tf
conference> De Leeuw followed the format of the logo of
conference,
intense debates
showed that health promotion now
reflects ‘Unity in Diversity’, a
slogan that also happens to be the
Indonesian national motto.
T radition
The
Ottawa
Charter
was
reaffirmed as having established a
health promotion tradition. Integral
dimensions of that tradition are
foci
on
community
action,
supportive
environments,
intersectoral action and social
change.
Participants
throughout
the
conference shared the values
associated
with the health
promotion
tradition.
They
determined not only a committed
working atmosphere, but also the
chance to advance knowledge and understanding in specific health promotion areas. Over
a hundred papers presented in the various symposia provided ample opportunity to
exchange views on both the practical and more abstract implications of the established
health promotion tradition to face future challenges.
Future
The conference found that indeed the future starts today. Developments in realms of
globalization and demography determine the challenges to health promotion and its
responses. Trade, communications and new trends in society all have an impact on health
The double burden of disease many countries face (traditional infectious disease patterns
on the one hand, diseases of affluence on the other) requires innovative health promotion
action. Ageing, and changing roles of previously marginalized groups would determine new
and important priorities for public health and health promotion.
Yet, these future developments also hold a promise. New (high tech, and yet high touch)
technologies, and increased understanding of health literacy and social capital for health
create challenging new prospects for health promotion.
The conference demonstrated that a wealth of information is already available. Networking
particularly in South-South contexts, would further facilitate adequate responses to qlobai
future challenges.
Evidence
Health promotion works; throughout the conference it was demonstrated that it is an
26
<1
essential and effective investment in society. Many presenters highlighted the fact that over
the years a wide range of methods, methodologies and theoretical insights have become
available in support of the many modalities of health promotion. Be it community action,
environments for health, policy development, or organisational change, it became clear that
an increasing part of the academic community is committed to providing evidence that it is
sensible to undertake health promotion action.
Yet, convincing evidence of the relevance of health promotion also pervaded the practiceoriented sessions of the conference. Workers in field positions showed that health
promotion has much more to offer to communities, and partners in the realm, than mere
health enhancement. Health promotion forges improved awareness of organisational and
policy determinants of well-being and social conditions, thereby setting the stage for
concerted action.
J
1
Partnerships
‘Evidence presented to the Conference outlining the “crisis of suffering" facing the
populations of the world clearly indicates the need for the private sector to play a full and
responsible part in working with WHO and governments, in both developed and developing
countries, to meet the challenges ahead’, read part of the commitment made by the sector
during the closing session of the conference.
Although a serious concern was expressed by some that new partnerships with other
sectors (particularly industry) might be driven by other motivations than health and well
being, the private sector agreed on the necessity to establish general protocols for
successful partnerships. Such protocols would include transparancy, accountability, mutual
benefits, and ethics. Particular partnership protocols could also include commitments to the
highest standards of professional and scientific conduct.
It became clear that already many partnerships are in place; not just between public and
private sectors, but specifically between either of these and Non-Gouvermental
Organizations. Many examples were provided that show the feasibility and success of an
expansion in partnerships for health promotion.
The beginning of the future
The Fourth International Conference on Health Promotion proved to be a milestone in health
promotion development. It brought together a range of organizations and individuals
reaffirming old commitments and pledging new commitments to the goal of joint promotion
of global health.
Statements from virtually every corner of the world, and presentations by both health
promotors engaged in everyday work with communities, as well as high-level politicians
demonstrated that the challenges of the future shall be met, because health promotion
works, and offers a tangible and effective investment in people’s health and well-being.
Recognition of this position in the Jakarta Declaration means that the Conference was not
an end-point of a decade of development since the adoption of the Ottawa Charter, but the
beginning of a future. A future which features health promotion prominently as a driving
force in the enhancement of global social capital.
27
d
The Jakarta Declaration
on
Leading Health Promotion into the 21st Century
Preamble
The Fourth International Conference on Health Promotion: New Players for a New Era Leading Health Promotion into the 21st Century, meeting in Jakarta from 21 to 25 July 1997
has come at a critical moment In the development of international strategies for health. It
is almost 20 years since the World Health Organization’s Member States made an
ambitious commitment to a global strategy for Health for All and the principles of primary
health care through the Declaration of Alma-Ata. It is 11 years since the First International
Conference on Health Promotion was held in Ottawa, Canada. That Conference resulted
in proclamation 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 (Adelaide, Australia 1988)
and supportive environments for health (Sundsvall, Sweden, 1991).
The Fourth International Conference on Health Promotion is the first to be held in a
developing country, and the first to involve the private sector in supporting health promotion.
It has provided an opportunity to reflect on what has been learned about effective health
promotion, to re-examine the determinants of health, and to identify the directions and
strategies that must be adopted to address the challenges of promoting health in the 21st
century.
4
The participants in the Jakarta Conference hereby present this Declaration oh action for
health promotion into the next century.
Health promotion is a key investment
1
Health is a basic human right and is essential for social and economic development.
Increasingly, health promotion is being recognized 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 investment and action, has a marked impact on the
determinants of health so as to create the greatest health gain for people, to contribute
significantly to the reduction of inequities in health, to further 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.
28
u
!
I
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 in the Fourth
International Conference on Health Promotion to draw upon the widest possible range of
resources to tackle health determinants in the 21st century.
Determinants of health: new challenges
The prerequisites for health are peace, shelter, education, social security, social relations,
food, income, the 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 urbanization, an increase in the number of older people and
the high prevalence of chronic diseases pose new problems in all countries. Other social,
behavioural and biological changes such as 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 the greater recognition of mental health
problems, require an urgent response. It is vital that approaches to health promotion evolve
to meet changes in the determinants of health.
Transnational factors also have a significant impact on health. Thpse include the integration
of the global economy, financial markets and trade, wide access to media and
communications technology, and environmental degradation as a result of the irresponsible
use of resources.
These changes shape people’s values, their lifestyles throughout the lifespan, and living
conditions across the world. Some have great potential for health, such as the development
of communications technology, while 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 is effective. Health promotion strategies can develop and change lifestyles, and
have an impact on the social, economic and environmental conditions that determine health.
Health promotion is a practical approach to achieving greater equity in health.
The five strategies set out in the Ottawa Charter for Health Promotion are essential for
success:
•
build healthy public policy
•
create supportive environments
•
strengthen community action
29
il
•
•
develop personal skills
reorient health services.
There is now clear evidence that:
1
•
comprehensive approaches to health development are the most effective.
Those that use combinations of the five strategies are more effective than single
track approaches.
a
•
particular settings offer practical opportunities for the implementation of
comprehensive strategies. These include mega-cities, islands, cities, municipalities,
local communities, markets, schools, the 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 them 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 fo break through traditional boundaries within government sectors,
between governmental and nongovernmental organizations, and between the public and
private sectors. Cooperation is essential; this requires the creation of new partnerships
for health, on an equal footing, 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 individuals
30
•
•
•
protect the environment and ensure sustainable use of resources
restrict production of and trade in inherently harmful goods and substances such as
tobacco and armaments, as well as discourage unhealthy marketing practices
safeguard both the citizen in the marketplace and the individual in the workplace
include equity-focused 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 multisectoral approach
including, for example, additional resources for education and housing as well as for the
health sector. Greater investment for health and reorientation of existing investments,
both within and among countries, has the potential to achieve significant advances in
human development, health and quality of life.
Investments for health should reflect the needs of particular groups such as women,
children, older people, and indigenous, poor and marginalized 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, organizations 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 for funding it locally,
31
<
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 maximized.
“Settings for health” represent the organizational 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 among countries and facilitate exchange of information on which
strategies have proved effective and in which settings.
Training in and practice of local leadership skills should be encouraged in order 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
J
The participants in this Conference are committed to sharing the key messages of the
Jakarta Declaration with their governments, institutions and communities, putting the
actions proposed into practice, and reporting back to the Fifth International Conference
on Health Promotion.
In order to speed progress towards global health promotion, the participants endorse the
formation of a global health promotion alliance. The goal of this alliance is to advance the
priorities for action in health promotion set out in this Declaration.
Priorities for the alliance include:
•
•
•
•
•
•
•
1
raising awareness of the changing determinants of health
supporting the development of collaboration and networks for health development
mobilizing resources for health promotion
accumulating knowledge on best practice
enabling shared learning
promoting solidarity in action
fostering transparency and public accountability in health promotion
National governments are called on to take the initiative in fostering and sponsoring
networks for health promotion both within and among their countries.
The participants call on WHO to take the lead in building such a global health promotion
alliance and enabling its Member States to implement the outcomes of the Conference.
32
J
A key part of this role is for WHO to engage governments, nongovernmental
organizations, development banks, organizations of the United Nations system,
interregional bodies, bilateral agencies, the labour movement and cooperatives, as well
as the private sector, in advancing the priorities for action in health promotion.
***************
i
33
STATEMENT ON HEALTHY AGEING
4JTdJN1^RNAT]ONA^
ON HEALTH PROMOTION, JAKARTA, JULY 1997
Ageing is currently the most important
demographic trend worldwide. Further
ageing of societies in developed
countries is now accompanied by
unprecedentedly rapid ageing of
populations in developing countries.
Successful projects depend on multi
sectoral involvement. The participation
of older people themselves as active
players and role models, reinvesting in
health as they continue to age, greatly
strengthens the process.
Firm
partnerships are needed with many
other agencies and sectors - NGOs,
governments, educational bodies, the
media and the private sector. Projects
should be evaluated to identify models
of good practice. Only through evidence
of effectiveness will decision-makers be
convinced and policy development
influenced.
The challenges and opportunities for
society are multiple and universal.
Investments for health throughout life
ensure that individuals reach old age
enjoying increasing levels of health. This
life-course perspective is essential.
Health in old age depends on
investment in health from childhood.
Further major benefits are gained from
interventions in adult life - to include
those targeting individuals already in old
age.
Health is the building block which
enables individuals to continue to
contribute to society. “Healthy older
people are a resource for their families,
their communities and the economy”
(Brasilia Declaration on Ageing, WHO
July 1996),
There is a clear evidence that health
promotion interventions in relation to
ageing work. Data from a number of
countries indicate that older people are
enjoying better physical and mental
health leading to improved social well
being.
A “healthy ageing" initiative has been
launched under WHO leadership. It
promotes a cycle of activities: the
strengthening of information bases;
dissemination of information; advocacy;
informed research; training; and policy
development. It encourages community
based and inter-generational activities. It
emphasizes gender and ethical issues.
25 July 1997
34
STATEMENT ON HEALTH PROMOTING SCHOOLS
4TH INTERNATIONAL CONFERENCE ON HEALTH PROMOTION, JAKARTA, JULY 1997
1
1
Every child has the right and should have the opportunity to be educated
in a health-promoting school. The participants of the 4th International
Conference on Health Promotion call upon international and national
agencies, governments, communities, nongovernmental organizations and
the private sector to support the development of Health Promoting
Schools. They urge governments, groups and individuals to promote the
concept of the health-promoting school as a sound investment in the
future, when considering policies, priorities and expenditures. They call
upon all agencies to support the integration of health-related issues into
a comprehensive approach that enable schools to use their full potential
to promote the physical, social and emotional health of students, staff,
families and community members.
25 July 1997
35
c1
STATEMENT ON HEALTHY WORKPLACES
4TH INTERNATIONAL CONFERENCE ON HEALTH PROMOTION, JAKARTA, JULY 1997
The participants attending the Symposium
on Healthy Workplaces at the 4th
International
Conference
on
Health
Promotion (Jakarta, July 1997) underlined
the great importance of work settings for
the promotion of health of working
populations, their families and friends, the
community and society at large. A healthy
workforce is vital for sustainable social and
economic development on global, national,
and local level.
roles. Among
means that
rMiiwuy other things,
uhii^o, this
lino iiicdiib
inai
strong links to existing setting approaches
such as Healthy Cities, Health Promoting
Hospitals and Health Promoting Schools
have to be established.
In the face of these future challenges,
WHO has developed a new initiative,
called WHO's global Healthy Work
Approach (HWA), which serves as a
catalyst for partnership between the
different stakeholders. This approach is
based
upon
the
following
four
complementary principles:
1.
health
promotion, 2. occupational health and
safety, 3. human resource management,
and
4.
sustainable
(social
and
environmental) development.
Together,
these fundamental principles make it
possible to deal with the impact of a wide
variety of factors on working people, the
surrounding community and society at
large.
The globalization of business life,
technological developments and changes
in the demographic structure of populations
are leading to new types of employment
patterns, such as temporary and part-time
work, self-employment and telework. High
rates of unemployment are becoming one
of the major social problems all over the
world. The participants of the symposium
stated that "there is no shortage of work,
only of jobs. We have to reconsider our
values
and
combine
economic
development with human development."
To strengthen such a global initiative the
participants of the symposium at the
Jakarta
Conference
stressed
the
importance to advocate for global unity and
solidarity to promote and protect the health
of employed and unemployed people.
Priority areas, criteria and key strategies
have to be specified in every region of the
world through an open dialogue between
the different sectors of society. This
process will have to be supported by a
strong investment in research on the
impact of workers health on social and
. economic development.
The various trends foreseeable in society
have to be taken into account for the
development of policies and action plans
influencing workers' health. Until now most
investments for health of working
populations have been made in large-scale
enterprises.
However, informal work
settings, small-scale and micro enterprises
are becoming increasingly important as
new venues for work, national stability and
economic growth. This poses considerable
challenges to all sectors of society, and
calls in line with the Jakarta Declaration for
partnership between non-governmental
organizations, all branches of the public
and private sector, educational bodies and
the media.
25 July 1997
Comprehensive workplace approaches are
essential which take into consideration
physical,
emotional,
psychosocial,
organizational and economic factors both
within work settings and all other settings,
in which people fulfill their multiple life
36
<1
STATEMENT ON PARTNERSHIPS FOR HEALTHY CITIES
“HEALTHY CITIES, VILLAGES, ISLANDS, COMMUNITIES” WORKING GROUP
4TH INTERNATIONAL CONFERENCE ON HEALTH PROMOTION, JAKARTA, JULY 1997
The global Healthy Cities movement,
which now incorporates islands, villages,
communities,
towns,
municipalities,
cities, and megacities around the world,
has been a very successful application
of the Ottawa , Charter's strategies.
Healthy
Cities
embodies
healthy
schools,
workplaces,
health
care
facilities, markets and other settings.
Healthy Cities is the balance of people's
spirit and technologies. The process of
creating healthier cities is a practical
example of the effectiveness of
partnerships between local governments
involving
different
departments,
residents,
NGOs,
private sectors,
community
organizations,
and
academics.
1
Tailor-made effectual formula
There is no single standard formula to
build up effective partnerships for
Healthy Cities. The leadership and
managerial skills affect its outcome.
Social pressure is a key to stimulate
leaders to make partnerships with the
concerned organizations and people to
enhance health promotion in places
where people live.
Health plans
developed
through
partnerships
contribute to health gain.
Key mechanisms
Mechanisms to constitute influential
partnerships are to tackle hot local
issues, to build on cultural and historical
backgrounds, to employ a holistic
approach, to build on mutual success, to
work step by step, to be aware of
generating additional financial resources
to sustain good partnerships, and to
involve decision makers of communities.
Commitment at local level
Commitment
to
build
successful
partnerships for Healthy Cities rests on
action at local level. Partnerships at
several levels with various partners
widens diversity in alliance. They include
partnerships within the health sector,
within the public sector, between cities,
and across sectors. This requests
participation from health, environment,
economy, ecology, education, and urban
planning
fields.
Decentralization
expedites influential partnerships.
Enablement
\Ne need to enable people of various
sectors to build partnerships at the local
level. People need skills to find partners,
work with different partners, mediate,
create participatory platforms, and work
towards the same goal. We need to
increase partnership literacy.
This commitment to building the Healthy
Cities movement is for the health of the
people.
25 July 1997
37
STATEMENT OF MEMBER COMPANIES AND GROUPS
AD HOC PRIVATE SECTOR GROUP
4TH INTERNATIONAL CONFERENCE ON HEALTH PROMOTION,
Private sector companies and groups attending
the Jakarta Conference warmly welcomed the
opportunity afforded to them by the WHO for
full participation in the ongoing health
promotion discussions, with the central theme
of building effective partnerships involving new
players.
JAKARTA, JULY 1997
become more effective if they are delivered
through practical, balanced and transparent
partnerships.
Having taken the first steps in creating such
partnerships during our time here in Jakarta,
the private sector companies and groups
would wish
to maintain a regular dialogue with the new
partners and WHO, leading to agree
partnership
protocols and commitments. General protocols
for successful partnerships must include
transparency, accountability, mutual benefit
and ethics. Other protocols must be tailored to
particular partnerships, such as commitment to
the highest standards of professional and
scientific practice.
Evidence presented to the Conference
outlining the “crisis of suffering” facing the
populations of the world, clearly indicates the
need for the private sector to play a full and
responsible part in working with WHO and
government, in both developed and developing
countries, to meet the health challenges
ahead.
Private sector companies and groups
represented at Jakarta are committed to
working with WHO, governments and NGOs to
help inspire similar commitment from other
responsible private sector companies and
groups. We share the view that the issue of
greater health expectancy is as important to
companies and the communities they serve, as
was the issue of the environment in the 1980s
and early 1990s. We further believe that best
practice in the workplace involves a
comprehensive and holistic approach to the
promotion of physical, mental and emotional
well-being for workforces and families. We are
also fully aware of the continuing need for
companies to be vigilant as to the health
impact of their products and services, as well
as to the way they are produced, delivered and
marketed.
The private sector seeks to ensure successful
partnerships by reaching agreement on
commitments to:
Regular measurement of goals and
objectives;
□ Sharing fully and openly all information
relevant, and wherever possible, sharing
resources
be
they
managerial,
technological, training or financial;
□ Maintaining open dialogue in the spirit of
understanding with an aim to reach
agreement
on
joint
values,
joint
responsibilities and joint action plans;
□ Open acknowledgement of the contribution
of each partner, and the responsibilities of
both new and “old” players in health
promotion. ■
□
The private sector at large has spent billions of
dollars over the last decade in health
promotion programs, stimulated in part by the
ground-breaking Ottawa Charter. However, for
millions of people in both developed and
developing countries the private sector's
crucial contribution to health promotion is as
wealth creators and job providers.
The
eradication of poverty through the provision of
opportunities to work is a crucial, yet
undervalued, contribution to health promotion
provided by the private sector. Yet there is
more to be done. Our view is that health
promotion programs in the corporate sector,
whether philanthropic or commercial, will
The Scope and Purpose Document prepared
by WHO for the 4th International Conference,
outlined the expected outcomes of the Jakarta
meeting.
We believe that our statement
addresses directly many of those outcomes,
particularly those regarding alliances and
partnership principles.
Private sector companies and groups at
Jakarta warmly welcome the Jakarta
Declaration and commit themselves to
participate fully in its implementation.
25 July 1997
38
day: zl ]uiy
8.30-9.00
transportation to
palace
Day 0
Plenary
9.0010.30
day 2: 22 July
NEWS
■
■
•
'
day 3: 23 July
NEWS
320
Ntws
I
“
day 5: 25 July
day 6
NEWS
_________________
Optional
.
CHALLENGE II: New Mindsets
Think Health: What
makes the difference?
OFFICIAL OPENING
(presidential palace
Istana Negara)
Break:
10.3011.00
3
CHALLENGE IV: New Policies
tranport to Conference
venue
- Hotel Horison -
CHALLENGE V: New Tools «
Technologies
New Policies for
Health Promotion
7
Soaps for Health:
health promotion through
entertainment
9
Break
Symposia
1 LOO12.30
day 4: 24 July
. NFWS
NEWS
Ntws
___________
4
Declaration
Break
l^DlNGqUH0EII
allenges sc
iponses
Plenary Discussion Jakarta
13
Break
Health
CHALLENGE VI
Partnerships for
Health Promotion
Surprise Speaker
LEADING QUNGtlH/
f^teadershlp skins for
health promotion
10
Break
8
12.30Plenary
14.0016.00
Registra
tion
DAY
LUNCH
LUNCH
CHALLENGE I:
Health Promotion :
A global challenge
CHALLENGE III: Health Futures
5
1
Break:
16.0016.30
Symposia
16.3018.00
18.00-
EVENING
EVENTS
Welcom
e
Cocktail
hosted
by WHO
Health 2020
Break
Break
Review K Evaluation
Health Promotion Futures
Health Pi
A.
■
LUNCH
LUNCH
LUNCH
LEADING CHANGE IV
LEADING CHANGE V
New Players for a New
Era - Final
Commitments Adoption
of
Jakarta Declaration
HP towards the 21 st
century
INDONESIA
DAY
11
Break
14
Closing Ceremony
PARTNERSHIPS IN ACTION III
Indonesian experiences
2
PARTNERSHIPS IN ACTION IV
Partner dialogues
strengthening
commitments
12
NETWORKING
NETWORKING
NETWORKING
NETWORKING
Welcome Dinner:
hosted by Ministry of
Health Indonesia
FREE
Dinner st Cultural Evening
hosted by Governor of
Jakarta
FREE
39
HP
Site
visits
i1
I
Sunday
20 July 1997
12.00-20.00
16.30- 18.00
Registration at Lobby of Krakatau Room
Welcome Cocktail hosted by WHO
MORNING
EVENTS
DAY 1 Monday 21 July 1997
7.30-8.30
Transport to Presidential Palace
Official Opening
Presidential palace
Official opening
"Welcoming address from Indonesia"
"Welcoming address from World Health Organization"
Transportation to the conference venue
9.00-10.30
1 1:00-12:30
12:30-14:00
14.00-15.30
LUNCH
Multi - Media Introduction
CHALLENGE I
Session 1
Plenary
Health Promotion - a Global Challenge
Chair:
►
►
H.E. Prof Dr Sujudi, Minister of Health, Indonesia
Welcoming address
Keynote speech:
Dr Uton Muchtar Rafei, Regional Director, WHO/SEARO
" Looking back...Looking Ahead: Health Promotion a Global
Challenger - Dr I. Potter, Assistant Deputy Minister of Health, Canada
Opening Panel: Health Promotion: A Global Challenge!
"Challenge in Hungary 81 Eastern European countries" - H.E. DrM.Kokdny, Minister of welfare,
Hungary
"Challenge in the pacific islands" - DrA.U.Boladuadua, Director Primary & Preventive Health
Service, Fiji
"Challenge fdr NG Os in Africa"- Dr F.Manguyu, President Medical women's International Association
Kenya
"Challenge for private sector"-Mr J./Vfu//en, Chairman, Private Sector for health promotion, USA
15.30-16.00
Introduction to programme of 4ICHP
Introduction to programme of 4ICHP
Introduction to "health promotion in action" (S2)
16:00-16:30
16.30-18.00
Dr D. O'Byrne, Chief HEP, WHO
Prof P. Gillies, Director Research, HEA
Break
I
-
PARTNERSHIPS IN ACTloO
is»i
f action, ’
< 'At ti
>f he.
inin'Sc
1session o -fm ms /vk
'■r
its®
lawSi
„fmp
nc^my Agelkg ' '‘.S ]
iii
i.
• •,;i ‘
I
Islands/ comi
-
18.00-19.30
NETWORKING
EVENING
EVENTS
Welcome Dinner, hosted by H.E. Prof Dr Sujudi, Minister of Health, Republic of Indonesia
_____________ __________
wpr
40
08937
)OO
MORNING
EVENTS
J
8.30-9.00
9.00-10.30
DAY 2 Tuesday 22 July 1997
IS
- .
___hL
.
Multi - Media Introduction
Session 3
CHALLENGE II: New Mindsets
Plenary
Think Health: What makes the Difference?
Chair:Mr J. Mullen, Chairman, Private Sector for health promotion
Key-Note speech: "Think Health: What makes the Difference?" Dr I.Kickbusch, Director HPR, WHO
The panel discusses how to place health promotion in the centre of development. How can health
promotion address the determinants of health in different economic, historic, social and cultural contexts?
Panel-presentations:
- 'addressing health determinants in the United States'
- ‘addressing health determinants- grass-roots perspective’
- ‘addressing health determinants- African perspective’
- ‘addressing health determinants- private sector perspective’
10:30-11:00
J
- Dr D. McQueen, USA
- Dr A.Mukhopadyay, India
- Dr W.Mwanyenge, Bostwana
- Dr M. Knowles, Belgium
Break
11.00-12.30
GF, I
-
£
'J
■
create h?
I
. V.'
E
El i
||8i
9
I
i
)
“
1“’":
I
Think globally act
Lcalty
A
12:30-14:00
LUNCH
1
J
41
14.00-15.30
Multi - Media Introduction
Session 5
CHALLENGE III: Health Futures
Plenary
Health 2020
Chair:
Dr F.Manguyu, President Medical Women's International Association, Kenya
Keynote speech:
"Demographic trends: health fit population responses" - H.E. Prof H.Suyowo, Minister of
Population, Indonesia
"Global Health Trends St Health Potentials" - Dr O. Shishana, South Africa
i
While moving into the 21st century, health promotion must respond to major challenges. This panel
introduces global health trends and selective responses.
Panel-presentations:
- 'Western pacific scenarios: New Horizons in Health'
-DrS. THan, Regional Director,
WHO/WPRO
- 'Illiteracy K Educational Responses'
- OrE. Jouen, Belgium
- 'Tobacco Trends St Health Responses'
- Dr S.Omar, Egypt
- 'Building Effective Networks: in the Community and Around the World' - DrR. Scott, Canada
15.30-16.00
Health Promotion Futures
HP Futures- introduction to 'Moving ahead' (S6)
- Dr R.Vaithinathan, Director, Training & Health Education Department, Ministry of Health Singapore
WHO Collaborating Centre
- Dr T. Hancock, Health Promotion Consultant
)
16:00-16:30
Break
;
16.30-18.00
Session 6
■
——
.
--
-
. . .
—
■
PAKTNEKHIPS IN ACTION II
Symposia
Moving Ahead
•
•
‘
. ....JW' .
. ip'Syniposia
iu symposia. .
.
SV..:
' ■■
This series of symposia will focus on different entry points for health promotion action most
■■■-likely to lead to significant gains in health and well-being by 2020. ' .
Participants will be engaged in proposing priority approaches and action steps based on the most
effective strategies as results of session 2 "Health Promotion in Action" Incorporating the trends
laid out in session 5. Proposals from these symposia will lay the basis for partner dialogues such
as in session 12.
; 'X
■
.gffir'...
‘i,,'„.
villages/ Islands/
communities
6.6
Sexual Health
18.00-19.30
...
SB
exssssaa—.
Health Promoting
Healthy
:•
Schools
Workplaces
____________
=—
6.7
6.8
Healthy Ageing
.
illl
societies
2
,
women's health
NETWORKING
EVENING
EVENTS
42
.
6.9
Health Promoting
healthcare settings
________________
6.5
Active Living/
Physical Activity
:
;<: - ■ ' z
6.10
Healthy Homes fit
Food Nutrition
■
.
(I
MORNING
EVENTS
DAY 3 Wednesday 23 July 1997
8.30-9.00
9.00-10.30
news
Multi - Media Introduction
Session 7
CHALLENGE IV
New Policies for Health Promotion
Plenary
This plenary focuses on how 3 countries and one interregional group use the integrative health promotion
approach to maintain and enhance health. Three of the most populated countries will outline their response
to the challenges to lead change in promoting the health of the people.
Chair:
H.E. Dr M.KokGny, Minister of Welfare, Hungary
"Health Promotion towards the 21st century: Indonesian policy of the future"
I
"Global health inequity and the role of Mega-countries"
"How is the most populated country facing the future health challenges?"
"European policies for health promotion"
10:30-11:00
1 1.00-12.30
- H.E. Prof Dr Sujudi, Minister of
Health, Indonesia
- DrD.Satcher, USA
- Dr Lu Rushan, China
- Dr M. Rajala, Luxembourg
Break
: s
LEADING CHANGE II
Session
>n 8
10 Symposia
Challenges & Responses
The world is changing rapidly, and many global trends have an impact on health. The parallel symposia in
this session will feature global trends and the discussions will represent challenges and responses. The
participants are challenged to define future action and strategies through which health promotion can bend
global trends to enhance health and equity.
,
\
s=
8.2.
New Ethical:
Challenges & HP
Responses
Global Health:
Global Alert &
Surveillance i
■8.6.
^Cities.
8.7.
The Changing
Social Fabric:
Challenges &
Responses
8.3.
Globa!
Movements:
I Tourism
—
ss
8.8.
New Consumers:
Challenges & HP
Responses
8.4.
information
Highway:
Challenges & HP
responses
8.5.
8.9.
Food Production
& Safety
8.10.
Forgotten people:
Challenges & HP
Responses
12:30-14.00
LUNCH
14.00-14.30
Operette - INDONESIA DAY
14.30- 16.00
Session I
• Detailed
programme of
Indonesia Day: see
separate booklet
14.30- 16.00
16:00-16:30
Session 11
Trade & Health:
Challenges & HP
Responses
ID1 Theme I a:
Religion and Health
Development in
Indonesia
ID2 Theme II:
Woman and Health
Development in
Indonesia
IDS Theme III:
Nation Wide Community Action for Health
ID4 Theme IV:
Local Specific
Community Action
for Health
IDS Theme V:
Intersectoral
collaboration and
Private Sector
IDS Theme VI:
Managed Care in Indonesia
ID1 Theme I b:
NGO's Health
Activities in
Indonesia
ID2 Theme V:
Woman and Health
Development in
Indonesia
IDS Theme III:
Nation Wide Community Action for Health
ID4 Theme IV:
Local Specific
Community Action
for Health
IDS Theme V:
Intersectoral
collaboration and
Private Sector
IDS Theme VI:
Managed Care In Indonesia
Break
PARTNERSHIP IN ACTION ill
18:00-19:30
NETWORKING
EVENING
EVENTS
Dinner ei Cultural Evening, hosted by the Governor of the metropolitan city of Jakarta
43
d
MORNING
EVENTS
DAY 4 Thursday 24 July 1997
8.30-9.00
9.00-10.30
NEWS
Multi - Media Introduction
Session 9
CHALLENGE V: New Tools SC Technologies
Plenary
Soaps for Heslth: health promotion through entertainment
i
The rapid spread and development of Information systems and communication infrastructures have a major
impact on our everyday life. Health promotion can benefit from the fact that nearly all communities in the
world and large numbers of individuals have access to communications technology including entertainment
on television. This session will show examples of broadcasting health in soap-operas from different parts of
the world.
Chair:
Dr A.U.Boladuadua, Director Primary & Preventive Health Services, Fiji
Key-Note Speech:
"Soaps for Health" Dr S. Fox, USA
"Trends in Health and in Communication: Opportunities 81 Strategies to mobilize
Partners"- Dr W.Feek, USA
Panel Presentations:
- Ms Roma Pereira, India
- Dr Kimani Njogu, Kenya
- Ms S. Ward, South-Africa
10:30-11:00
11.00-12.30
Break
Session 10
LEADING CHANGE III
which are*, las.
———
10J
through advocacy
10.6
Leadership
through policy
framewdrics T
communtQtio«U for
MMMi Leadershlpthrough -.
|| ^^nhlpbSing I
1 .......
10.7
10.8
Acquiring leadership
Economic
skills through
accountability for
training
• HP
12:30-14:00
14:00-16:00
s
10.9
Leadership through
coordinating the
HP-Networks
10.10
n
Positioning HP In
health care reform
LUNCH
Session 11
LEADING CHANGE IV
Plenary
Health Promotion towards the 21st century
>
.
■
■
Chain H.E. Dr M.K6k6ny, Minister of Welfare, Hungary
In anticipating a rapidly changing world, this session summarizes and synthesizes the challenges, key
strategies and priority areas for future health promotion action. The session allows for the plenary
discussion of the draft Jakarta Declaration.
Panellists:
-DrD. Nyamwaya, Kenya
- Dr D. Nutbeam, Australia
Ms N. Mattison, Switzerland
. - Drs Dachroni, Indonesia
Discussions of the draft Jakarta Declaration in 10 parallel groups
44
sii
<1
16:00-16:30
Break
16.30-18.00
PARTNERSHIPS IN ACTION IV
- Sympoto
Partner dialogues: strengthening commitments
■
TWs afternoon session offers the possibility for different organizations and agencies to meet and negotiate
with varies global (WHO) Health Promotion initiatives and networks on potential Joint health promotion
3|ctiog<OuK:qmes of the partnerdialogues are presented In plenary session 13 "Partnerships for health
prdmotlon".
:
•
How tan we build new partnerships and alliances to reduce the health gap and promote Health for AH In the
;ilst century?
»'
; What new playen are wHIIng to form a global alliance for Health Promotion?
•
...How can we capture the positive momentum from partnerships and alliances for a dynamic Health Promotion
■
'•>
-
•
:•,
k/Sk9*165
iNwwort
■
■
hl2.......
112.3
H°?hrh^
Health Initiative
Healthy Ageing
|| Initiative
12.7
WW
Initiative
18.00-19.30
foundationsII Initiative
12.8
for Chronic Health
|| conditions
NETWORKING
EVENING
EVENTS
)
45
12.4
Healthy Work
Initiative
r
12.5
Active Living
Initiative
12.9
Health Promoting
Health Promoting
Hospitals- Initiative
Media settings
12.10
MORNING
EVENTS
DAY 5 Friday 25 July 1997
!
8.30-10.30
Multi - Media Introduction
Session 13
Plenary
Partnerships for Health Promotion
Chair:
Dr F.Manguyu, President Medical Women's International Association, Kenya
Plenary discussion on Jakarta Declaration proposal
11:00-11:30
Panellists:
- Dr D.Mukaji, India
- Dr A.Malaspina, USA
- Dr J. Catford, Australia
- Dr R. Davies, USA
11:30-14:30
Break
14:30-16:00
Plenary
;
Closing Ceremony
-
fit Si
»stSS
'
'J
_ ________________ :__ gS
MORNING
EVENTS
8.00-8.30
DAY 6 (optional) Saturday 26 July 1997
Busses are waiting in front of the lobby Hotel Horison
8.3O-1O.OO
3 Site Visits:
)
1.
Taman mini Indonesia indah (the garden of wonderful Indonesia in Minature)
2.
Kebun Raya Bogor (the Bogor botanical garden)
3.
Taman safari Cisarua (the safari garden, Cisarua)
10:00-12:30
Site Visits to health promotion actions in Indonesia
12:30-14:00
14.30-16.00
LUNCH
Back to Hotel Horison
46
d
f
Introduction to Symposia
The conference programme features on two tracks of symposia:
•
'Leading Change'-symposia in the mornings
•
'Partnership in Action'-symposia in the afternoons
'Leading Change' symposia
The symposia in the 'Leading Change' track are structured as learning sessions. The items addressed
in these symposia trigger discussion and debate between the participants with a new reconciling to
different perspectives and adopting a stronger, more united approach to health promotion.
The following three 'Leading Change' sessions are discussed in detail in the next pages:
•
Session 4, Think Health
•
Session 8, Challenges St Responses
•
Session 10, Leadership skills for health promotion
Tuesday 22 July 1997
Wednesday 23 July 1997
11.00- 12.30
11.00- 12.30
H
Thursday 24 July 1997
11.0- 12.30
■^Thgchanobu,
IGE11
’•‘■J
leaderships^
promc....
bbWB if
eg
•i'
10
'Partnerships in Action' symposia
The symposia in the 'Partnership in Action' track give the participants the opportunity to work in
depth in one of ten health promotion areas.
Within 'Health Promotion in Action' session 2, the participants will illustrate successful Health
Promotion strategies, methods and approaches by presenting selected case studies. Building on these
successful strategies, participants will identify future Health Promotion action areas. In the
'Challenges at Responses' symposium key action steps to reach the greatest health gain by the year
2020 will be discussed. The focus of 'Partnerdialogues ■ strengthening commitments' is the
enhancement of the commitment on joint action among "old and new players" interested or
involved in the respective health promotion initiatives.
Monday 21 July 1997
16.30- 18.00
Tuesday 22 July 1997
16.30- 18.00
SWISRS
I-PARTNERSHIPS ACTION I!
ION I
. ...
in In
MMi
in
.................................... ■
I-
J-
Rf i ■
Thursday 24 July 1997
16.30- 18.00
HMM
PARTNERSHIPS IN ACTION IV
Partnerdialogue
••/Vi'i j
strengthening commitments
-
12
47
I
Session 4: Think Heslth - Tuesday 22 July 1997, 1 1.00-12.30
LEADING CHANGE- symposia (Sessions 4-3-10)
Symposia
Speaker
Respondents
Facilitator
4.1
(Intersectoral Action •
Dr N.Kotani, Canada
- Dr M.Szatmari, Hungary
- Ms R.Bonner, Switzerland
Dr J.Mwanzia, Kenya
4,2
Healthy public policies
Dr N.Ngwenya, Zimbabwe
Dr D.McVey, UK
- Dr R.Parish, UK
- Dr C.Colin, Canada
Dr H.Hagendoorn,
Netherlands
4.3
Investing in health
Dr E.Ziglio, Denmark
Dr A.Rutten, Germany
- Ms J.Jett, USA
Ms R.Tenny$on, UK
4.4
Investing in equity
Dr G.Dahlgren, Sweden
- Dr M.Danzon, France
- Dr G.Perez, South-Africa
Dr A.Mukhopadhyay,
India
4.5
City Health Plans
Dr A.Kiyu, Malaysia
- Dr C.Daniel/ Dr J.Goepp, USA
- Dr T.Ohta, Japan
Dr J.Urbino-Soria,
Mexico
4.6 *
Evaluating policies
Dr 1.Rootman, Canada
(Dr S. Jackson)
- Dr M. Ahmed, Bangladesh
Dr C.Kelleher, Ireland
4.7
Evaluating settings
Dr j.Pellkan, Austria
- Dr J.Adenlyi, Nigeria
- Dr Ramji Dhakal, Nepal
Dr J.Catford,
Australia
Prof P.Gillies, UK
- Dr D.Nyamwaya, Kenya
- Dr D.McQueen, USA
Ms C.Hamilton, New
Zealand
Dr R.Gurr, Australia
- Dr A.Etsri, Togo
Dr D.Mukarjl, India
Dr Chowdhury, Bangladesh
- Dr Boon Yee Yeong, Singapore
- Dr F.Lostumbo, USA
Dr B.Petterson,
Sweden
..
; Evaluating community health
programmes
(integrate perspectives)
The question 'how do we create health' leads to new approaches in policymaking, financing and evaluation. The
symposia will provide examples of innovative action.
Symposia Goal
•
To address different key approaches to create health
Symposia Objectives
•
to learn about new and innovative approaches in creating health;
•
to introduce the health promotion perspective on policymaking, financing and evaluation;
•
to integrate new perspectives of innovative action into existing approaches.
Symposia Outcomes
•
identified new and innovative approaches in creating health;
•
identified ways how new perspectives of innovative action can be integrated into existing approaches.
Symposia Structure
•
introduction of topic and speakers by facilitator and designation of a rapporteur;
•
keyspeaker: presentation on an innovative health promotion approach of policymaking, financing or
evaltuation in "creating health" (15 minutes),
•
one or two speakers responding to the presentation providing new perspectives on the health promotion
approach (5 minutes each);
•
discussion along questions prepared by the facilitator and key speaker;
•
summary of the discussion by the facilitator;
•
written report developed by a designated rapporteur.
Background material
•
key speaker to provide all participants with input/material (if possible specific prepared paper) for the
symposium.
48
(
Session 8: Challenges & Responses - Wednesday 23 juiy 1997,11.00-12.30
LEADING CHANGE- symposia (Sessions 4-8-10)
Symposia
Speaker
Respondents
Facilitator
8 J.
New Ethical Challenges
Prof H.Hannum, USA
- Ms M.Modoio, Italy
- Dr Egwu, Nigeria
Dr H.Hagendoom,
Netherlands
Global Health:
Global Alert & Surveillance
Dr Hapsara, WHO/HST
(global health trends)
- Dr L.Kuppens, WHO/EMC
(global alert St surveillance)
Dr B.Petterson,
Sweden
Global Movements:tourism
Ms E.Simon, Switzerland
(global Hospitality
Industry)
- Ms D.D'Cruz-Grotte, UNAIDS
(AIDS - tourism)
Dr J.Catford,
Australia
Dr S.Connelly, USA
- Ms C.Herman, UK (internet)
- Ms B.Kabre, Cote d'Ivoire
Dr J.Mwanzia,
Kenya
Si
8.3.
84.
)
.... . 1 •
.......... ==
information Highway:
Challenges &-HP
responses
8.5.
Trade &Heal(ti:
Challenges & HP
response^
cancelled
8.6.
Mega Cities:
Challenges & HP
responses
Dr T.Takano, Japan
- Dr C.De Sa, India
- Mrs M.Broglia, USA
Dr F.Memon,
Pakistan
8.7.
The Changing Social
FabricjChallenges &
Dr J.Davies, UK
- Dr D.Mukarji, India
- Dr V.Naweya, Kenya
Dr J.Urbino-Sario,
Mexico
*8.|3,
8.9.
New■Consumers:
Challenges & HP
:^sponses
Dr Z.Mirzar, Pakistan
Food Production & Safety
Dr C. Kelleher,
Ireland
Dr M.Edmundson
- Ms J.Koch, Switzerland
- Mr A.Gueniffey, France
Dr D.Mukarji, India
Dr P.Makara, Hungary
(Gypsies)
- Dr R.Mihi, New Zealand
(Maori)
- Dr C.Ten Haeff, Netherlands
Dr
A.Mukhopadhyay
India
■
8.10. ■: Forgotten people.
challenges & HP
/ responses' \ . .
___
The world is changing rapidly, and many global trends have an impact on health. The parallel symposia in this
session will feature global trends as challenges for health promotion and the discussions will represent
challenges and responses. The participants are challenged to define future action and strategies through which
health promotion can bend global trends to enhance health and equity.
Symposia Goal
•
to analyse challenges for health development and how health promotion can best respond to these challenges
Symposia Objectives
•
to learn about global trends in terms of their challenge that they pose for health promotion;
•
to analyse these trends in terms of their challenge that they pose for health promotion;
•
to discuss and develop future strategies of action for addressing these trends.
Symposia Structure
•
introduction of topic and speakers by facilitator and designation of a rapporteur;
•
key speaker: presentation of global trends and its impact on health (by an expert in the field - keyperson) with
emphasis on the health promotion response (15 minutes);
•
one or two speakers responding to the presentation providing new perspectives on the health promotion
challenges and responses (5 minutes each);
•
discussion along questions prepared by the facilitator and key speaker;
•
summary of the discussion by the facilitator;
•
written report developed by a designated rapporteur.
)
Symposia Outcomes
•
identified global trends that are a challenge for health promotion;
•
Identified responses and future strategies of action for addressing these trends.
Background Material
•
key speaker to provide all participants with input/material (if possible specific prepared paper) for the
symposium
49
<
Session 10:Leadership for health promotion - Thursday 24 July 1997,11.00 12.30
LEADING CHANGE- symposia (Sessions 4-8-10)
!
Symposia
10.1
Leadership through Advocacy
Speaker
Repondents
Facilitator
Dr F.Lostumbo, USA
- Dr H.Aroyo, Puerto Rico
- Mr D.Boddy, UK
Ms C. Hamilton, New
Zealand
- Mr P. Mitchell, UK
Dr J.Urbino-Soria,
Mexico
10.2
Leadership through
communications for health
Dr J.Yadava, India
10.3
Leadership through
partnershipbunding I
Ms R.Tennyson, UK
10.4 Leadership through Pannenhip
_^ingir
10.5
Dr Kawaguchi, WHO
(Dr ].Miller - rapp.)
cancelled
Global Leadership through
conventions
Dr N.Mboi, Indonesia
(child rights)
- Dr S.Omar, Egypt
(tobacco free societies)
Dr C. Kelleher,
Ireland
■ Dr N.Enyimany, Ghana
- Dr LParsons, UK
Dr F.Memon,
Pakistan
Dr H.Saan, Netherlands
- Ms L.Ong Pool
- Dr K.Hyu, Korea
Dr J.Catford,
Australia
Dr J.Van der Horst,
Netherlands
- Dr S.Geddes, Australia
Dr D.Mukarjl, India
Dr P.Chandran John,
India
- Ms H.Macdonald,
Australia
- Ms I.Dinca, Romania
Dr B.Petterson,
Sweden
Dr).Castro, Mexico
Dr C.Connolly, Canada
Dr J.Mwanzla, Kenya
-_____________________
10 6
Lead rshl th
gh
I’
----------------------------------—_
— ------------------------------------------ —■—
“■7
"108——Ta------ b-----------Economic AccounubUlty for
J
IMO
..... w
Dr).Bennett, Australia
==^_
—1_L_
The symposia in this session challenge the participants to integrate different health promotion strategies which
are the basis for leading health promotion ahead. Building on the best practices participants get the chance to
explore diverse leadership skills.
Symposia Goal
•
to explore and identify diverse leadership skills for health promotion;
Symposia Objectives
•
to learn about key health promotion strategies:
to integrate diverse leadership activities and skills into existing ones;
•
to enhance leadership skills of participants.
Symposia Structure
•
introduction of topic and speakers by facilitator and designation of a rapporteur;
•
key speaker: presentation of successful strategy and leadership (15 minutes);
•
each°r
speakers resPondin8 t0 the presentation providing new perspectives of leadership (5 minutes
•
•
•
discussion along questions prepared by the facilitator and key speaker;
summary of the discussion by the facilitator;
written report developed by a designated rapporteur.
Symposia Outcomes
•
identified diverse models of good practice of leadership skills:
•
identified ways to integrate diverse leadership activities and skills into existing ones;
Background Material
•
symposhjkmr t0 prOV'de aH ParticiPants with inPut/ material (If possible specific prepared paper) for the
50
PARTNERSHIP IN ACTION - symposia (Sessions 2-6-12)
BI SESSION 6 - Tues,
I SESSION 2.Monday 2T-
SYMPOSIA
H /Health Promotion in Action *
|| Il
1 •«':
.JI jB|Bf
‘
-
- “Healthy City Kuching”
- “Queensland Healthy Cities"
- “Healthy Island activities”
- "Evaluating Healthy Cities & Health
Promotion”
-
jl fMovin AfiGad*
22
SYMPOSIA
SESSION 12- Thursday
24
‘Partner dialogues’
____I
- “Health Promotion Futures: Healthy
Cities”
- “Future Directions for Healthy Cities”
- “Future Directions for Healthy Cities”
“Partnerships for the
Global Healthy City
Network”
■■
■
2. Health Promoting Schools
3. Healthy Workplaces
.
■ •
■
......... v
■
4. Healthy Ageing
: 7
■
cc.
5. Active Living/ Physical
Activity
6. Sexual Health
T
8
- “A Health Promoting School"
- "National strategies improving school
health programmes in Megacountries"
- “European Network of Health Promoting
_ Schools”
- “HP Futures-Health Promoting Schools"
- “Working Conditions and Quality of
Working Life: The Health Circle
Approach”
- “Workplace Initiative- public/private
partnership"
- “Future Strategies for Effective Workplace
Health Promotion in Europe"
- “Health Promotion Futures: promoting
health at work"
12.2 Global School Health Initiative
12.3 Healthy Work Initiative
========^^
12.4 Healthy Ageing Initiative
“Health Promotion Futures”:
- Dr Andrea Prates, Brazil
- Ms Maria Stefan, USA
- “Active Living"
- "Tongan Weight Loss Campaigns"
- “Active Living - case study Japan”
- “Future through/with Active Living"
- “Future through/with Active Living”
- “Future steps through Activity”
12.5 Active Living Initiative
- “Family Planning Project”
- “HIV/AIDS Prevention in private sector”
- “Sexual Health - Casestudy"
“Global Business Council on HIV/AIDS"
12.6 Mega-country Initiative
“Health Promotion Futures: tobacco free
Societies"
“Health Promotion Futures: USA policies"
“Tobaccofree futureplans for Australia”
“Healthy Work Initiative"
“Partnership building for
Healthy
Work”
___
—•
■
“The WHO perspective on
Ageing and Health”
“Partnership building for
Healthy
Ageing”
“Global Partnerships for
Active
v
...
“Women’s Health in India”
“Promoting Women’s Health: private
sector
Case-study"
“Promoting Women’s Health: NGO case"
“Partnerships building for
School
Health"
Panel discussions
- “Health Promotion in Action”:
- Ms 1. Hoskins, USA
- Dr T. Setoabudhi, Indonesia
- Dr K. Kawahara, Japan
- “Tobaccofree Thailand"
- “Tobacco free Finland”
- “No Smoking Islands in the Maldives"
Panel of Healthy City
experts
Living”
I
12,7 Health Promotion Foundations - initiative
_____________
. '
tti B
•_______________ .
______
“Education - the right to a better way of life"
"Men’s Health impact onWomen’s Health"
________
■
; < * neaim rromoting
Healthcare Settings
'
.
■
iO. Healthy homes/ families
:
\
~
~
,
..
----------------------------------------------- ———
‘Project ‘HOPE’ in Poland”
"Health Promoting Healthcare in Africa1’
“Anesthesia Patient Safety - Casestudy”
“Health 2020”
“Health Promotion Futures: responses to
Non Communicable Diseases”
12.9 Health Promoting Hospitals- initiative
"Healthy Homes”
"Healthy Homes & Families”
“Development of food-based dietary
guidelines”
“Healthy Homes & Families: a future
perspective”
12 J O Health Promoting Media settings
52
■■
1
Session 2: Health Promotion in Action
Monday 21 July 1997, 16.30-18.00
Symposia on successful Health Promotion strategies and approaches (advocating, enabling, mediating, intersectoral
action, strengthening community action, etc.) illustrated by case stones. These case stories reflect a wide range of
health promotion in action. The outcomes or this session will provide important input, particularly into session 6
"Moving Ahead" and session 12 "Partnerdialogues".
Symposia Goal
•
to Illustrate successful Health Promotion strategies, methods and approaches by presenting selected case
studies
<
Symposia Objectives
•
to learn about two models of "good practice" in Health Promotion at different levels of society;
incorporating different players;
•
to identify indicators for success of Health Promotion action;
•
to identify ways in which the different players in Health Promotion are successfully applying Health
Promotion strategies to implement and strengthen programmes;
Key Questions
•
What are successfull approaches to implement and strengthen HP programmes and/or to improve health at
different levels of society?
•
What environmental conditions were indicators for success of Health Promotion action?
•
Which partners made a difference in health promotion action (public/NGO/private sector;
researchers/professionals, groupings of people such as self-help or other groups; etc.?)
Symposia Outcomes
•
Models of good practice of strategies/ approaches In creating health: a list of strategies/ approaches;
•
Models of good practice within the respective HP area: list of successfull casestudies;
•
identified Indicators for success of Health Promotion action (HP outcomes).
)
Symposia Structure
•
introduction of topic, rapporteur and speakers by facilitator;
•
presentation of two to three case studies covering a range of international, national and local Health
Promotion action with emphasis on intersectoral partnership approaches;
•
discussion along key questions prepared by technical adviser and the facilitator;
•
summary of the discussion by the facilitator, including statement for Jakarta Declaration;
•
written report developed by rapporteur.
Background Material
•
Technical Adviser and facilitator to decide and distribute on the material that should be available for
participants (50 copies)
•
Speakers to provide all participants with input/ material (if possible specific prepared paper) for the
symposium (50 copies)
Session 6: Moving Ahead
1
Tuesday 22 July 1997, 16.30-18.00
This series of symposia will focus on different entry points for health promotion action most likely to lead to
significant gains in health and well-being by 2020.
Participants will be engaged in proposing priority approaches and action-steps based on the most effective strategies
as results of session 2 "Health Promotion in Action^ incorporating the trends laid out in session 5. Proposals from
these symposia will lay the basis for partner dialogues such as in session 12.
Symposia Goal
•
to identify future Health Promotion action areas and key action steps to reach the greatest health gain by
the year 2020
Symposia Objectives
•
to learn about a vision of "potential futures in 2020" in various Health Promotion action areas;
•
to identify action steps that need to be taken today to reach the "preferred future In 2020";
•
to identify three action steps for TODAY.
Key Questions
•
What are key future priorities for global/intemational, national, and local level action to reach a state of
achievement of greatest health gain?
53
•
2020"?y aCtl°n $tePS neGd t0 bG taken tOday'in 1' 3 and 5 years' t0 reach that "Preferred future by
support &n^aakhnep?o(motioCn
WhiCh (P^'NGO/private) partnerships can
Symposia Outcomes
^obal^eveD;0"^ aCti°n areaS “ reaCh a "preferred future b* 2020" «-e. action in partnerships and at
•
identified key action steps which need to be taken today, in 5, 10 and 15 years;
Symposia Structure
•
introduction of topic and speaker by facilitator;
one or two responses to the presentation;
5 H h
qu$esd u"5 ere?ar$d by 1,16 facilitator and technical adviser;
summary of the discussion by the facilitator n written report developed by rapporteur.
Background Material
partdpa^B (50^coapies)aCilltat0r t0 deC'de and distribute on the material that will be available for
•
•
for the ™slum 50 copi« «ch(Speciflc Health
PremoTonVcen^
Session 12: Partner dialogues: strengthening commitments
Thursday 24 July 1997, 16.30-18.00
varinm t’KhS^WMn1? mSd Poss‘bi,ity f2r different organizations and agencies to meet and negotiate with
various global (WHO) Health Promotion initiatives and networks on potential joint health promotion action.
Symposia Goal
Kp^hea’K
aCti°n am°ng "°ld and "eW P'ayerS" interested or invo,ved in
Symposia Objectives
•
to communicate the interests of the partners;
to develop and strengthen the commitment of partners on health promotion action•
to decide upon key action steps in leading health promotion initiatives forward
'
•
to enhance partnerships around the health promotion initiatives.
Key Questions
theW2 it? cctH? neW Partner5hipS and aIliances t0 reduce the health 8ap and Promote Health for All in
What new players are willing to form a global alliance for Health Promotion’
Promotion^ftiture?"6
P°SitiVe momentum from Partnerships and alliances for a dynamic Health
Symposia Outcomes
identified partnerships to strengthen health promotion action in the respective areapartaerehips^ °n aCtI°n SteP$ bY different Partners (Public, NGO, private) and in (public/NGO/private)
•
identified ways to build maintenance for partnerships.
Symposia Structure
•
presentation of partner Interests:
•
facilitator moderates the discussion:
•
summary of the discussion by the facilitator;
•
preparation of a statement of committment for Joint action (a letter of intent) •
wrfTn tra^piesei?tatl'!leuto
the dement in the plenary panel in session 13;
•
written report developed by rapporteur.
Background Material
JartdpanB d50ecoapniifaachT°r tC> deC‘de and distribute on the material that will be available for
impo^um ^r0Vcdpies)PartiCiPantS With inPUt/ material (if pOSSib,e specific prepared paper) for Ihe
54
cj
J
nities. . I
nds/ Con..,,uli,u^
"Healthy City Kuching"
- Dr A.Kiyu, Malaysia
"Queensland Healthy Cities"
- Dr P.Davey, Australia
"Healthy Island activities"
- Dr P.Toelupe, Samoa
"Evaluating Healthy Cities & Health
Promotion"
- Dr F.Baume, Australia
hit
"Health Promotion Futures: Healthy Cities"
Mrs S.Thanarajah, Singapore
9971^
"Future Directions for Healthy Cities"
- Dr T.Hancock, Canada
7-
"Future Directions for Healthy Cities"
- Dr G.Gurevitsch, Denmark
lllftts
"Partnerships for the Global Healthy City
Network"
- Dr G.Goldstein, WHO
i
iiiii
I
Panel of Healthy City experts, will include:
•
Dr El Din Mustafa A'Alla, Sudan
•
Dr Y.Paisachalapong, Thailand
•
Dr T.Hancock, Canada
•
Dr F.Baume, Australia
•
Dr G.Gurevitsch, Denmark
oil
Facilitator::
Facilitator session 2-6-12:
Dr F. Perkins, Canada
n
.
Rapporteur
session 2-6-12:
Dr K. Nakamura, Japan
Dr M. Chula vachana, Thailand
■
.r-:
T
h ■
I Ad /
- L;
‘Wi'r.
'i
■
Dr G.Goldstein, WHO
Dr R.Erben, WHO/WPRO
": Maigfc
55
il
J
in A Ai
'a'
>p
"Health Promoting Schools"
- Dr Kan Xuegui, China
"National strategies improving school
health programmes in Megacountries"
- Dr L.Kolbe, USA
"European Network of Health
Promoting Schools"
- Ms V.Rasmussen, WHO/EURO
"Health Promotion Futures: Health
promoting schools"
- Ms V.Prema, Singapore
1
IW®
Panel will include:
•
Dr M.Ahmed, Bangladesh
•
Dr I.Capoor, India
•
Mr E.Jouen, Belgium
•
Ms M. Bell Broglia, USA
•
Dr V.Pollesky, Russian Federation
•
Dr LPfieffer, USA
•
Dr L.Rowling, Australia
•
Dr Ye Guang-Jun, China
■
■■
•
.<
'■:- Ms A.Bunde-Birouste, France
Mmw^o
5SSBB*
Mr J.
.1 Jones,
Jnnpc WHO/HEP
WHO/HFP
Mr
Technical Adviser:
■
_
•
56
■
■
<1
}
===^^
"Working Conditions and Quality of
Working Life: The Health Circle Approach"
- Dr G.Breucker, Germany
■ Hsadh P.
'"'ft.
"Workplace Initiative- public/private
partnership”
- Dr W.Bjerke, Norway
• <
■a
M
- ""ft '
■■ft-ft'
'■
.
__
6 3 Mo
"Future Strategies for Effective Workplace
Health Promotion in Europe”
- Dr H.KIoppenburg, Luxembourg
"Health Promotion Futures: promoting
health at work"
- Dr J.Koh, Singapore
iwi
'ft' A'''-'!'
(3H0auh,;
■ '7 '$
J
■T ; *
eloiaoo
"Healthy Work Initiative”
- Dr J.Jarvisalo, Finland
or k Initiative
M7
y
y/
ffiH®
,v, -
"Partnership building"
- Dr J.LIados, Dr E.Noehrenberg,
Switzerland
to
i--.
■
‘■12:
Fachtator seston 2-6-
Dr C.Chu, Australia
Ra^eursassion 2-6-12:
Dr J.Jarvisalo, Finland
Dr J. Koh, Singapore
w A
J.
-
SO Jil
rMM^: mor
,g MBH
ftafSS
• ' •' r-ty I'
Oft? '> oi.
•••'■
•
•
'
DrE.Ziglio, WHO/EURO
Ms A.Sfitzel, Germany
j:
__________
57
il
4
■
W
1
■
■..
■
'Healthv Aoeinn'
.........................................................
'
J "Health Promotion in Action":
| •
Ms I. Hoskins, USA
<
'<
•.
J'''.'.'?;
Dr T. Setoabudhi, Indonesia
Dr K. Kawahara, Japan
•
|| •
ttWB
WSSL
i/ i?
"Health Promotion Futures":
•
Dr Andrea Prates, Brazil
•
Ms Maria Stefan, USA
loWii
sip I
'
?
The WHO perspective on Ageing and Health"
Dr A. Kalache, WHO
Dr H. Noack, Austria
.
.k5S
■
'
‘
•••
■
Facilitator session 2-6-12:
D
apporteurs 2-6-12.
Dr J. Crown, UK
fcs ■ '’»■
MiMs L. Daichman, Argentina
Ms A. Prates, Brazil
"........
. if
I
■
Dr A. Kalache, WHO
Dr A! Khateeb (WHO/EMRO)
•■gaM
■ % -i..-
■
< i"
’X-u—•:i'
58
j
■
.
.
.
■
-
■
.• • -.1
<1
iRiiiiiiz
IlBSilllilt
A;
in Action-5 -Aoto. ILMn,
Iwoi
bl ICS;
12 5 Health Prom
”'
"Active Living"
- Dr F.Trowbridge, USA
uly
S-ri
"Tongan Weight Loss Campaigns"
- Mr M Ofanoa, Tonga
"Active Livipg - casestudy Japan"
- Dr S.Kato, Japan
W
;
!■
.
■
"Health Future through/with Active Living"
- Dr V.Matsudo, Brazil
"Health Future through/with Active Living"
- Dr J.Miller, Australia
"Health Future through Activity"
- Mr M.Knowles, Belgium
ihglnrtiativ
f 1997
16.30-18.od:S:? ...
"Global Partnerships for Active Living"
- Dr L.Vuori, Finland
Sil
<
•f'
^rs^n2612-
Dr L. Vuori, Finland
$l* A ‘ii
Rapporteur sessmn
. .
bn 2-6-12:
A '‘I- 5^'r-nj
i:?'
Dr K. Chan, Hongkong
Ms M.C. Lamarre, France
1
■
?:•
^h;.
Dr H.Benaziza, WHO (not attending)
Dr Jadamba, WHO/SEARO
Technical Adviser
r:.
/-
■;
lOIBBililSKv
:■.■■■
■
■
'■
HMMrahlil
_____________________
_
59
ii
"Family Planning Project"
- Dr L.Aaro, Norway
"Global Business Council on HIV/AIDS"
- Dr J.LIados, Dr E.Noehrenberg, UNAIDS
Facilitator session 2-6:
Dr N, Uddin, Bangladesh
Rapporteur session 2-6:
Dr P. Lincoln, United Kingdom
Technical Adviser:
Dr M.T.Cerquiera, WHO/PA HO
60
d
K^fn'Action-r^
free Sodet.es-
gw??''?..'''
2.7 Health Promotion in Action
'-
"V
:
"Tobaccofree Thailand"
- Dr B.Ritthipakdee, Thailand
■ y-/.
Monday 21 July 1997
"Tobacco free Finland"
- Dr T.Piha, Finland
SO
■
-
■
iisrtiw
"No Smoking Islands in the Maldives"
- Dr M.Osei
■
S3
■ Modng Ahead
"Health Promotion Futures: tobacco free
Societies"
- Dr R.Vathinaithan, Singapore
SSWgSjSfflBi
1018.00
I
"Health Promotion Futures: USA policies"
- Ms S.Asma, USA
•.v-
"Tobaccofree futureplans for Australia"
- Mr A.Carrol, Australia
•'
.7
'
'
' ■
'■
? ■.
' ■
■
j-"'
■■■■■/x.
r.A./
Facilitator session 2-6:
C;
1
'Z
Dr J. Chideme-Maradzika, Zimbabwe
W:
|H|j|
■
Rapporteur session 2-6:
Dr B.Buchel, Thailand
- • •:
'T^^^lE^yfser:
DrM.Osei, WHO/SEARO
61
_
j’'fx
4-*::Bg’?
I
J —!n-sH»lth-
ner:
■ -u^x x > 'i' -
~ •
O'Q I I -- -■ ui;' 'fS.-. - --
*
“““1
>>■
,'~---1 *'■'
'
"Women's Health in India''
- Dr C.de Sa, India
2W1
-•
"Promoting Women's Health: private sector
Case-study"
- Dr M.Harrison, USA
1
"Promoting Women's Health: NGO
casestudy"
- Dr E.Wolfson, USA
R
‘'■'I
"Education - the right to a better way of
life"
- Ms M.Fouilloux, Belgium
■
"Men's Health impact on Women's Health"
- Ms S.Hines
*
J:
■;
■
F.cimt<,rSBSS,onL.
.
1
; Efe.;
'J:/*:
Dr E. Howze, USA
W
Dr M. Westphal, Brazil
Ms J. Koch, Switzerland
■
OSl sOii
Bia
■■■tT''
■
•
az/.z/^rTechnical Adviser:
.
■
r>r Hafez,
i
Dr
WHO/EMRO
■
alBi
_ _______________________
62
_
<‘
1
• ?' •
—
Illi
MIS
"Project 'HOPE' in Poland"
- Mr J.Mullen, USA
>1 July
"Health Promoting Healthcare in Africa"
- Dr F.Namisi, Kenya
)
"Health 2020"
- Dr P.Siriwanarangsun, Thailand
"Health Promotion Futures: responses to
Non Communicable Diseases"
- Dr M.Tsechkovsky, WHO/NCD
"Health Promoting Hospitals"
- Dr J.Pelikan
i
•■■J'
ii
»
Facilitator session 2-6napponeur se
'ez, South Afnpa
■
TeMcnl Ari^r,ser:
*
""""
63
sasa
J-.......
"Healthy Homes"
- Dr T.Godal, WHO/TDR
)
"Healthy Homes & Families"
- Dr A.Usfar, Indonesia
IgS®
WnarAfie’at
"Development of food-based dietary
guidelines"
- Dr R.Florentino, Philippines
-a;-
,6.30.18.0
MS®
j
■fe
WSO'
ili
:K''
■
■■■■■ ■-> :,J.
"Healthy Homes & Families: a future
perspective",
- Dr F. Lostumbo, USA
W-
.■
HI?
■
!
ftcBaWs,
- session 2-6:
i’;./:-?:;
..
ysA
Dr C.
i'?-io; •,
WW«w»®
'OS - Technical A dviser:
W5
•' .
....."
zV •:■?':',7* **••■' : :
•t
64
.8zS
Wi
wlBW®
...
’"'tC
.
J
12.6 Mega-country Initiative
.
Ms K, Douglas, USA
77aa\<; a a-';'.’ ■
Dr D.McQueen, USA
Facilitator:
Rapporteur:
. -a;..','‘... a:.,.;.;. ■„ .
a
12.7 Health Promotion Foundations - initiative
?r :aa \'
iteWSas^asR^s
r.:.::
■i: :
:
Facilitator:
Dr R.Galbally, Australia
Rapporteur:
Dr Suprakorn, Thailand
’'?Z
'
a .- a a -:,
.a-'
•: ■•.?
Bl?;a-aa/-<
■’
■
______
======./..'A.- ■
12.8 Health Promotion for Chronic Health conditions
a--
!
Facilitator:
Ms C. Funnell. UK
Rapporteur.
Ms A. Hayes, UK
aa-a
■•
I
12.9 Health Promoting Hospitals- initiative
~
"
’x''rxr'
i®
.......... . *
' . • ••
•-V-
Dr B.
P. Trowell,
iroweii, UK
Facilitator:
■
■ ■■ £"
-.
■
DrG. Perez, South Africa
Rapporteur:
^•-7’ •
Dr
L J.Pelikan, Austria
Speaker.
-. .J•; wyilB : ,, ,, ,
112.10 Health Promoting Media settings
:■ ’
-V
>
a
■'•.a
Dr C. Deutsch, USA
Rapporteur
Mr C. Powell, WHO/iNF
Speakers-
Mr W.Feek, USA
Dr S.Connelly, USA
a
'
■
<'
..
“
friCuri
■-“•***’
-.z ■■
7^'
k's 4v
,T
.
SB ■'
■.
Facilitator:
>
■
7?."''
■
Ifiii
...
■: vy’:
_____ _____ .
65
!
Annex 2 - Conference Secretariat
WHO ORGANIZING COMMITTEE
INDONESIAN ORGANIZING
COMMITTEE
WHO Headquarters Secretariat:
Dr D. O'Byrne - 4ICHP Focal Point
Dr I. Kickbusch - HPR Director
Ms U. Broesskamp-Stone
Ms T. Tsujisaka
Ms P. Heitkamp
Ms A. Raviglione-Paraluppi
Ms E. Cruz-Aquinde
Ms C. Riedweg
I
Advisors:
Ir Azwar Anas, Co-ordinating Minister for
Social Welfare, Republic of Indonesia
Prof Dr Sujudi, Minister of Health,
Republic of Indonesia
Honorary Chairperson:
Mr Surjadi Soedirdja, Governor of Jakarta
WHO South-East Asia Regional Office
Dr Z. Jadamba
Ms M. Osei
Chairperson:
Dr Hidayat Hardjoprawito
WHO representative office (Indonesia)
Ms J.Sikkens
Ms S. Loo
Vice Chairpersons:
Dr Brotowasisto
Dr Nardho Gunawan
Dr R. Kim-Farley
Mr R.S. Museno
Secretaries:
Drs Dachroni
Drs Suprijadi
Ms Jacoba Sikkens
LOC Focal Points:
Dr Brotowasisto
Drs Dachroni
Drs Suprijadi
Dr Soetedja
!
66
Annex 3 - Conference Advisory Group
4th INTERNATIONAL CONFERENCE ON HEALTH PROMOTION
CONFERENCE ADVISORY GROUP (CAG)
H. ARROYO
Chairman, Puerto Rico Host Committee for the
16th World Conference on Health Promotion and
Health Education
P.O. Box 365067
San Juan 00936-5067
Puerto Rico
fax: 787-754 6621
J. ESKOLA
Director of Preventive and Social Health Policies
Ministry of Social Affairs and Health
PL 267 & 268
SF-00171 Helsinki
fax: 00358 9 160 4492
L. PURLER
First Assistant Secretary
Public Health Division
Department of Health & Family Services
Commonwealth of Australia
GPO Box 9848
Canberra ACT 2601
fax: 11-616 289 8422
T. BHATT!
Health Canada
Health Promotion & Program Branch
Room 468, Jeanne Mance Building
Postal locator 1904A2
Ottawa Ontario K1A 1B4
Canada
fax: 1-613 954 5542
)
P. GILLIES
Director of Research
Health Education Authority (HEA)
Hamilton House, Mabledon Place
UK-London WC1H 9TX
fax: 44171 413 0335
M. CHRISTIE
Norwegian Board of Health
Calmeyers gate 1, P.O. Box 8182 Dep
N-Oslo 0032
fax: +4722 24 95 91
L. GREEN
Director, Institute of Health Promotion
Research University of British Columbia
Faculty of Graduate Studies
2206 East Mall, LPC Bldg, rm-314
Vancouver, B.C. V6T 1Z5
Canada
fax: 1-604-822 9210
Drs DACHRONI
Head, Centre for Health Education
Ministry of Health
JI. H.R. Rasuna Said Kav. 4-9, Blok C, 6th floor
P.O. BOX4765/JKTM
Jakarta 12950-1ndonesia
fax: (6221) 522 3017
1
S. HAGARD
President
International Union for Health Promotion and
Education (IUHPE)
2, rue August Comte
F-Vanves 92170
fax: 331 46 45 0045
G. DAHLGREN
Assistant Director-General
National Institute of Public Health
Box-27848
S-Stockholm 115 93
fax: 468 5661 3505
C. DEUTSCH
Senior Programme Associate
Harvard Project on Schooling and Children
14 Story Street, Second Floor
Cambridge, Mass. 02138
USA
fax: 1-617 496 4488
C. KELLEHER
Professor of Health Promotion
Department of Health Promotion
Clinical Science Institute
University College
Galway-Ireland
fax: (35391) 522 514
N. ENYIMAYEN
Ministry of Health
P.O. Box 145
Sunyani
Ghana
fax: 0023321 666 808/663 810
N. KOTANI
CPHA Former President
Director, Community Health Networks
Vancouver Richmond Health Board
Burrard Health Unit
1770 West 7th Avenue
Vancouver, British Columbia V6J 4Y8
Canada
fax: 604 734 5918
67
<1
M. K6K6NY
Ministrer of Welfare
Ministry of Welfare
Arany Janos utca. 6-8, P.O. Box 987
1051 Budapest V
Republic of Hungary
fax: 00361 269 1303
D. MCQUEEN
Director, Division of Adult & Community Health
Roaer Office Park, Rhodes bildg .
3005 Chamblee-Tucker Road, MS K-45
Atlanta GA 30341, USA
fax: 1-770-488 5974
M. KOZUH-NOVAK
Rakovnik 102
1215 Medvode
Slovenia
fax:386 61 612 085
i
i
A. MUKHOPADHYAY
Executive Director
Voluntary Health Association of India
40 Institutional Area
New Delhi 110 016, India
fax:9111-685 3708
N. KUMARA RAI
Director-General of Community Health
Ministry of Health
JI.H.R. Rasuna Said Kav. X 5 N°:04 s/d 09
Jakarta 12950
Indonesia
fax: 62-21-520 1588
J. MULLEN
201 Morris Avenue
Spring Lake
New Jersey 07762
USA
fax: 1-908-449 68 84
LU Rushan
Institute of Medical Information
Chinese Academy of Medical Sciences
3, Yabao Rod, Chaoyang District
Beijing 100020
China
fax:86 10 6512 8176
J. MWANZIA
Director of Medical Services
Ministry of Health
P.O. Box 30016
Nairobi - Kenya
fax:002542 713234
W. MANYENENG
Family Health Division
Ministry of Health
Private bag 0038
Gaborone
Botswana
fax:267 35 31 00
K. NAKAMURA
Head of the Urban Health Research Unit
Promotion Committee for Healthy City
Tokyo Department of Public Health &
Environmental Sciences
Tokyo Medial & Dental University
Yushima 1-5-45, Bunkyo-ku
Tokyo 113 - Japan
fax: 3-813-3818 7176
J. S. MARKS
Director
National Center for Chronic Disease Prevention
and Health Promotion Centers for Disease
Control (CDC)
Koger/Rnodes Bg Rm2129
4770 Buford HWY
Atlanta GA 30341, USA
fax:. 1-770 4885971
D. NYAMWAYA
Regional Programme Director
African Medical and Research Foundation
(AMREF)
Wilson Airport P.O. Box 30125
Nairobi - Kenya
fax: 254 2 602 188/506 112
N. MATTISON
Pharmaceutical Partners for Better Health Care
PPBH
99-103 Hammersmith Rd
UK-London W14 0QH
fax: 44171 603 7119
M. RAJALA
Head of Unit
Health Promotion & Disease Surveillance
European Commission
Directorate General V
Luxembourg 2920
fax: +352 4301 32059
G. MONGELLA
Formerly Secretary-General of the 4th World
Conference on Women
P.O. Box 31293
Dar-es-Salaam
1
O. SHISANA
Director-General
Ministry of Health
Private Bag X 828
Pretoria 0001
South Africa
fax: 2712-328 6107
Tanzania
fax: 255 51 75132
UNDP fax: 255 51 11 32 72
68
<j
!
W. SIMONS
Senior Associate (retired)
Industry Council for Development (ICD)
240, East 27th Street
New York, N.Y. 10016, USA
fax: 212 684 2017
)
J.S. YADAVA
Indian Institute of Mass Communication
Aruna Asaf Ali Marg. JNU New Campus
New Delhi 110067
India
fax:9111-685 3708
M. SPEERS
Behavioural & Social Sciences Coordinator
Office of the Associate Director for Science
CDC
1600 Clifton Road, NE MS A-20
Atlanta, GA 30333, USA
fax:1-404 639 7341
Branford M. TAITT
Member of the Parliament
10 Stanmore Crescent
Black Rock
St Michael
Barbados W.l
fax:246 424 5436
1
P. TROWELL
45 Heath Drive
Rutters Bar
Hertz EN6 EJ
UK
R. VAITHINATHAN
WHO Collaborating Centre for Health Education
and Health Promotion Training
Director, Training & Health Education Department
Ministry of Healtn
College of Medicine Bldg
16, College Rd
Singapore 0316
fax:65-4755022
P. VUTTHIPONGSE
Director-General, Dept of Health
Ministry of Public Health
Tiwanond Road, Nonthabur
Bangkok 11000
Thailand
fax: 66-2-5918181/2
B. WASISTO
Senior Adviser to the Minister of Health
Ministry of Health
JI. H.R. Rasuna Said Blok X5, Kapling 4-9
Jakarta 12950
Indonesia
fax: (6121) 522 3017
P. WIUM
Chief Medical Adviser
Norwegian Board of Health
P.O. Box8128
N-Oslo 0032
fax: (0047) 22 24 88 68
69
<1
WHO Expert Advisory Panel on Health Promotion and Education
Professor J.D. Adeniyi
Department of Preventive & Social Medicine
University College Hospital
Ibadan, Nigeria
Mrs Indu Capor
Director
Centre for Health Education Training & Nutrition Awareness
Lilavatiben Lalbai’s Bungalow
Civil Camp Road, Shahioaug
Ahmedabad, 380004 Gujarat
India
Dr Igbo N. Egwu
Associate Professor and Director
Graduate Programme
Department of Community Health, College of Medical Sciences
University of Clabar
Calabar, Nigeria
fax: 087-222 145
Dr David Hopkins
University of Cambridge
Institute of Education
Shaftesbury Road
GB-Cambridge CB2 2BX
Dr Lloyd J. Kolbe
Director
Division of Adolescent & School Health
National Centre for Chronic Disease Prevention
and Health Promotion
Centres for Disease Control
4770 Buford Hwy NE
Atlanta, GA 30341-3724
USA
Mrs Khatoun Sanguor
Head of the Science Section
Curricular Development
Ministry of Education
Manama, Bahrain
Professor YE Guang-Jun
Director, Institute of Children and Adolescents’ Health
Beijing Medical University
Beijing 100083 China Professor J.D. Adeniyi
Department of Preventive & Social Medicine
University College Hospital
Ibadan, Nigeria
70
<1
Annex 4 - List of Background Papers
REVIEW AND EVALUATION OF HEALTH PROMOTION
Conference Working Papers
4th International Conference on Health Promotion - Jakarta, 21-25 July 1997
>
1.
Desmond O’Byrne (1997) Foreword for the Folder with key background papers on “Review &
Evaluation of Health Promotion”. ref.HPR/HEP/4ICHP/RET/97a
2.
WHO (1997): Evaluating Health Promotion: Progress, Problems and Solutions; Conference
working paper. WHO, Geneva, ref. HPR/HEP/4ICHP/RET/97.1
3.
Suzanne F. Jackson, Rick Edwards, Michael Goodstadr, Irv Rootman (1997): Report of the
International Health Promotion Indicators Project. Ref. HPR/HEP/4ICHP/RET/97.2
4.
World Health Organization, Regional Office for Europe, Health Promotion and Investment for
Health Programme (1997): Auditing Health Promotion Capacity: An Action Framework.
WHO/EURO, Copenhagen, ref. HPR/HEP/4ICHP/RET/97.3
5.
Cheryl Vince-Whitman, Alice Jones, Tania Garcia, Nicole Hagen (1997): Rapid Assessment
and Action Planning Process (RAAPP): A means to build capacity and infrastructures for
promoting health through schools. WHO, Geneva, ref. HPR/HEPZ4ICHP/RET/97.4
6.
WHO (1997): “Research for Health Promotion: A Challenge for the 21st Century”; Conference
working paper. WHO, Geneva, ref. HPR/HEP/4ICHP/RET/97.5
7.
WHO (1997), The Effectiveness of Alliances or Partnerships for Health Promotion, A global
review of progress and potential consideration of the relationship to building social capital for
health; Conference working paper. WHO, Geneva, ref. HPR/HEP/4ICHP/RET/97.6
7.1
Annex A: “Case Studies”, Overview table “Health Promotion Case Studies from around the
world”. WHO, Geneva, ref: HPR/HEP/4ICHP/RET/.A/97.a
8.
WHO (1997): International Comparisons of the Key Factors Affecting Health: An analysis of
international databases on health; Conference working paper. WHO, Geneva,
ref. HPR/HEP/4ICHP/RET/97.7
9.
Greg Goldstein, Yasmin von Schirnding (1997): Environmental Health Indicators in Evaluation
of Health Cities Programmes. WHO, Geneva, ref. HPR/HEP/4ICHP/RET/97.8
10.
Irving Rootman, Michael Goodstadt, Louise Potvin, Jane Springett (1997): Towards the
Framework for Health Promotion Evaluation. World Health Organization, Regional Office for
Europe, Copenhagen
11.
World Health Organization, Regional Office for the Western Pacific (1996) Regional
Guidelines: Development of Health Promoting Schools. A framework for action. WHO/WPRO,
1099 Manila, P.O. Box 2932, Philippines
12.
M. Van den Cruijsem, J.T. Jones, V. Barnekow Rasmussen, E.J.J. de Leeuw (1997): An
Examination of Two Large-Scale Approaches for Promoting Health through Schools. WHO,
Geneva, ref. HPR/HEP/4ICHP/RET/97.9
71 ’
HEALTH PROMOTION FUTURES
4th International ^nfer^ceonHealt^Pmm^io^Ha^ana 27-25 July 1997
1.
KKSS,W"h toy
2.
K4S:?WHoI^©neva° reh^PfVHBa/4?CHROra^*1DnS '°r *** Pro'nO"On
3.
^R/^EPM^CHP/FT/g?1?1 202° Global Scenarios for Health Promotion. WHO, Geneva, ref.
4.
WHOJSenevT^^^^
5.
Sivaneavary Arulanandam, Andrd Shi-Lin Wansaicheong, Chng Chee Yeong, Mohammed Jais
HPR/HEPmVcHP/FT/STh4Promotlon FutL,res: Tobacco Free Societies. WHO, Geneva, ref.
6.
Audrey Tan Sivanesyary Arulanandam, Lee Yee Cheong, Saroiini Thanaraiah (1997) Health
Promotion Futures: Healthy Cities. WHO, Geneva, ref. HPR/HEP/4ICHP/FT/97.5
P*“s »’Health
°f Ei9ht SpeCifiC Health Promotion Futures-
7.
H“l,h Pr"no,lon p'jn,res: F°°d a"d
8.
Foo-Koh Yang Huana, Chang Yin Wuan, Clare Tan, Saroiini Thanaraiah, Yvonne Sum (1997)
Health Promotion Futures: Promotion Health at Work. WHO, Geneva ref
HPR/HEP/4ICHP/FT/97.7
9.
Lik Sing Yong, Alice Leong, Florence Law, Prema V, Yueh-ti Wong (1997) Health Promotion
Futures: Health Promoting Schools. WHO, Geneva, ref. HPR/HEP/4ICHP/FT/97.8
10.
H.'?nS- Mei Fen Chan' Elaine YaP’ Lim Lian ChinQ. Teo Kiok Seng, Wong Kee
yVen, 1997) Health Promotion Futures: Promotion Health of the Elderly. WHO, Geneva, ref
HPR/HEP/4ICHP/FT/97.9
11.
Chris Chean Hean Aun, Chia Siok Hoon, Vivian Heng, Rashida Bte Yah Kathier, Martin Lee
H^R/HEP/^HP/F?'97eiOh Promot'on Futures: Sexual Health. WHO, Geneva, ref.
12.
Shirley Wan, Cheng Chui Fui, Jayakumari d/o Govindasamy, Lee Soek Ee Joyce, Lim Su Ling
GenevaMre7 HPWHEPAnCHP/FT/g^??Health Promotion Futures: Women's Health. WHO,
)
72
PARTNERSHIPS FOR HEALTH PROMOTION
Conference Working Papers
4th International Conference on Health Promotion - Jakarta, 21-25 July 1997
I
1.
Desmond O’Byrne (1997) Foreword for the Folder with key background papers on
“Partnerships for Health Promotion”, ref. HPR/HEP/4ICHP/PT/97a
2.
WHO (1997) “Partnerships for Health in the 21st century: 2+2=5", draft paper, ref.
HPR/HEP/4(CHP/PT/97.1 (distr.: Limited)
3.
WHO (1997) “A New Global Health Policy for the 21st Century: an NGO Perspective”, ref.
HPR/HEP/4ICHP/PT/97.2
4.
Ros Tennyson (1997) The Partnership-building process, ref. HPR/HEP/4ICHP/PT/97.3
5.
Peter Makara (1997) Partnerships for Health Promotion, ref. HPR/HEP/4ICHP/PT/97.4
6.
Ilona Kickbusch (1996) New Players for a New Era: How to date is Health Promotion ? Editorial
for HPI, vol. 11, N°4. ref. HPR/HEP/4ICHP/PT/97.5
I
73
t
OTHER PUBLICATIONS/ SOURCES
4tn International Conference on Health Promotion - Jakarta, 21-25 July 1997
1.
WHO (1997) Jakarta Declaration, WHO/HPR/HEP/4ICHP/BR/97.4, WHO, Geneva
2.
WHO (1998) Health Promotion Glossary. WHO/HPR/HEP/98.1. WHO, Geneva
3.
C™da <199’> H“«1’
4.
Bosse Haglund and Gordon McDonald (1997) Resources for Health Promotion, Inventory on
Education and Training for Health Promotion: A Global Survey
HPR/HEP/4ICHP/RS/97.3 *
Y
5.
WHO (1997) World Health Magazine N°3, May-June 1997, New Players for a New Era
74
41
!
Annex 5 - Follow-up Activities
HEALTH PROMOTION - Follow-up activities in 1998
i
The Jakarta Conference served as a catalyst to stimulate action to build capacity for
health promotion at local, national and international levels in both developing and developed
countries. Follow-up activities in 1998 based on the HEP 5-Year Plan of Action are being
planned and carried out in all WHO Regions, jointly with the Regional Offices and through
Member States, WHO Collaborating Centres, NGOs and other partners in health promotion.
Such activities include:
•
Health promotion in the ten most populous countries (Mega Country Health Promotion
Network);
•
Further strengthening of the Global School Health Initiative;
•
Developments of the “Health Promoting Workplaces” concept;
•
Developing tools for health promotion review and evaluation;
•
Co-sponsoring two international conferences: the XVI World Conference on Health
Promotion and Health Education in San Juan, Puerto Rico, June 1998; and the
“Working together for better Health”, International conference, Cardiff, United Kingdom,
September 1998;
•
Implementing the 51st World Health Assembly Resolution on Health Promotion
(WHA51.12).
The WHA Resolution endorsed the call to break through traditional boundaries
between government sectors, between governmental and nongovernmental organizations,
and between the public and private sectors. WHO is called on to take the lead in elaborating
a Global Alliance for Health Promotion, while all Member States are urged to implement the
five priorities of the Jakarta Declaration and to adopt an evidence-based approach to health
promotion policy and practice. In 2000, a progress report will be submitted to WHO’s
Executive Board and World Health Assembly, and it will also provide input into the Fifth
Global Conference on Health Promotion, to be held in Mexico City, on June 2000.
75
!
Annex 6 - World Health Assembly 51, Resolution on Health Promotion
(WHA51.12 Health Promotion)
17 f
The Fifty-first World Health Assembly,
Recalling resolution WHA42.44 on health promotion, public information and education
for health and the outcome of the four international conferences on health promotion (Ottawa
1986; Adelaide, Australia, 1988; Sundsvall, Sweden, 1991; Jakarta, 1997);
Recognizing that the Ottawa Charter for Health Promotion has been a worldwide
source of guidance and inspiration for development of health promotion through its five
essential strategies to build healthy public policy, create supportive environments, strengthen
community action, develop personal skills, and reorient health services;
Mindful of the clear evidence that: (a) comprehensive approaches that use
combinations of the five strategies are the most effective; (b) certain settings offer practical
opportunities for the implementation of comprehensive strategies, such as cities, islands, local
communities, markets, schools, workplaces, and health services; (c) people have to be at the
centre of health promotionaction and decision-making processes if tneyarelo be effective;
(dyaccess to education andThformation Is vital in achieving effective participation and the
‘empowerment” of people and communities; (e) health promotion is a “key investment” and an
essential element of health development;
Mindful of the new challenges and determinants of health and of the need for new
forms of action to free the potential for health promotion in many sectors of society, among
local communities and within families, using an approach based on sound evidence;
Appreciating the potential of health promotion activities to act as a resource for societal
development and the clear need to break through traditional boundaries within government
sectors, between governmental and nongovernmental organizations, and between the public
and private sectors;
Noting the efforts made by the 10 countries with a population of over 100 million to
promote the establishment of a network of most-populous countries for health promotion;
Confirming the priorities set out in the Jakarta Declaration for Health Promotion in the
Twenty-first Century,
1.
2.
URGES all Member States:
d)
to promote social responsibility for health;
(2)
to increase investments for health development;
(3)
to consolidate and expand “partnerships for health";
(4)
to increase community capacity and “empower” the individual in matters of
(5)
to strengthen consideration of health requirements and promotion in all policies;
(6)
to adopt an evidence-based approach to health promotion policy and practice,
using the full range of quantitative and qualitative methodologies;
CALLS ON organizations of the United Nations system, intergovernmental and
nongovernmental organizations and foundations, donors and the international
community as a whole:
d)
to mobilize and to cooperate with Member States to implement these strategies;
76
(2)
3.
4.
to form global, regional and local health-promotion networks;
CALLS ON the Director-General:
(1)
to enhance the Organization’s capacity and that of Member States to foster the
development of health-promoting cities, islands, local communities, markets,
schools, workplaces, and health services;
(2)
to implement strategies for health promotion throughout the life span, with
particular attention to vulnerable groups, in order to reduce inequities in health;
REQUESTS the Director-General:
(D
to take the lead in establishing an alliance for global health promotion and in
enabling Member States to implement the Jakarta Declaration and other local or
regional declarations on health promotion;
(2)
to support the development of evidence-based health promotion policy and
practice within the Organization;
(3)
to give health promotion top priority in WHO in order to support its development
within the Organization;
(4)
to report on progress to the Executive Board at its 105th session and to the
Fifty-third World Health Assembly.
(Tenth plenary meeting, 16 May 1998
Committee A, fourth report)
77
(J
!
Acknowledgements
Special thanks to the following for their support in the preparation of the Fourth International Conference
on Health Promotion
Australia, Ministry of Health
Canada, Health Canada
Canadian International Development Agency, (CIDA)
European Union, European Commission
Finland, Ministry of Health
>
Germany, Government of the Federal Republic
UK, Health Education Authority (HEA)
Japan, Ministry of Health and Welfare
Kenya, African Medical & Research Foundation (AMREF)
Norway, Norwegian Board of Health
Singapore, Ministry of Health
Switzerland, Pharmaceutical Partners for Better Healthcare
Switzerland, Swiss Development Agency
WHO Collaborating centres:
- Centre for Health Promotion, University of Toronto, Canada
- Division of Adult and Community Health, National Center for Chronic Diseases Prevention and Health
Promotion, Centers for Disease Control and Prevention (DACH NCCDPHP/CDC), Atlanta, U.SA.
- Division of Adolescent and School Health, National Center for Chronic Diseases Prevention and Health
Promotion, Centers for Disease Control and Prevention (DASH NCCDPHP/CDC), Atlanta, U.S.A.
- Karolinska Centre on Supportive Environments for Health, Karolinska Institute Department of Public Health,
Sunbdyberg, Sweden
- National Centre for Health Promotion, Department of Public Health & Community Medicine, University of Sidney,
Australia
- National Institute for Health Promotion, Budapest, Hungary
- Vasternorrland Centre for Supportive Environments for Health,
Vasternorrland County Council, HarnOsand, Sweden
Department of Community Health,
For video production at the beginning of each plenary session:
supported by European Philanthropy Committee, Johnson & Johnson, UK and produced by Rapier Productions
Ltd., UK
This project has received financial support from the European Commission
☆
☆
WHO LlBHAKY
iillilliSH
*00081238*
78
☆
☆
^.6
!
4
World Health Organization, Geneva vnj^l^nV/
Organisation mondiale de la Sante, Geneve
I
J
)
© World Health Organization, 1998
This document is not a forma) publication of the World Health Organization (WHO), and all rights are
reserved by the Organization. The document may nevertheless be freely reviewed, abstracted,
reproduced or translated into any other language, but not for sale in conjunction with commercial
purposes. The World Health Organization, the Division of Health Promotion, Education, and
Communication, Health Education and Health Promotion Unit would appreciate receiving one copy of
any translation.
'Phc designations employed and the presentation of the material in this document do not imply the
expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization
concerning the legal status of any country, territory, city or area of its authorities, or concerning the
delimitation of its frontiers or boundaries.
WHO/HPR/HEP/98.10
Distr.; general
English only
(I
NGO RESPONSE TO JAKARTA DECLARATION
This report is the record of an NGO briefing held during the 1998 World
Health Assembly, in Geneva, 13 May 1998. The aim of the briefing was to
highlight some of the ways NGOs are participating in the follow up to the
Jakarta Declaration, whilst at the same time collaborating with other NGOs,
UN Agencies or the Governments.
page
Introduction
.....
Intervention ofBerhaneRas-Work, IAC
Moderator of the briefing
Intervention ofDr H. Mahler
1
3
Intervention ofDr Olive Shisana, Government ofSouth Africa
7
Intervention ofDr Desmond O' Byrne, WHO
9
Intervention ofDr Ian Hill, IBO
11
Intervention of Dr Tesfamicael Ghebrehiwet, ICN.
13
Intervention ofMats Ahnlund, IHCO
17
Intervention ofDr Elaine Wolfson, GA WH.
19
Discussion and comments from the floor
21
Joanna Koch, ACWW
Rapporteur of the briefing
List ofparticipants ............
22
5
23
J
1
il
NGO RESPONSE TO JAKARTA DECLARATION
>
Berhane Ras Work - Moderator of the Briefing
(President, Inter-African Committee)
It is my privilege to moderate this afternoon's briefing on the Jakarta Declaration
and the response made by NGOs, WHO and Governments.
This is a very important occasion for us all. It is well accepted in the field of
health promotion that partnership is vital. Too often the intention to co-operate
with a broad spectrum of public opinion is there but the reality is something
different.
NGOs are being asked for their advice and support more and more andNGOs
themselves are constantly looking for ways to relate to United Nations Agencies
and Governments. We are particularly fortunate to work with Dr. Desmond
O'Byme and WHO. Dr. O’Byme has our special thanks for organising this
Briefing and keeping us all involved and informed about the follow up to the
Jakarta Conference.
The new Director General, Dr. Gro Brundtland has sent the following message:
"Dr. Brundtland sees the importance ofestablishing close-co-operation
with NGOs working in the field ofhealth. The WHO Transition Team,
together with Dr. Brundtland is doing in-depth studies on how to improve
collaboration with key players, like NGOs in the health sector."
<1
At the international level, with support from the UN Secretary General and the
UN Secretariat, it is becoming easier to see the importance of partnership with
NGOs. This understanding is the first step toward implementing cooperative
agreements that bring results in areas such as health promotion.
Major problems still remain at the national and local level where the
promotion of health education is essential. It is here that cooperation
between WHO officials and grassroots organisations is so important. WHO
country representatives at this Briefing could offer important insights.
)
In bringing the Briefing to a close, Mrs. Berhaiie Ras-Work hoped that the
present dialogue would be the first of many linking stakeholders, both large and
small, in the Jakarta Declaration in a joint effort to promote health education.
The Inter-African Committee works on traditional practices affecting the health
of women and children, with a network of affiliates in 26 African and 4
European countries. The IAC also represents thousands of volunteers from high
African government officials to traditional leaders and young women in rural
African villages who are determined to ensure the health and well being of
women and children.
NGO RESPONSE TO JAKARTA DECLARATION
Dr. Halfdan Mahler, M.D.
(former WHO Director General)
You have one big problem with health promotion, namely that it is very
gender insensitive. Health promotion requires very horizontal thinking and
action, and most men are very bad at that. I speak from my own childhood
experience where the women in my village knew exactly how to think
multisectorally. The males, all of them, always were like the experts who
have a lot of fun telling you why nothing can be done. This is in my opinion
a real problem.
Emotionally, I have always had a ’’feel” for health promotion, since
tuberculosis was my professional background. The resistance against health
promotion is still strong in the traditional health professions though the
nurses are coming much more naturally to it than the medical profession.
But, the medical profession has so much more power in most countries than
the nursing profession has. You have my true admiration for having come
from a very small beginning to as far as you have come with health
promotion, not only at Ottawa, Adelaide, Sundsvall and Jakarta, but in
practical applications.
The NGOs are beautiful and powerful when they come to big international
conferences, in Cairo, Copenhagen, Vienna etc. But, when they come back
to their own countries they don’t get together in national networks. If you
want to have political clout then theNGOs have to leam that horizontalism
also when they come home from the big international conferences. I am
sure all of you have done ’’something” but much more is required. Because,
when it comes to health promotion, then it is really true what I always have
been obsessively saying health is politics and politics is health on a large
scale. If you really want to move healthy public policies forward in a
big manner then you have to have the political dynamite that is
necessary to move these immovable mountains that politicians normally are.
So I have always been wondering how you get such ammunition- How
would you be able to make all this abstract horizontalism reasonably
concrete-
>
>
Many intellectual people can speak for days about human rights but when
you stand in an Indian village, as I did the other day, and there was a woman
who asked me "We have heard that health and human rights go together,
could you please explain that" I found it very difficult. The same thing goes
for health promotion. In order to make it truly concrete for both ordinary
and sophisticated people you need to find a way of having a programme
from the global to the local level and from the local to the global level
which is based on getting a constant feedback from nsome operations
research”. That sounds fanciful but you need to have something done with
scientific discipline so you are sure and can show that it works, and that you
can fight on from that level of ammunition. I am grateful that I am allowed
to be here today.
NGO RESPONSE TO JAKARTA DECLARATION
Olive Shisana, Sc.D
>
(Director-General of Health, Government of South Africa)
Collaboration between NGOs and Government
(speech delivered by Rose Mazibuko, ChiefDirector, Northern Province, South Africa,
winner of the Sasakawa award)
The South African Department of Health works in partnership with non
governmental organisations in a number of areas in order to promote and
protect the health of South Africans.
We start from a point of view that government does not have a monopoly to
deliver all the services It is therefore necessary to have partners, who are the
non-governmental organisations, the statutory councils and the community. We
consider a National Health System as including the participation of all these
partners in aspects of service delivery, health promotion and protection of
citizens.
With this premise in mind, we have set up formal structures to consult
NGOs to contribute to policy development, conduct scientific research and
participate in planning, and where necessary to deliver services.
Policy
We have established the national consultative health forum, whose mission is
to consult with a variety of stake holders in health. The Forum includes labour
organisations, progressive health organisations, statutory councils, political
organisations as represented by Parliamentary Standing Committees, the private
health sector, national, provincial and local government representatives. The
Forum considers major health policy initiatives before they become government
policy. The Forum has sub-committees which discuss possible new policy areas
to ensure that input is obtained early. It is certainly not easy to co-ordinate such
a massive organisational structure, hence there may be some issues that slip
through the cracks and are not consulted upon adequately.
There are many other fora where NGOs provide input on a routine basis. These
include the Health Promotion Forum, the HIV/AIDS Advisory Committee
(which is being restructured to be consistent with our white paper on the
<1
!
transformation of the health care system), and the Human Resource Forum, etc.
These fora give input to specific policy areas and also help to draw up
particular health plans and ensure the smooth introduction of health policy.
Service Delivery
The Department of Health funds more than 200 NGOs to deliver health services
on its behalf. Most of these NGOs are in the HIV/AIDS area. Some of the
NGOs have contractual arrangements with national and provincial government
to deliver hospital services. We also have a major NGO which is dealing with
TB.
Advocacy
We also fund NGOs to do advocacy work for us, particularly in areas where
government is weakest. For example, we have an NGO dealing with Anti
Smoking campaigns. This NGO hag been extremely effective in convincing
. government to increase excise tax on tobacco. It successfully advocated for the
introduction of warning labels on cigarettes, and assists the Department of
Health in monitoring compliance with these labels. The NGO also monitors the
rate of cigarette smuggling into South Africa.
We fund many AIDS advocacy organisations in South Africa. Their role is to
ensure there is a focus on HTV/AIDS at governmental and private sector levels.
To work with social partners it is necessary to ensure there is a clear
national policy on the involvement of such groups in health activities. It is also
necessary to ensure that donor funds are not provided to NGOs to initiate
activities that generate a demand for services that will not be met when donor
funds dry up.
However, working with NGOs and other social partners is not easy, as each has
its own niche to fulfil. It is therefore necessary that roles be defined and each
one understands the respective functions.
In the health promotion area, it is even more crucial to define these roles
because a potential for conflict exists between government and NGOs. This is
so, particularly where the two have different policy positions.
a
NGO RESPONSE TO JAKARTA DECLARATION
Dr Desmond O’Byrne
(Chief Health Education and Health Promotion Unit, WHO, Geneva)
This meeting is the result of the initiative of a group of NGOs responding to
the challenge of the Jakarta Declaration. The new framework document on
Health for All (HFA) in the 21st Century fully recognises the important role to
be played by NGOs and that HFA strategies in our changing world would need
to "recognize the expanded role of civil society in health."
Our newly-elected Director General, Dr Gro Harlem Brundtland, in her
message to this meeting sees the importance of establishing close
collaboration between WHO and NGOs.
I wish to express my thanks to all those NGOs who are actively following up on
Jakarta, and in particular all those who have arranged this meeting. Also, I wish
to express on behalf of all present our appreciation to Dr. H. Mahler, former
Director-General of WHO, and one of the leading figures in public health of this
century, for giving his valuable time to come and to address our meeting. Hie
challenge of Jakarta is to form networks, a global health promotion alliance.
I
Dr Mahler has drawn our attention to the many difficulties of translating into,
horizontal collaboration the many good intentions generated at meetings and
conferences. Today's meeting is a positive indication that such difficulties can
be overcome.
The Jakarta Conference and Declaration (July 1997) was not just for the few,
but for all sections of society. It is through the NGOs in particular that all
levels, especially the grass root level will be able to contribute towards
meeting the priorities identified in the Jakarta Declaration.
The five priorities for health promotion in the 21st Century are:
• promote social responsibility for health;
• increase investment for health development;
(including investments that reflect the needs of particular groups such as
women, children, older people, and indigenous, poor and marginalized
populations;)
d
• consolidate and expand partnerships for health;
• increase community capacity and empower the individual;
• secure an infrastructure for health promotion.
In relation to each of these priorities, NGOs through their advocacy role, and/or
through their direct contact with the community have an important contribution
to make; health promotion wants to mobilize all sections of society to work
together towards the goals of HFA. Civil society, NGOs and the co-operatives
have , through their many networks and practical knowledge and outreach to the
community, a unique resource to contribute in mobilizing the community and
society for health.
Our colleagues on the platform representing many different NGOs, including the
Inter-African Committee, International Council of Nurses, International
Baccalaureate Organisation, International Co-operative Alliance, the Associated
Country Women of the World, and the Global Alliance for Women’s Health,
are a clear demonstration of networks, and of networking of networks towards a
common goal; in this instance in response to the Jakarta Declaration.
!
Health promotion needs to build bridges and collaboration with all sectors of
society, this very definitely includes the medical profession and the health care
professions who have such an important role both in their own professions but
also as strong partners and advocates for promoting and protecting health.
We need to have a common vision and a common goal. The HFA 21st Century
provides a framework for that goal, now we need to work together as partners
towards its realization. Civil society, NGOs, co-operatives, have a special
contribution to make towards the realization of that goal. As we proceed in our
work, we need to monitor our progress, and to assess how it is going in order to
learn both from our successes as well as our failures. When we look back in the
year 2000, we will be able to see how our work has progressed and be able to
document the valuable contributions made by NGOs and be able to learn and
build for even greater efforts towards health promotion in the 21st Century.
I would like to end. by thanking you all for your good work to date and look
forward to our ongoing and strengthening collaboration.
<1
IBO RESPONSE TO JAKARTA DECLARATION
Dr Ian Hill
(Regional Director for Africa/Europe/Middle East, International Baccalaureate Organisation)
The IBO starts with a premise that youth is our future in relation to many
things, including health education; educating youth is really the key to
forming good habits - good health habits and attitudes. We need to explain why
good health is important to people and give young people responsibility for their
own well-being. These things are basic to our own health education programme.
We also include mental and social health, as well as physical health. In a school
situation children are not always dealing with physical health problems but also
with mental and social health.
We want to collaborate with WHO and anyone or any organisation which is
serious about the promotion of health. We do not, of course, just deal with
health; we deal with other issues, but health is important and mandatory in our
Middle Years Programme for children from 11-16 years of age.
I was very pleased to take part in the Partners in Health Conference that was
held in Dakar, Senegal in February this last year. It was an excellent conference
which showed the value of networking. One of the things I remember very much
at that conference was that as NGOs we sometimes are very critical of
government institutions and of huge UN organisations like WHO, UNESCO,
and so on. It is very easy to be critical. But I remember Dr Samba saying at that
Conference: “Be wary, because there is an African saying that if you point the
finger at somebody, there will be three fingers that are pointed back at you”. I
think it is very true. We have to look at both sides of what we do, and be wary
about being too critical. Government organisations, particularly huge
organisations like WHO, have many different people to contend with and many
different countries; I think we have to respect that.
Internal IBO Network
I want to talk about how we try to network and reach out to other people; we are
hoping other people will also come to us. We have two aspects - an internal
networking which is via the curriculum for health education and so here we
simply have the IBO schools. There are over 800 of them in 95 countries. This is
I
>
our own internal network through health and social education and a service
component to the community which is compulsory. This means that young
people are involved in various activities throughout the curriculum.
For example, in geography they deal with health problems near coal power
plants. In physics they talk about bums caused by sun. and steam. In language
classes there is discussion about peer pressure in relation to drug abuse, poor
nutrition. In maths there is analysis of statistics related to health problems. In
history: who invented alcohol, cigarettes, etc. In drama they perform and write
short plays related to social problems including health.
Network External to IBO
Then there is the external network. This comes from any single IB school which
could be in any part of the world, and it reaches out to different people. We have
students involved in local villages, local hospitals, elderly peoples’ homes, local
schools.
Let me give you a couple of examples. One of the schools which teaches our
programme in Swaziland has contact with the WHO local office in that country
and in fact the children there raise money in Mbabane to buy equipment for the
Government Health Department in conjunction with WHO to enable testing in
State primary schools for hearing and sight. The Government did not have
money to buy this equipment; students raised the money even better, these
people who were 17, 18,19 years actually went to the schools; they were trained
to do the testing and gave the results back to WHO which transmitted them to
the Government. This was an excellent initiative. And, so the young children
would not be frightened, the IB students performed little plays to show them
why they were doing this testing, because sometimes this can be quite daunting.
Two other very quick examples follow.
In a school in Ghana we had a group of students who decided to create a
pipeline to bring fresh water to a village where the women were carrying the
water for two km and of course it was not good water anyway. So the students
dug a pipeline, laid it, and actually the water now goes through to the village.
They did it with the villagers. On their own, the villagers might not have done
this.
The final example is a school in Europe which helps with blind children;
once a month they play football in the dark at night with the blind children.
The blind children always win but for the development of their mental and
social health this is an amazing thing. The blind are put into a context where
their disability is of no consequence.
These are some of the things we are trying to do and we are looking for other
partners.
as
4'
ICN RESPONSE TO JAKARTA DECLARATION
Dr. Tesfamicael Ghebrehiwet
(Consultant, Nursing & Health Policy, International Council of Nurses)
Mobilizing Nurses for Health Promotion
Introduction
Founded in 1899, the International Council of Nurses (ICN) is a federation of
national nurse associations in 118 countries and this number is constantly
growing. iCN’s mission is to develop nursing’s special contribution to society
with respect to health and quality of life. ICN’s goals are to influence nursing,
health and social policy, assist nurses to improve nursing standards and promote
strong national nurses’ associations. ICN achieves its goals by working with and
through its member associations, UN agencies such as WHO and NGOs.
ICN Activities in Health promotion
The ICN Code for Nurses first adopted in 1953 identifies four fundamental
responsibilities of the nurse one of which is health promotion. Think of the
millions of nurses working in schools, workplaces, health centres, and hospitals
world wide. One of ICN’s goals is to mobilise the millions of nurses for health
promotion and disease prevention. Health promotion is central to the activities
of ICN and much of the health promotion agenda is integrated or mainstreamed
into the main programme areas. Often the health care delivery system gets
distorted and tends to focus on cure and caring rather than on health promotion
and disease prevention. ICN works with its member associations to align or
balance that focus so that health promotion and primary health care become vital
components of health care services.
Health promotion in ICN focuses on a number of areas:
Smoking and health aims to enable nurses become effective in reducing the
demand for tobacco and promote tobacco free lifestyle especially in young
people. Nurses working in schools are strategically located to promote healthy
lifestyles and growing up tobacco free.
EffitgW
Women's health. The social and economic position of women puts them at
increased health risks and ICN lobbies for promoting women’s health, and
putting women's health issues on the agenda.
Child health including the Girl Child. ICN has through its position statements
arid guidelines focused on promotion of child health, human rights of children
and the role of nurses working with communities, in multidisciplinary health
teams and other sectors.
Young peoples’ health. This is an issue which is increasingly of concern to ICN.
In 1997 ICN had a special issue for the International Nurses Day which focused
on young peoples health. Under the theme of healthy young people = a brighter
tomorrow, ICN disseminated a resource kit to its member associations.
Healthy Ageing. ICN promotes the notion of healthy ageing through its
publications such as the International Nurses Day Resource Kit and other
guidelines.
School Health. ICN promotes school health initiatives that focus on healthy
environments and monitoring of children’s health.
HIV/AIDS and STDs. Since the early years of HIV/AIDS coming into the
picture, ICN has been working actively with member associations and WHO to
mobilise nurses for HIV/AIDS prevention and care. ICN continues to lobby and
advocate for quality of care for people living with HIV/AIDS (PWA) and to
fight any discrimination against PWA or people considered to be at risk such as
commercial sex workers, intravenous drug users, etc.
Mental Health. ICN promotes health in its holistic sense of which mental health
is a vital aspect that is inseparably linked to physical, social and spiritual health.
Health of Special Populations. ICN is concerned with the health of migrants and
refugees and the health of indigenous populations and has position statements
and guidelines on promoting the health of these vulnerable groups.
More broadly ICN lobbies for healthy public policy to ensure that health
becomes a vital agenda in the work of all the sectors not just the health sector.
ICN working in partnership with its member associations, UN agencies such
WHO and NGOs is in a strategic position to promote health. ICN also lobbies
for elimination of harmful cultural practices such as female genital mutilation,
nutritional taboos that discriminate the female child, boy preference and sex
selection.
ICN Strategies for Health Promotion
ICN strategies for health promotion include:
•
•
•
•
•
•
Advocacy
Lobbying
Enabling
Training of Trainers
Partnerships
Networking/linkages
Jakarta and Beyond
Since the Fourth International Conference on Health Promotion and the Jakarta
Declaration, ICN has:
• disseminated the Jakarta Declaration to its member associations in 118
countries and called on them to translate it into action;
• endorsed the Jakarta Declaration at the 101st WHO Executive Board in
January 1998;
• selected health promotion as a theme for International Nurses* Day 2000;
• consolidated health promotion as a priority area for international nursing
research;
• revisited PHC and community development concepts to integrate health
promotion into nursing education and nursing practice.
ICN believes that health promotion is a unifying agenda for all health
professionals and other sectors. ICN is committed to health ideals that promote
’’healthy futures” for all.
I1
’I
|.iniiiwiM
t1
!
IHCO RESPONSE TO JAKARTA DECLARATION
>
Mats Ahnlund, Secretary General
(International Health Co-operative Organisation)
There is a “Call for Action” in the Jakarta Declaration and this Call for Action
includes co-operatives. That is the first time Co-operatives were singled out in
that way in a WHO document. One can ask why now ?
One reason they are now mentioned could be that there are a lot of health co
operatives growing around the world. I was not aware of that when I started to
work as Secretary-general of IHCO. I come from the Consumers Co-operative
sector and I ended up learning about health co-operatives just recently. The
United Nations published this year a big report on health co-operatives in the
world and it turned out, which was a surprise for most of us, there are more
than 100 million households in the world served by health co-operatives, in
53 countries. It is probably even more than that, but this is what is documented
in the UN report. The report is available in the UN bookshop here, for 25
dollars.
What are we talking .about ? Here are some examples:
It could be the clients who own their hospitals. Like the health co-operative
movement in Japan, that, like in many other cases started the fact that the public
sector could not satisfy the needs of the Japanese after the war. In Japan those
health co-ops are still a growing part of the health sector.
The members in a
Japanese health co-op
meet for mutual check
up
But a co-operative could also be created and owned by doctors or other
providers. For example in Brazil we have a huge doctor-co-operative with 70
thousand doctors that joined together in a co-operative serving especially the
countryside. They run their own helicopters, planes etc... A co-operative could
also be run by both clients and doctors together in a multi-purpose or mixed co
operatives like the Espriu Foundation in Spain which is another large health co
operative.
There could also be small health co-operatives. I come from Sweden and I
recently visited a very small health care centre owned by the staff there. It was
the community, the public sector, that had found they could not afford to run
this, so they decided to privatise it. The staff wanted to buy it and they did and
they have now created a new co-operative. The chairman of the co-operative is
an auxiliary nurse so she is bossing over the doctors now. That has by the way
surprised several visitors from other countries.
What is a co-operative? Here is a basic definition:
They are not for profit. People in there don’t own them primarily to make
money but because they are involved.
Co-operatives are owned by the involved. It could be the consumers, the
clients, or the providers.
A real co-operative is always independent from state. There are some
created and ruled by the state in some countries but we don’t really
recognise these as real co-operatives from the international co-operative
movement.
There is always concern for the community. This is written into the basic
co-operative principles. Actually as late as 1995, even if it very often also
previously been the concern of most co-ps.
There are other types of co-ops which are very appropriate for health promotion.
If we talk about enabling people to create the essential conditions for health,
which is a part of the Ottawa Charter, another WHO document, we can very
well include housing co-operatives that are creating good housing or simply
creating any housing at all in many countries. Food co-operatives concerned
with nutritious food. Worker’s co-operatives and the working conditions,
always better in a co-operative owned by the people working there, than in most
private companies. All these mentioned co-operatives are not in the health
sector but could be a part of the health promotion.
Two years ago the health co-operatives created a new international NGO*
the International Health Co-operative Organisation (IHCO). Our message
is that we are prepared to be a partner in this “Jakarta Declaration Call
for action” and we are also prepared to participate in this network that WHO
will create with different partners.
We are part of the NGO sector and we want to go on with this WHO-NGO
collaboration.
ssssssai
GAWH RESPONSE TO JAKARTA DECLARATION
Dr. Elaine Wolfson
(President, Global Alliance for Women’s Health)
Thank you very much for inviting me to speak. I am delighted to be able
to talk about the Jakarta Declaration and our response to it. I was
privileged to attend the July meeting in Jakarta last year and the energy
was truly exciting.
The Global Alliance of Women’s Health is focused on many issues as
they relate to women’s health throughout the life span. The organisation
is four years old and is committed to advancing women’s health through '
all phases and stages of life. The mission includes public policy
formation as well as implementation and monitoring of services. We
were very pleased that in the Jakarta Declaration there was a specific
mention of the “empowerment of women”. Indeed in the section on the
determinants of health, the empowerment of women was listed. We
think that it is very critical to have recognised that this half of the
population of the world is still not empowered equitably and does not
receive parity in terms of health care services and research.
We have been working on a number of areas in health promotion. Since
my academic field is public policy and I have been involved for the past
30 years on formation of public policy, we attempted to influence the
action documents of the Beijing Conference and the Social Summit in
Copenhagen. We developed partnerships with many NGOs in order to
produce a compendium of women’s health provisions. More than 70
international and national NGOs who had come to New York for various
meetings joined in consultations providing suggestions that were
incorporated into the more than 200 provisions of the Compendium. We
distributed more than 20,000 copies of the Compendium through 1994
and 1995 to NGOs around the world.
In the past year, we have focused on promoting women’s health through
publications, mobilising NGOs through information and establishing
1
to draw your attention to one of our most popular publications,
Depression and the Mature Woman. We invited social workers,
geriatricians and NGOs to speak. What we tried to do in the edited
proceedings was to capture the exchange between the audience and the
experts talking about issues of women’s health, comparing mature
women’s issues of mental health and depression across many cultures. In
addition to African American women, the other women who were the
subjects of these talks, were mainly immigrants to the United States, for
example Latina women, Indian women, and women from Eastern Europe.
We were fortunate to get funding from Pfizer to produce this book. We
brought the Depression book to the NGO meeting in Dakar. The women
at the meeting were veiy impressed with the book and asked whether it
could be translated into French.
We have also worked on women’s health issues and promotion with
foundations^ At the request of the Edna McConnel Clark Foundation, we
were asked to place trachoma in the framework of women’s health. In
other words, we looked at an infectious eye disease from a women’s
health perspective in the context of the issues that were being addressed
by the women’s health movement nationally and internationally. With
the assistance of graduate students from Colombia University School of
Public Health, we reviewed the medical and social science literature and
wrote a position paper for the Foundation. It was well received and we
were granted additional support for publishing this work as a booklet.
In this publication, Trachoma: A Women fs Health Issue, we make some
recommendations on how the World Health Organisation’s efforts on
behalf of trachoma elimination could be linked with the Jakarta
Declaration. The effort to promote SAFE strategies in communities
where trachoma is endemic is fundamentally an educational and
promotional undertaking.
>
Finally, we are promoting women’s health through linkages with NGOs
and governments. We have been circulating a proposed draft resolution
on “Women’s Health throughout the Lifespan”, and have been holding
briefings in New York and Geneva. We believe that, if this resolution is
passed by the General Assembly at the United Nations, it will help WHO
and NGOs who are promoting health in the regions and the countries of
the world.
i!
NGO RESPONSE TO JAKARTA DECLARATION
Discussion and comments from the floor
After the Panel Speakers, the floor was opened and a lively discussion took
place with questions directed to the Panel and contributions made by those
present.
One NGO showed how they introduced the care of the new bom child into the
Safe Motherhood Initiative, and had helped to bring about the much needed
partnerships between obstetricians, neonatologists, and nursing staff. They
have a global partnership programme to prevent childhood blindness, bringing
in the community, which is sometimes a neglected partner.
A Youth Organisation stressed the importance of involving the youth and
young professionals and that they need to be supported and strengthened and
helped to develop their professional abilities. Other NGOs underlined the
importance of participation with the youth and young professionals, the need
to promote young leadership, and in particular to include them in national or
official delegations.
A question was raised about involvement with the private sector and the
impact of alliances with transnationals. In reply Dr O'Byme said that the
private sector were present in Jakarta in their personal capacity. He said that
all partners need to work openly and transparently, and that it is essential to
protect the independence and good status of the UN and of WHO when working
with different partners from the private sector.
Mats Ahnlund (IHCO) said that his organisation has no official standpoint as it
is very decentralised and every cooperative has the right to discuss with any
partner. We are all very different and this meeting is about how we asNGOs
can contribute to partnerships.
Elaine Wolfson (GAWH) noted that some pharmaceutical companies had taken
the lead in instituting research on women’s life span health issues, particularly
middle life and ageing and have thereby provided a service for women's health.
They had donated resources and filled the gap to combat river blindness ,
trachoma and lymphatic filorisias, and other gender related diseases. She noted
that it would be good to have more socially responsible corporations helping
a
women’s health.
A question was raised about the need for reform in legal issues and national
laws. The hope was expressed that the Jakarta Declaration on Health Promotion
should look at legal issues, property law, etc. which sometimes put women into
a very marginalised situation.
Elaine Wolfson recalled that CEDAW (the
Convention on the Elimination of all Forms of Discrimination against Women)
and the Beijing Platform of Action are two legal instruments for use by the
international community. Unfortunately, ratification and monitoring of the
conventions do not always take place. Tesfa Ghebrehiwet (ICN) said that it is
important to go beyond legislation to implementation and action, and that the
medical profession needs to be empowered and sensitised when treating
victims of violence.
Two NGOs talked about the importance of involving human rights in health
promotion, and that the application of human rights can achieve empowerment.
Three NGOs supported the idea of establishing an NGO Human Values Caucus
in Geneva which could focus on and reawaken human values to translate them
into daily life,
The International Alliance of Women explained that their organisation had
developed a family planning component through another established project,
and had initiated education programmes for adults and youth, and then
established a dispensary for delivering services. This had required additional
funding and she explained that NGOs are sometimes able to facilitate funding
resources from a third party.
s
The rapporteur for the briefing was Joanna Koch, representing Associated
Country Women of the World (ACWW), the only international organisation of
rural women and fanning women. ACWW aims to promote international
goodwill and to help raise the standard of living and education of rural women
and their families. The organisation works through training programmes and
community development projects in health, HIV/AIDS, income generation,
nutrition, water management, and other agricultural issues.
<1
LIST OF PARTICIPANTS
Organisation
former WHO Director-General
Aga Khan Foundation, Pakistan
Argentinian Association Public Health
Art of Living Foundation
Associated Country Women of the World .
CAMHADD
CIRAC / BASE
Commonwealth Medical Association
GINA, Geneva
Global Alliance Women's Health
IFMSA, Denmark
IFMSA, WHO
IFMSA, Holland
Inter-African Committee
Int. Alliance of Women
Int. Baccalaureate Organisation
Int. Council Jewish Women
Int. Council of Nurses
Int, Council Social Welfare
Int. Federation of Red Cross and Red Crescent Societies
Int, Federation on Ageing
Int. Federation Medical Students Association
Int. Peoples' Health Council
1LO
Int. Ass. Agriculture. Medicine & Rural Health
Name
Dr. Halfdan Mahler
Yasmin Amarsi
Carlos Ferreyra Nunjez
Petra F. de Antonio
Elsa Neiva Saleme
Edgard Eric Ferreyra
Werner Luedermann
Joanna Koch
R. Varma
V. Pandurangi
Maluza Wasiluadio
Berhane T. Medhin
John Havard
Marianne Haslegrave
Astrid Stuckelberger
Elaine Wolfson
Rupali Chopra
Jakob Krarup
Francesca Porta
Bjdrg Forsteinsdottir
Berhane Ras-Work
Gudrun Haupter
Renate Kircheisen
Ruth Bonner
Ian Hill
Rebecca Muhlethaler
Tracy Terminsley
Louise Sanchez Seatman
Ursula Klein
T. Ride
Tesfa Ghebrehiwet
Nils Dahlquist
Michelle Greater
Maria Nonova
Juja Kim
Leila Passah
Brian Rawson
Grace lijima
A. Hoffmann
Tigran Vilotijevic
David Saunders
Herman Raus
Jacquier Christian
Ashok Patil
(I
Int. Health Cooperative Organisation
>
1
Mats Ahnlund
Won-SikNoh
ISRRT, Wales
P. Yule
ISRRT, Canada
D. Yule
La Leche League Int.
Giselle Laviolle
Medical Mission Sisters
Velasco Dulce Corazhon
Medical Womens International Association
Dorothy Ward
Vibeke Jorgensen
Ministry of Health, Health Promotion, Mexico
Javier Urbina Soria
Ministry of Health, Hesse, Germany
Christian Luetkens
Ministry of Health, Namibia
Maggie Nghatanga
Ministry of Health and Social Welfare, Swaziland
Shongwe
Ministry of Health, Burundi
Bakanibuna Renovat
Ministry of Health, South Africa
Rose Mazibuko
National Council for Int. Health
Debra Smith
Margaret Gwynne
Ron Wilson
NGO WG on Nutrition
Gilberte van Haelst
N.O.W.
Jean Harris
Pan Pacific and South East Asia Womens Ass.
Clarissa Starey
Rotary International
Gunter Hermann
SCORP, (IFMSA) Egypt
Hazem Wafa
SINAN, Swaziland
Dlamini Tyler
Swiss Nurses Association
Magali Bertholet
UNICEF, Pakistan
Maaike Arts
World Ass. of Societies of Pathology and Lab. Medicine> William Zeller
World Federation of Poison Centre
J.F. Deng
World Fed. Methodist & Uniting Church Women
Renate Bloem
World Organisation Scout Movement
Mateo Jover
WHO
Yu Sen-Hai
Peter Iverson
Ursel Broesskamp-Stone
P. Nordet
Jack Jones
Merri Weinger
Desmond O'Byme
Isolde Birdthistle
Petra Heitkamp
Irene Hoskins
Roberta Ritson
Gina Cheatham
Andr£ Chirondel
Marilyn Rice
Katharina Hauck
World Union of Catholic Women Org.
Ursula Barter-Hemmerich
Womens World Summit Foundation
Elly Pradervand
Zonta International
Danielle Bridel
“Die Tageszeitung”, Berlin
Andreas Zarmach, Journalist
K
<1
NGO Activities before and after
the Fourth International Conference
on Health Promotion
“New Players for a New Era,
Leading Health Promotion into the Twenty-first Century”
Jakarta, Indonesia, 21-25 July 1997
NGOs based in Geneva which participated in the Fourth International Conference for
Health Promotion held in Jakarta in July 1997, have been working closely with the
Health Education and Health Promotion Unit (HEP) of WHO since before the
Conference and in follow-up activities.
We have organised a number of informal briefings to sensitise Geneva based NGOs
about the Conference and to become involved in the follow up, and we have shared the
Jakarta Declaration, approved by the Conference participants. This Declaration has been
translated into a number of languages and copies are available from the HEP Unit of
WHO.
!
Following Jakarta, we have distributed Information Sheets, reported about the
Conference at national and international fora, included articles in Newsletters for our
membership, and incorporated health promotion ideas in ongoing work and future
programmes. Statements made at the WHO Executive Board meetings in January 1998
pointed to the importance of NGO participation in health promotion in all aspects of life
including healthy schools, healthy cities and countries, healthy workplaces, and so on.
Mindful of the dedicated members of the health profession who would be present for the
World Health Assembly in May, we were keen to arrange an NGO Briefing on the NGO
Response to the Jakarta Declaration. This was done with the help of WHO. The
purpose of the briefing was to show how Governments, WHO and NGOs can work
together on health promotion. "Hie aim was to encourage others to become involved, in
as many different ways as possible, through their organisations, and through their
different mandates and programmes. This report records the highlights of that Briefing.
1
We invite NGOs and others to exchange information and ideas on how to translate the
Jakarta Declaration into action, and to share with us their hopes as we move towards the
j *^20QQrna^°na* C°nference on Health Promotion which will take place in Mexico in
Contact Addresses:
Joanna Koch, ACWW, Tel/ Fax: (Ml 1) 715 1946
Mats Ahnlund, IHCO/1CA, Tel: (+41 22) 929 8888, Fax: (+41 22) 798 4122
Elaine Wolfson, GAWH, Tel: (+1 212) 286 0424, Fax: (+1 212) 286 9561
d
«2? dSMer
*&
Call for action
The participants in this Conference are committed to sharing the key messages of the Jakarta
. Declaration with ttieir governments, institutions and communities, putting the actions
^proposed into practice, and reporting back to the Fifth International Conference on Health ?•
Prombtibrii
'
participants endorse the
: fpmpbtiqnpf-a global health promotion ailiance.jhe goal of this alliance is to advance the
pribritiias foraction inhealth promotion set put in this Declaration.
:
• raising awareness of the changing determinants of health
• supporting the development of collaboration and networks for health development
• mobilizing resources for health promotion
; .
• accumulating knowledge on best practice
• enabling shared Jearmng
. . '
.
•
•
• promoting solidarity In action
<
.
,
• fostering transparency and public accountability in health promotion
:
National governments are called on to take the initiative in fostering and sponsoring
networks for health promotion both within and among their countries.
/ The participants call oh WHO to take the lead in building such a global health promotion
alliance and enabling its Member States to implementfhe outcomes of the Conference. A key
part of this rble is for WHO to engage governments; nongovernmental organizations,
development banks, organizations of the United Nations system, interregional bodies, • \ s
bilateral.agehdfei the:labour movement and cobpqratives,as well as the private sector, in ,
. advancing the pribrities for action in health promotion.
, from the Jakarta Declarationon Leading Health Profnotion intothe list Centuryjuly 1997
■J!'
t)
World Health Organization
20 Avenue Appia, 1211 Geneva 27, Switzerland. MUW
tel:(+4122) 7912111,fax:(+4122) 791 0746,
e-mail: hep@who.ch
0^
'
;
i!
The Fifth Global Conference on Health Promotion
Health Promotion: Bridging the Equity Gap
5-9h June 2000, Mexico City
1.
Introduction
2
2.
The Opening Ceremony
5
3.
Joint Technical-Ministerial Sessions
6
4.
The Technical Themes and Case Studies
6
Technical Theme 1 : Evidence Basefor Health Promotion...................................................
6
Technical Theme 2 : Investment for Health..........................................................................
7
Technical Theme 3 : Social Responsibility for Health..........................................................
9
I echnical I heme 4: Building Community Capacity and Emrpowerment of the Individual...
10
Technical Theme 5 : Securing an Infrastructure for Health Promotion...............................
12
Technical Theme 6 : Reorienting Health Services..................................................................
13
5.
A Framework for Countrywide Plans of Action on Health Promotion
15
6.
Health Promotion in Mexico
15
7.
Key issues arising from the meeting,
16
Restatement ofthe relevance of health promotion...
16
Hocus on the determinants of health.....................
17
Bridging the Fruity Gap......................................
17
Health promotion is scientifically sound...............
18
Health promotion is socially relevant...................
18
Health promotion is politically sensitive...............
!9
The role of women in health development..............
19
Conclusions and Recommendations
20
8.
9.
Strengthening the "'science and art" ofhealth promotion..........
20
Strengthening political skills and actions for health promotion
21
Annexes...........................................................................
23
<!
1.
)
Introduction
fhc Fifth Global Conference on Health Promotion (5GCHP) — [health Promotion: Bridging the
Equity Gap — was held 5-9" June, 2000 in Mexico City. This conference built on the advances of
the previous four International I lealth Promotion Conferences, particularly taking forward the
priorities of the last International Conference on Health Promotion held in Jakarta, Indonesia in
1997.
The First International Conference on Health Promotion held in Ottawa, Canada, in 1986
created the vision by clarifying the concept of health promotion, highlighting the conditions and
resources required for health and identifying key actions and basic strategies to pursue the WHO
policy of Health for All. The Ottawa Charter for Health Promotion identified prerequisites for health
including peace, a stable ecosystem, social justice and equity, and resources such as education,
food and income. Key actions to promote health included building healthy public policy, creating
supportive environments, strengthening community actions, developing personal skills, and
reorienting health services. The Ottawa Charter thus highlighted the role of organizations,
systems and communities, as well as individual behaviours and capacities, in creating choices and
opportunities for the pursuit of health and development.
Building healthy public policy was explored in greater depth at the Second International
Conference on Health Promotion in Adelaide in 1988. Public policies in all sectors influence the
determinants of health and are a major vehicle for actions to reduce social and economic
inequities, for example by ensuring equitable access to goods and services as well as health care.
The Adelaide Recommendations on Wealthy Public Policy called for a political commitment to health by
all sectors. Policy-makers in diverse agencies working at various levels (international, national
regional and local) were urged to increase investments in health and to consider the impact of
their decisions on health. Four priority areas for action were identified: supporting the health of
women; improving food security, safety and nutrition; reducing tobacco and alcohol use; and
creating supportive environments for health.
This latter priority became the focus of the Third International Conference on I lealth
Promotion in Sundsvall, Sweden, in 1991. Armed conflict, rapid population growth, inadequate
food, lack of means of self determination and degradation of natural resources are among the
environmental influences identified at the conference as being damaging to health. The Simdwall
Statement on Supportive Environments for Health stressed the importance of sustainable development
and urged social action at the community level, with people as (he driving force of development.
This statement and the report from the meeting were presented at the Rio Earth Summit in 1992
and contributed to the development of Agenda 21.
>
The Fourth International Conference on Health Promotion held in Jakarta, Indonesia, in 1997
reviewed the impact of the Ottawa Charter and engaged new players to meet global challenges. It
was the first of the four International Conferences on Health Promotion to be held in a
developing country and the first to involve the private sector in an active way. The evidence
presented at the conference and experiences of the previous decade showed that health
promotion strategies contribute to the improvement of health and the prevention of diseases in
developing and developed countries alike. These findings helped to shape renewed commitment
to the key strategies and led to further refinement of the approaches in order to ensure their
continuing relevance. Five priorities were identified in the Jakarta declaration on Eeading Health
Promotion into the 2 T' Century.
2
These were confirmed in the following year in the Reso/ntion on Health Promotion adopted by the
W orld Health Assembly in May 1998:
1.
9
3.
4.
Promoting Social Responsibility for I lealth
Increasing Community Capacity and Empowering the Individual
Expanding and Consolidating Partnerships for Health
Increasing Investment for Health Development
Securing an Infrastructure for Health Promotion
At the start of the new century, two challenges remain: to better demonstrate and communicate
that health promotion policies and practices can make a difference to health and quality of life;
and to achieve greater equity in health. Concern for equitv is at the core of the health promotion
concept and a thread that runs through the previous conferences and their declarations. Outunderstanding of the root determinants of inequities in health has improved significantly. Yet
inequalities in social and economic circumstances continue to increase and erode the conditions
for health. For these reasons, the Fifth Global Conference on Health Promotion focused on
bridging the equity gap both within and between countries.
Conference objectives, structure and processes
1
I'he Fifth Global Conference on Health Promotion had as its overall goal an examination of die
contribution made by health promotion strategies to improving the health and quality of life of
people living in adverse circumstances. The joint organizers were the World Health Organization
(WHO), the Pan American Health Organization (PAHO/AMRO) and the Ministry of I lealth of
Mexico.
The conference objectives were:
❖ To show how health promotion makes a difference to health and quality of life,
especially for people Living in adverse circumstances;
❖ To place health high on the development agenda of international, national and local
agencies;
❖ To stimulate partnerships for health between different sectors and at all levels of
society.
Ihe conference brought together a wide range of participants from about 100 countries,
reflecting the various groups and sectors of society that are responsible for or influence the
determinants of health. These included Ministers and other major policy- and decision-makers
from both health and other sectors; representatives from international and national development
agencies, non-governmental organizations, community-based organizations; the private sector;
and scientists and practitioners from various fields, including experts in evaluation and
communication.
The conference had two programme components: a five day technical programme and a two
day ministerial programme. These were linked by two joint sessions. At the end of the ministerial
programme, several political delegations joined the technical programme.
The preparation of the ministerial programme invoked the development of the Mexico
Ministerial Statement for the Promotion of Health: Prom Ideas to Action, signed at the conference by 86
Ministers of Health or their representatives - a clear sign of political commitment to health
promotion. The Ministerial Statement is available in the Annex of this report.
J
I he Statement:
❖
*:•
affirms the contribution of health promotion strategies to the sustainability of local,
national and international actions in health, and
pledges to draw up a country-wide plan of action to monitor progress made in
incorporating health promotion strategies in national and local policy and planning.
I’he technical programme was structured around the priorities for health promotion set out in
the Jakarta Declaration (1997) and confirmed in the World Health Assembly Resolution on
Health Promotion (1998) . The six technical sessions addressed areas Member States and
societies as a whole are urged to act upon:
❖
❖
❖
❖
Strengthening the Evidence Base for Health Promotion
Increasing Investments for Health Development
Promoting Social Responsibility for Health
Increasing Community Capacity and Empowering Individuals and Communities
Securing an Infrastructure for Health Promotion
Reorienting I Icalth Systems and Services with Health Promotion Criteria
Each of the six thematic sessions consisted of a plenary followed by breakout sessions allowing
discussion of the key elements in smaller groups. In each plenary three case studies and one
technical report were presented, then the floor was opened for questions and comments. The
technical reports were presented in final draft form to allow for a peer review process during the
conference. These are published separately from this report-.
I he conference provided several mechanisms for active participation of all participants.
1
After each plenary, up to 15 breakout sessions were held. These were supported by a facilitator
and rapporteur who worked as a team throughout the week (see Annex 6).They guided the
debate along pre-defined questions, as well as considering the issues that emerged out of the
plenary debates. Breakout sessions provided participants with the opportunity to both:
❖
•••
give input into the conference report being written during the event, and
provide targeted feedback towards the finalisation of the technical reports.
A writing team (see Annex 6) was established to ensure a participator}- writing process of this
conference report on the technical programme ’. Breakout session rapporteurs met regularly with
this team to provide feedback from participants’ discussions. In addition, two drafts of the
conference report were circulated during the course of the week, allowing all participants to
provide further comments in writing.
A similar process was set up for participants’ work towards the framework, for Country wide Plans of
Action for Aealth Promotion. I he intention ot this framework was to provide countries that signed
the Mexico Ministerial Statement for the Promotion of Health: From Ideas to . Action, with a tool that
guides and supports their efforts to develop and implement country specific action plans. This
framework is also available separate from this report1.
/\ll products of the conference.
1 Sec Annex for Wl IO Document \X'I IA 51.12, May 1998
2 Sec Annex for information on how to obtain this document
3 See Annex regarding the report of the Ministerial Programme see Annex
1 See Annex tor information on how to obtain this document
4
❖
❖
❖
the six technical reports
the case studies
the Mexico Ministerial Statement for the Promotion of Health: from ideas to action
the framework for country wide plans of action for health promotion, and
this conference report
are being made widely available beyond the group of 5GCHP participants via various
communication channels, including print media and the WI IO website’.
2.
The Opening Ceremony
The opening ceremony was held at the National Anthropological Museum, Mexico City on
Monday 5'1' June. The conference audience was addressed by Lie. Jose Antonio Gonzalez,
Minister of Health, Mexico; Dr Gro Harlem Brunddand, Director General, World Health
Organization; and Dr George A.O. Alleyne, Director, Pan American Health Organization.
Participants witnessed the signing of the Mexico Ministerial Statement for the Promotion of Health: from
Ideas to Action. The conference audience was then addressed by Dr Ernesto Zedillo Ponce de
Leon, President of Mexico.
Some selected quotes are provided below.
“Considering that the commitment for health goes beyond the boundaries of the health
sector, the Conference is a platform to discuss the character of a Global Alliance for
Health Promotion to harness the potential of the many sectors of society, and create new
partnerships in equal footing among the different sectors and at all levels of
government.” (Uc. Jose ..Antonio Gon-^ale^, Minister of Health, Mexico)
“WHO’s overall strategy helps to set priorities. It lays out four strategic directions:
reducing excess mortality and disability, reducing risks to human health, developing
health systems that equitably improve health outcomes, and putting health at the centre
of economic and development policy. All these four directions have elements of health
promotion. Each involves us in disseminating knowledge, establishing consensus on how
knowledge can be implemented, and encouraging healthy public policies that encourage
people to implement the knowledge for themselves.” (Dr Gro Harlem ftrnndtland, DirectorGeneral, World Health Organisation).
“It is not enough to look at the health outcomes. One must look at those social
conditions that determine health outcomes - the determinants of health
During this
week we must look at the disparities in these determinants of health and determine to
what extent they are distributed so unequally as to produce health disparities. It is of
fundamental importance that in discussions on equity we understand the difference
between disparities in health status and disparities in the determinants of health that
cause these health inequalities or inequities.” (Dr George A.O. .Alleyne, Director, Pan
American Health Organisation)
“Health is a collective responsibility that necessarily implicates the active participation of
the population especially in preventive action and in health promotion action like those
3 Sec Annex for information on how to obtain these documents
5
c
that will be analysed during this conference.” (Dr Ernesto T^edillo Ponce de Leon, President of
Mexico.)
The complete speeches of Dr Brunddand and Dr Allevne arc provided in Annex 1 and 2.
3.
Joint Technical-Ministerial Sessions
Phe technical and ministerial programmes combined on two occasions. The first occasion was
on Monday 5" June on rhe theme setting the stage. Presentations were given by:
♦>
>
Dr Achmed Sujudi, Minister for Health. Indonesia, who spoke of the Jakarta
Declaration and Indonesia’s progress in implementing its national plan for health
promotion;
❖
Professor Michael Marmot, University College London. United Kingdom, who gave
the keynote speech on determinants of health with special emphasis on social and
economic factors and inequities in health;
❖
Dr Alex Kalache who described the new organizational arrangements for health
promotion in WHO, Geneva.
Professor Marmot’s speech is published jointly with the six technical reports of this conference.
The second joint technical-ministerial session was held on Tuesday 6" June and provided an
opportunity for feedback between the two programmes and sharing conclusions from the
Ministerial meeting. This session was structured around the four key themes addressed at the
Ministerial meeting, namely:
Healthy Public Policies: Equity, Investment for Health and Development;
❖ Social Responsibility for Health Promotion: Community Participation and the
Involvement of all Sectors;
❖ Re-Orienting Health Systems and Services;
❖ Mental Health and Healthy Life Conditions: Major Challenges for I lealth Promotion.
Fhe main outcomes and conclusions from the Ministerial Programme are published separately
from this report6.
4.
The Technical Themes and Case Studies
This section summarizes the discussions that took place in the breakout sessions following the
six plenaries. The technical reports and case studies presented in the plenaries arc available in
separate documents and are not covered in detail in this report .
Technical Theme 1 : Evidence Base for Health Promotion
The nature of evidence in the context of health promotion was the focus of the first plenary.
The technical report “Strengthening the Evidence Base for Health Promotion1' was written and
presented by Dr David McQueen. This technical session was unusual in that no case studies
were presented and no breakout sessions followed the plenary. I lowevcr, the issue of evidence
6 See Annex tor intormation on how to obtain this document
" See Annex: Conference products/documents.
6
il
1
was discussed as a cross-cutting theme during all other technical sessions and was taken up in all
breakout sessions. This is referred to below in the relevant sections. In addition, a special
5GCHP Ad Hoc Working Group on Evaluation in Health Promotion met on several da vs
during the networking time.
A number of major initiatives concerning this issue have been undertaken in North America and
Europe. These were outlined in the plenary presentation. Overall, the concept of evidence was a
source of considerable debate throughout the conference. Traditional scientific, and particularly
medical, definitions of evidence were felt by many conference participants to be too limiting. It
was felt that health promotion is a form of participatory action that requires participatory
research leading the development of evidence. Traditional scientific convention does not allow
for this. Participants felt that evidence needs to be derived from (he full range of experiential
knowledge. Moreover, the focus of health promotion on the determinants of health and on
personal and social change requires relevant measures and indicators. It was the view of many
that we are currently not measuring the right things.
Further discussion took place in the 5GCI IP Ad Hoc Working Group on Evaluating Health
Promotion that was initiated by WHO to help clarify and define the role of health promotion
evaluation, and identify those gaps that need to be addressed further. In a series of meetings, the
working group participants discussed and challenged the evidence debate presented in the
plenary session on evidence and the related draft technical report. Major points of the lively and
sometimes heated discussions were:
❖
❖
❖
the distinction between purposes for evaluation and types of evidence to be collected
for each purpose;
the evidence debate from a global perspective, and the yet missing voices and
approaches, such as those from developing countries;
the differences between evidence and evaluation, and the issues of measuring
complex systems of change;
the need for partnerships with stakeholders and for measuring both processes and
outcomes.
The working group developed the following core set of concrete recommendations for WI IO:
❖
❖
to continue the discussions and work, across regions and schools of thought, started
by this 5GCHP evaluation working group, and
to assist in the development of an infrastructure and core set of technic]ties for health
promotion evaluation?
Several experts expressed that their institutions may be interested in becoming part of a global
infrastructure to be created in support of health promotion evaluation.
Technical Theme 2 : Investment for Health
The theme of Investment for Health was explored in the second plenary session, presented by
Dr Erio Ziglio and Professor Spencer Hagard. The connection between health and human
development was explored with particular reference to the Investment for Health approach
adopted by the European region of WHO. This is a vehicle which, through benchmarking,
enables governments, regions and localities to explore the contribution of each sector to the
creation and maintenance of health. The strong connection between social, economic and
8
See Annex for a more detailed description.
7
human development, and health was highlighted. Case studies from 1 rinidad and Tobago, Gaza
and Germany were presented
Five broad rhemes emerged from the discussions amongst conference participants:
investing in human and social development;
❖ achieving integrated, multi-sectoral investments for health;
❖ improving understanding of the relationship between investment and health;
❖ improving the quality of indicators used to assess development in countries.
Investing in human and social development
Through the breakout sessions, the conference participants strongly expressed the view that
Investment for Health is not about economics, but about human and social development. If the
prerequisites for health do not exist, social and economic development will be stalled. To the
prerequisites identified by the Ottawa Charter should be added democracy and political stability.
Specifically, it was felt that countries need to re-negotiate their external debt relations to include
good health and social development conditions, alongside those concerned with economic
development. Human resource and social development should be the cornerstone of any
countrywide development plan.
Ichieving integrated, multi-sectoral investments for health
Conference participants felt there was extensive evidence to show that integrated, multi-sectoral
approaches to investment for health are effective in contributing to both health and economic
development. Much of this evidence is of a historical and comparative nature, but provides a
compelling case for investing in health.
Improving understanding of the relationship hetiveen investment and health
One fundamental step in this process is to make people aware of the relationship between
different forms of investment and health. Through such understanding, people are far more
likely to relate to and take ownership of health as a public good.
Examples from the case studies and wider discussion indicated that understanding and
ownership depend on the reference points of those receiving the message. Not everyone sees the
relationship between human and social development and health in a broader sense. Most
fundamentally, the concept of health held by those in key political positions is crucial.
I
(
For example, the municipalities in all parts of the world that have made greatest progress in
taking actions to promote health and achieved a more holistic/integrated approach, arc those in
which the mayor holds a more broadly based concept of health. This demonstrates both the
importance of engaging people and the impact of individual decision-makers on progress.
Sharing experiences, stories and case studies as “evidence”, alongside more traditional forms of
evidence is important. Stories influence decision-makers as well as scientific evidence. The
political and technical dimensions interact. Disseminating case studies in a consumable form (like
the videos shown at the conference) can generate political change. This approach can also
address the issue of public accountability.
0 Sec Annex
8
c
improving the quality of indicators used to assess development in countries
Conference participants were also concerned that there was still a paucity of health indicators (as
distinct from disease indicators) used at the global and local level. Such health indicators may
include measures relating to the determinants of health. Moreover, given the close links between
socio-economic development, inequities in access to resources and health, health in itself
becomes an indicator of development. Similarly, participants felt the prerequisites for health and
major determinants of health should be the focus of indicators. There is also a need to develop
indicators on equity separate to the measures of inequality which now exist.
Technical Theme 3 : Social Responsibility for Health
The issue of social responsibility emerged during the jakarta Conference with particular
reference to the role of the corporate sector as potential new partners in promoting health. The
technical paper Promoting Social Responsibility for [dealth: Progress, Unmet Challenges and Prospects was
written and presented by Professor Maurice Mittelmark in this plenary. In his presentation.
Professor Mittelmark focused more on community level issues and concerns. The concept of
equity-based health impact assessment was presented. Case studies were presented from Gujarat
and Calcutta in India, and I lenan in China1".
Five broad themes emerged from the discussions amongst conference participants:
❖
❖
❖
What constitutes social responsibility for health?
I low do you measure it?
Issues of equity and gender
The case studies and what they reflected in terms of the prerequisites of success
Cultural diversity
II ’hat constitutes social responsibility?
It was clear from the feedback received from participants that social responsibility, like health,
means different things to different people. Defining it becomes particularly important when
identifying who is responsible for what. In working together people need to be clear about rights
and responsibilities and need to go through a process of defining social responsibility for health
in their own terms so that there is collective ownership.
)
Different levels, as well as different sectors, need to be clear on roles and responsibilities.
Participants identified that Governments are socially responsible for the promotion of
democracy, for mobilizing key players and bridging the gap between human rights and social
rights at the community level. Some participants fell that Governments too often sign up to
Human Rights but fail to follow through and support them at the local level.
However, if social responsibility is devolved, governments too often give up their own
responsibilities. A key challenge is to link the different levels of society and develop a dialogue to
overcome the inherent tensions.
Some participants pointed out that both workplaces and trade unions have a role to play. Trade
unions in particular are currently under-utilised allies. I lowever, some participants felt that in the
private sector, social responsibility only signifies economic self-interest.
10 See Annex
9
il
To some participants social responsibility for health is also about the ability to respond - and that
implies skill development and capacity building. To others it is seen as a right.
Participants also identified the development of social responsibility for health as a political
process and a potentially dangerous one for its advocates. In at least two breakout groups, this
led to a discussion on the barriers to its development
Finally, conference participants pointed out that at the centre of social responsibility lies the issue
of respect, respect for the social fabric of a community.
Hojp do we measure social responsibilityfor health, and is there an evidence base
It was felt by conference participants that little evidence is currently collected on the mechanisms
through which social responsibility is related to health improvement. Indeed it is an important
dimension missing from current research, particular^- in relation to sectors other than health.
I he key challenge is to come up with appropriate benchmarks for different levels of government
and society.
Gender and equity
In many parts of the world, women currently play a prominent role in social responsibility for
health at community level. Ihe issue of equity in relation to women emerged as an important
issue, which some felt had been neglected, in contrast to social structure inequities. Social
responsibility is always seen as the primary responsibility of women, thus men currently take only
a marginal role. Moreover, there are different perceptions as to what constitutes social
responsibility between men and women. Nevertheless, social responsibility needs to be the
responsibility of the whole community.
Thefocus on the community and case studies
The case studies became an important focus of discussion within the breakout groups. They
demonstrated multifaceted action, all starting a different point but with long-term and
sustainable consequences. They were developed over long periods of time, had political
commitment, reflected partnership approaches particularly between expert, community and local
government. They used appropriate technolog}7 and were examples of the strong link between
environment and health. They also showed the importance of good feedback to the community
as part of the process.
Cultural diversity
)
|ust as there are different perceptions of what constitutes social responsibility between men and
women, participants argued that there is no national or international consensus on its definition.
Social responsibility and how it is defined is a culturally specific concept. Discussion and
operationalisation of the concept, as well as measurement of social responsibility, must take this
into account.
Technical Theme 4: Building Community Capacity and Empowerment of the Individual
i
Dr Helena Restrepo summarised the key points in her technical paper on Increasing Community
Capacity and Empowering Communities tor Promoting Health. She argued that community
capacity building lies at the heart of health promotion. Drawing on the work of Paulo I riere she
10
i!
i
outlined rhe main characteristics of community capacity building. She also highlighted the
challenges to this approach, particularly in the context of general trends towards economic
insecurity, corruption, lack of solidarity, and human rights violation. Her presentation was
followed by case studies from Nigeria, Colombia and the United Kingdom". Both the case
studies and the presentation generated a passionate response from participants.
The debate in the group breakout sessions was equally lively. Five themes emerged, all
demonstrating the tensions around community capacity building and empowerment:
❖ Capturing the evidence of success and value of communin' capacity building
❖ The need for capacity building amongst community health promoters
❖ The keys to successful community capacity building
❖ Government and health sector perceptions
The role of women
Capturing the evidence ofsuccess and value ofcommunity capacity hui/ding
All participants felt that there was a long and established history of community development
involving varied and innovative experiences. The systematic documentation of these is crucial.
This implies the development of research skills amongst practitioners as well as the development
of a greater number of opportunities to communicate work in this area, including publication in
journals. One scientific challenge is to find ways, using appropriate qualitative data, of describing
the growth and change that takes place in people and communities through empowermentoriented health promotion strategies. A simple measure of the outcome of community capacity
building could be the actions that people take in response to adversity. The systematic
relationship between community capacity building, social capital and health needs more and
better documenting.
The need for capacity building amongst community health promotion workers
A consistent theme that came through in all the group discussions was the need for better
training of community health promotion workers to ensure good practice. Advocacy skills were
seen as particularly important. There also needed to be greater investment in network
infrastructures. A suggestion from one group was a global website on community capacity
building, including guidance on best practice.
The keys to successful community capacity building
Some discussion took place around defining the keys to successful community capacity building.
Fundamental to this process is that control of decision-making rests with the community
concerned — with little or no outside involvement. Where governments or outside agents are
involved, they should take the role of facilitator, not provider. Process is at the core of
community capacity building. That process is often slow, and generally needs to be slow to
ensure relevance to community aspirations, cultural sensitivity, and to improve the chances of
sustainability. Participants also emphasised the importance of systematic planning and good
facilitation.
Government and health sector perceptions
i
See Annex
I I
Participants expressed concerns that both government and the health sector still do not
understand community-based health promotion. Indeed it was emphasised that many top-down,
governmental interventions in the past have cut across existing community strengths and
undermined existing, locally relevant activity. This danger still remains, especially in some
countries where, according to some participants’ perception, there is a return to centralisation of
health promotion within health services. Community capacity building requires considerable
skills and these should be addressed in the training of health professions and public servants in
order to avoid or minimise the chances of such practices in the future.
The role ofwomen
As in previous discussions, participants again emphasised the role of women at the core of
health development and capacity’ building initiatives. Some participants felt that this issue comes
up repeatedly because of the inherent skills of women which still do not receive proper
recognition. Women who are already
al Lead v organised can transfer skills and enhance their own
capacity with new skills.
Technical Theme 5 : Securing an Infrastructure for Health Promotion
In presenting his paper on Infrastructure to Promote Health: The .Art of the Possible, Dr Rob Moodie
stressed the need both to build on and improve existing infrastructures to promote health and
create a core of dedicated infrastructures for Health Promotion. Tn light of the barriers
identified, he stressed that Health Promotion does not happen by chance. This presentation was
followed by two case studies12 from South Africa and Mexico and one case study illustrating the
global movement for active ageing1 \
The debates in the breakout sessions highlighted four main themes:
❖
❖
❖
❖
Appropriate infrastructures for health promotion
Equity
Development of human resources
Building collaboration
Appropriate infrastructures for health promotion
There was a general discussion on the importance of having an infrastructure that reflects health
promotion concepts and principles. That implies not developing new bureaucratic infrastructures
or centres but building on what already exists. This means strengthening the capacity to act and
developing the mechanisms to do this, and in turn, moving away from traditional vertical
structures to networking type structures. It also means recognising that responsibility is not just
with government, but involves a whole range of sectors. Appropriate structures are those which
strengthen democracy and provide sustainable, continuing support at all levels, particularly at the
community level. There should also be mechanisms that provide leverage on resources, and clear
benchmarking of standards.
There was much discussion and little agreement on whether a national body dedicated to health
promotion was required. Points of view depended ven’ much on the situation in a country.
12 Sec Annex tor a more detailed description.
13 See Annex
12
il
Equity
1
As with discussions on the other topics, the issue of equity was a consistent theme that ran
through the consideration of infrastructures for health promotion. Ensuring that any
infrastructure pays attention to encouraging equity is fundamental. Such infrastructures also
encompass the global dimension. At this level, new forms of mentorship need to be developed
between regions and countries. It is also important to recognise that differences in access to
technology such as the internet have the potential to increase inequity in access to information.
This needs to be addressed in any communication infrastructure.
At all levels, attention to equity means reallocation and redeployment of resources. Any
infrastructure needs to have capacity to apply leverage on government policy to ensure that
equity considerations remain to the fore. Such an infrastructure also requires equality in topdown and bottom-up elements for delivery of all the elements of health promotion to be
successful.
Development of human resources
Participants discussed the need for capacity building in human resources as an essential element
of any infrastructure for health promotion. An infrastructure for effective training should be in
place and some specific skills are essential. Skill development in democratic planning was
highlighted as particularly important. Closer integration between universities and community
members was also felt to be important. More fundamentally, there should be basic education for
all in what constitutes a health-promoting society.
building Collaboration
It was reiterated by participants that multi-sectoral collaboration lies at the heart of health
promotion and of any infrastructure needed to support it. Communication must be encouraged
and credibility established with existing organizations by building coalitions to develop an
effective agenda, with emphasis on good practice. Such coalition building takes health promotion
beyond the sole remit of the health sector.
Technical Theme 6 : Reorienting Health Services
>
Dr Daniel Lopez Acuna presented the major findings of rhe technical report on Reorienting I lealth
Systems and Services with Dealth Promotion Criteria, co-written by five authors 4. He expressed the
need to integrate health promotion and prevention as an integral part of the health care delivery
process and to incorporate health promotion principles into health services management. He laid
out several strategies to achieve this and outlined steps towards a “second wave of health sector
reform”. The three key steps highlighted in the paper were to reorient health systems and
services with health promotion criteria to increase the effectiveness of health interventions, to
promote the quality of care, and to improve public health practice.
His presentation was followed by presentation of case studies from Ecuador, the USA and
Pakistan'1.
I'1 Sec Annex
l’’ Sec Annex tor a moic detailed desciitpion.
13
a
The crucial role of communities in evaluating the quality of health care services was highlighted.
A core question raised was that of the role of governments or the state in the reorientation of
health systems and services.
The breakout session consisted of very lively discussions which focused on four main themes:
❖ Making the case for reorientation
❖ I equity
❖ The public/private mix
❖ I low to move things forward.
Making the case for reorientation
A number ot participants felt that the reorientation of a health system should involve the
integration of health promotion at every stage of the system. The challenge in doing this was in
making the case for change. Inevitably, systems are resistant to change. There is a need for clear
arguments that can persuade people of the need for change from inside and outside the system.
This includes presenting the evidence in such a way as to make it meaningful to politicians. A
central role was proposed for WHO in setting up a committee to explore such a reorientation
and how it should be implemented. Overall government leadership and political will are most
important for any reorientation.
The public/private mix
The case studies provided examples of the reorientation of health care services rather than the
larger issue of the reorientation of a health system. Moreover, they reflected only the example of
nongovernmental organisations (NGOs). This led to considerable debate as to who is
responsible for what within any health system.
There was also a general debate on the role of the state in the provision of the public health
function. This is especially important in countries where health service delivery is increasingly
managed by the private sector. Issues were also raised relating to universal access to health
services in a health care system predominantly managed by the private sector .
In some countries, the models that NGOs have developed have allowed better involvement of
the community in decision-making. However, participants felt strongly that Governments should
take responsibility for reorientation.
Tquity
Coverage in terms of access lies at the heart of equitable health systems. There are some
examples of successful reorientation of health systems in different countries, and all have made a
contribution to equity. Participants commented that, at its best, an equitable system would
include health system reorientation in any needs assessment within a community, as well as a
community-controlled health committee.
Hoiv to move things forward.
Participants had a far-ranging discussion on how to move forward in terms of a “second wave”
of health reform. Although reorientation of health systems had been a fundamental element of
the Ottawa Charter, development has been patchy and there has been no systematic analysis of
14
(I
what has happened and what is possible. The technical paper was seen as a first stage in
developing a strategy for change.
5.
A Framework for Countrywide Plans of Action on Health Promotion
The Mexico Ministerial Statementfor the Promotion of Health: I'rom Ideas to Action (MMS) was signed by
87 Ministers of Health or their designates at the official opening of the conference. The MMS
was the outcome of a carefully planned process of consultation and briefings, which took place
throughout the proceeding year. An initial draft statement prepared by (he conference organisers
was circulated globally to all Ministers of Health for their comments and suggestions. The
Statement was modified accordingly and a revised version once more circulated. Two briefing
sessions on the draft statement were held for the diplomatic corps accredited to the UN at
WHO. The MMS took forward the spirit of the UH I Ikesoh/tion on I \ calth Promotion (W 11A51.12).
The MMS states that health promotion must be a fundamental component of public policies and
programmes in all countries in the pursuit of equity and better health for all and pledges support
for the preparation of countrywide plans of action for promoting health. It states that the plans
will vary according to national context, but will follow a basic framework agreed upon during the
Fifth Global Conference on Health Promotion. In follow-up to this commitment, on arrival at
the conference, participants received a first draft of a framework, for Countrywide Plans of Action in
Health Promotion. This first draft was used as the basis for a plenary presentation on Tuesday 611
June, followed by a breakout session to discuss the content, direction and application of such a
framework. Following further discussion and feedback, a revised version was approved by the
conference. This final version is available on the conference website.
6.
Health Promotion in Mexico
During Mexico Day, Wednesday 7" June, Plenary session D was dedicated to showcasing a range
of Mexican experiences of health promotion as a cross-cutting approach applied to disease
prevention. The five themes were: an overview of the strategic programmes of the Vice Ministry
for Disease Prevention and Control; health promotion strategy of the immunisations
programme; health promotion approaches in health of the elderly; the basic health care packages;
and the health education components of the free textbook provided by the Ministry of Public
Education.
The following initiatives and points were discussed: a programme on health of the elderly with
special attention to diabetes and hypertension; a programme to encourage physical activity; the
important role of the community in housing improvement and achieving health development
goals; communication strategies such as “The Messenger for Health” which provides
information via radio to encourage adequate use of health services and self-care; and the “Heart
to Heart” campaign for prevention of noncommunicable disease.
Programmes using the Settings approach were also presented. There are 1,483 “Municipalities
for Health”, a strategy that advocates for healthy public policy, and enables cross sector action to
create healthy and supportive environments. I bis strategy has succeeded in placing health on the
local development agenda and on the national agenda. The “I lealth Promoting Schools”
initiative provides socially and culturally relevant life skills and school health activities centred on
the development of youth and adolescents. The family health programme “Health begins at
home” trains local community7 health workers as health promotion agents with the purpose of
establishing “health-friendly houses”. There are 46 indicators to evaluate the impact and process
of these programmes.
15
il
The Immunisations Programme covers children, youth and pregnant women, and is extending
coverage to the elderly. The Health of the Elderly programme carried out by the Mexican Social
Security Institute (IMSS) focuses on primary and secondary disease and risk prevention. This
programme emphasises self-care and physical activity. An important activity is the establishment
of an information system that monitors results and reports on risk factors identified by the
surveillance system.
PROGRES A is a programme that provides a basic health care package. Its objective is to extend
coverage to health services. A communication strategx’ using persuasive messages is in place to
prevent tobacco use. The programme encourages self-care and provides ongoing training of
health workers to deliver the basic health care package. This model of primary health care
provides basic services while reducing the costs of health care.
The school health programme of the Ministry of Education has introduced key health concepts
which are included in the free textbook programme. Public education provides 3 million children
with free textbooks (approximately 160 million books have been distributed). The content
centres on the development of life skills, values, attitudes and practices for a healthy and
fulfilling life, including self-esteem, self-respect and respect for others, gender equity and
tolerance education. Children develop an integral concept of health and development, learn to
express and manage their feelings and to establish nurturing relationships, learn about the
changes in their own bodies and how to protect the environment.
During the Mexican case study presentations, a variety of experiences were shared that illustrate
culturally relevant health promotion at the community level. There were nine simultaneous
working groups with approximately 5 presentations in each. Each session centred on a health
promotion approach. One session was dedicated to health promotion strategies with different
population groups. Another showcased health promotion experiences across the life cycle and
with a family focus. Yet another group presented and discussed experiences with the settings
approach: schools, municipalities, communities and workplace health promotion. The richness
and diversity of experiences illustrated the relevance of health promotion at the local level. This
session facilitated a common understanding of health promotion and provided input for many
reflections. During the discussions, however, it became apparent that a common understanding
of health promotion was lacking and that the existing networks of “Health Promoting Schools”,
“Healthy Municipalities and Communities” and the “Consortium of Universities”, could very
well be engaged in promoting a common understanding of health promotion.
7.
Key issues arising from the meeting.
Restatement of the relevance of health promotion
Health promotion is the process of enabling people to exert control over the determinants of
health and thereby improve their health. As a concept and set of practical strategies it remains an
essential guide in addressing the major health challenges faced by developing and developed
nations, including communicable and noncommunicable diseases, and issues related to human
development and health.
Health promotion is a process directed towards enabling people to take action. Thus, health
promotion is not something that is done on or to people, it is done
with and for people either as
individuals or as groups. The purpose of this activity is to strengthen the skills and capabilities of
individuals to take action and the capacity of groups or communities to act collectively to exert
control over the determinants of health and achieve positive change.
16
<1
In tackling the determinants of health, health promotion will include combinations of the
strategies first described in the Ottawa Charter, namely developing personal skills, strengthening
community action, and creating supportive environments for health, backed by healthy public policy. Special
attention is also given to the need to reorient health services towards health promotion.
Thus, health promotion will include actions directed at both the determinants of health which
are outside the immediate control of individuals, including social, economic and environmental
conditions, and the determinants within the more immediate control of individuals, including
individual health behaviours.
The inputs to the conference in the form of presentations, case studies and posters clearly
demonstrate that health promotion remains as powerfully relevant a strategy for social
development as it was when it first emerged as a concept at the First International Conference
on Health Promotion fifteen years ago. In particular, it remains an important set of strategies to
address the factors influencing inequities in health.
Focus on the determinants of health
Health is a resource for life which enables people to lead individually, socially and economically
productive lives. It is a positive concept emphasising social and personal resources (physical,
mental and spiritual).
It has long been acknowledged that there are certain prerequisites for health which include
peace, adequate economic resources (and their distribution), food and shelter, clean water, a
stable ecosystem, sustainable resource use, and access to basic human rights. It was clear from
the conference that the challenge to meet these fundamental needs must remain a core goal for
all action directed towards health, social and economic development.
Recognition of these prerequisites highlights the inextricable links between social and economic
conditions, structural changes, the physical environment, individual lifestyles and health. These
links provide the key to an holistic understanding of health, and arc meaningful to people’s lives
as they experience them.
Bridging the Equity Gap
A major underlying theme of the conference was to consider ways in which health promotion
strategies can be employed to bridge inequitable differences in health status in populations, both
between and within countries. The issue of equity in health was considered consistently in the
breakout sessions, and addressed directly or indirectly through each of the technical reports.
Considerable attention was given to underlying causes of inequity in health, especially regarding
access to resources for health, and both social and structural inequities, especially gender
inequity. By maintaining a focus on the determinants of health, and by emphasising the
importance of empowerment, health promotion strategies also address the fundamental
determinants of inequity in health. Thus, health promotion represents a viable, strategic response
to inequity in health.
Because of the focus on addressing the determinants of health, health promotion requires
political, social and individual actions. These actions need to be scientifically sound, socially
relevant and polidcally sensitive.
17
Health promotion is scientifically sound
fhere is no single scientific “discipline” of health promotion. Given the range of strategies that
arc employed to promote health, the scientific basis for health promotion is drawn from a wide
range of disciplines, including the health and medical sciences, social and behavioural sciences,
and the political sciences. 1 lealth promotion may be considered an integrative discipline, using a
systematic process to bring together different disciplinary perspectives to achieve intended
outcomes.
For this reason it is difficult to determine a simple and universally agreed set of rules of evidence
for health promotion. “Evidence” is inevitably bound to social, political and cultural context, and
will be related to the method of action, process of change and measure of outcome which are
valued by the population affected by actions to promote health.
I lealth promotion is scientifically sound. The different inputs to the conference (presentations, case
studies, posters) demonstrated that there is a rich experience of practice as well as the traditional
scientific literature which continues to guide decision-making in health promotion. This evidence
can be used as the foundation tor transparent accountability for actions taken. I lealth promotion
actions should be based on a sound analysis of (he issue being addressed, and should be
informed by established theories and models ot change drawn from its broad scientific base. A
systematic approach to programme planning will, in many cases, greadv improve the chances of
detecting a successful outcome and of being able to link observed outcomes to the actions taken. It
is important to emphasise that health promotion strategics translate into more than defined
programmes and products. For example, assessment of the value and impact of public policy
requires quite dif ferent measures and mediods to those used in programme evaluation.
J
It is clear from the deliberations at the conference that much work remains to be done to locate and
assemble health promotion experiences from around the world to improve the scope and quality of
the scientific basis for action, and contribute to knowledge development, t his must include further
debate on the mediods and measures which can be appropriately used to evaluate health promotion
strategies.
Health promotion is socially relevant
All actions to promote health occur within a social context. The strategies adopted to address the
determinants of health need to be continually adapted to ensure their social and cultural
relevance and to ensure that their effect increases rather than reduces equity in health. This is
especially true for actions addressing health determinants in indigenous populatioins. I leakh
promotion must be socially and culturally relevant.
Many of the case studies presented at the conference demonstrated that strategies to promote
health should be grounded in a meaningful assessment of people’s needs and aspirations, and
should engage people in the process of addressing these. This ensures that social responsibility
for health is genuinely shared between people and their government, and public and private
interests at all levels.
The report of the Ministerial meeting and the Ministerial Statement make it clear that
governments have special responsibilities to guarantee basic and universally accepted human
rights, support democratic and participatory processes, and create infrastructures and conditions
which support action to address rhe determinants of health.
18
The different inputs to the conference also strongly demonstrated the importance of collective
action at the local level. Effective action at this level is built on an informed population, equitable
participation in decision-making and a sense of belonging. It was also clear from the case studies
that health promotion at this level is inextricably bound with economic and social development.
In this regard, building the capacity of communities to take action to address locally determined
problems is central to health promotion. Part of this process of building community capacity is
to create the conditions within which community leadership and social entrepreneurialism can
emerge and act as catalysts for change.
Many find the concept of social capital useful in describing both the process and outcome of
locally based action for health.
Health promotion is politically sensitive
Health promotion is an inherently political process as it is essentially concerned with individual
and community empowerment. Health promotion often necessitates actions which require
political processes in the form of resource allocation, legislation and regulation.
The determinants of health are not restricted to the influence of health ministries and health
professionals. Addressing these determinants and achieving greater equity in health requires
political processes and actions which extend well beyond these boundaries. For these reasons,
the role of health ministers and of health ministries is substantially greater than a restricted
concern with the provision of essential health services.
Achieving greater investment for health in other sectors, by both governments and the private
sector, remains an important goal, and one for which health ministers and ministries have an
important advocacy role. As new models of governance emerge it is essential that health
ministries retain this important health leadership role.
This responsibility was recognized by the Ministers of Health and their delegates in their report
to the technical conference. Emphasis was given to the role of health ministers and ministries as
advocates for health within government, and as the organizational mechanism through which
health impact assessment of government policies could be managed.
What also emerged from that meeting was a clear request for health promotion actions to be
informed by and responsive to prevailing political realities. This included the need for
accountability, built on the use of scientifically sound health promotion actions.
4
J
Tension exists between emphasising the direct role of government in health promotion and the
need to transfer powers and responsibilities to communities to determine their own health.
The continued effects of globalisation reduce the powers of national and local governments, yet
also place greater responsibility on them to monitor and manage the health, social and
environmental impact of global trade and transnational businesses. Private enterprises have a
major influence on health. This influence can be direct in terms of the employment and
economic rewards they offer, as well as their impact on working conditions and job security.
Other impacts are less direct, for example environmental pollution. Ar present, the political
processes required to manage the health impact of globalisation are not well developed.
The role of women in health development
A continuing theme throughout the conference was the role of women as a cornerstone of
health development. The poor living conditions and social status of women lie at rhe heart of
19
i1
!
inequity in health, since women take social responsibility for themselves and for their children in
such disadvantaged circumstances. The empowerment of women through economic actions,
through education and, importantly, through women’s collective action is a crucial element in rhe
resolution of the major inequities in life circumstances. Ensuring women have a voice in
decision-making processes, and supporting their participation could have a substantial impact in
effective health promotion.
8.
Conclusions and Recommendations
The conference process was directed towards addressing some of the fundamental challenges
which need to be met to ensure continued progress in addressing inequities in health bv drawing
upon the concept and strategies of health promotion. The products of these processes include
the development of the Mexico Ministerial Statement for the Promotion of Health: brom Ideas to Action
and a Framework, for Counttywide Plans for .Action to support its implementation. These documents
provide useful guidance for countries and for their Ministers concerning action to address the
determinants of health and to ensure greater equitv in health.
The conference also considered the resources and structures needed to develop and sustain
capacity for health promotion at local, national and international levels. These are considered
below.
Strengthening the “science and art” of health promotion
)
J
It was clear from the technical discussions and ministerial meeting that continued efforts need to
be made to strengthen the “evidence base” on which health promotion policies and practices are
founded. This can be done if all forms of evidence, derived from the full range of experiential
knowledge, are included. In addition, this evidence needs to be better disseminated through
improved exchanges of information within and between countries. Finally, it was clear that this
evidence has to be communicated in ways that are politically, socially and culturally relevant to
countries and communities.
This will require:
continued investment in appropriate research and evaluation to improve
understanding of the determinants of health, and the effectiveness of health promolion
strategies to address these determinants. This will require a broad range of research
methods which reflect the values, process and intended outcomes of health promotion
policies and practices;
*>
the development of indicators which are more sensitive and relevant to health (as
opposed to disease), health determinants, equity in health, and the short-term impact of
particular health promotion strategies, and processes of change;
❖ improved interaction, co-operation, and participation among researchers, policy
makers, practitioners, and the communities with whom they work. Through improved
interaction there is a greater chance that researchers will answer questions that arc valued
and valuable for decision-making, and that policy-makers and practitioners will make
greater use of research findings;
identification of practical strategies that can be employed to better locate, assemble,
synthesise and communicate findings from ongoing research and evaluation, and
experiences from case studies. This can be achieved in a variety of wavs using established
20
methods such as through conferences and grass-roots networks, and publication in
journals, as well as making use of newer technologies, including the internet;
<♦
greater attention to opportunities to communicate evidence in ways that are socially
and politically relevant. This has to do, in part, with the timing and orientation of the
presentation of evidence.
The case studies presented at the conference were testimony to the extraordinary spirit, creativity
and resourcefulness of practitioners and activists, mostly operating at community level.
Processes which develop practical skills and capacities for health promotion, which encourage
leadership for health, and which support the emergence of social entrepreneurs in communities
are vital for the continued development and implementation of health promotion ideas and
actions. This will require:
*:• solidarity among practitioners and activists who arc often working in adverse
circumstances with meagre resources. The development of networks, alliances and
partnerships for health by concerned individuals and organisations is an important
practical strategy for building solidarity;
mobilisation of resources (financial, material and human) to ensure the implementation
and sustainability of health promotion policies and practices at all levels. Such resources
may come from a variety of government, non-government and private sector sources.
Governments at all levels have a responsibility to ensure that the necessary resources are
mobilised to implement existing and new policies and programmes, laws and regulations
for health;
❖
the development of community capacity which is built on good access to information
on the determinants of health and supportive infrastructures, including training;
❖
the development of human resources through education, training and exchange of
experience. Universities and other educational institutions have a vitally important role in
ensuring exposure of a wide range of professions to health promotion concepts and
strategies (including but not limited to the health professions);
*:• creation of networks and associations of practitioners for mutual support and
personal development. These associations should avoid exclusivity. Given the multi
disciplinary nature of health promotion there is considerable advantage in opening up
such associations to a broad range of people and professions.
Strengthening political skills and actions for health promotion
A strong and consistent theme of the technical meeting concerned the need to work with and
through existing political systems and structures to ensure healthy public policy, adequate
investment in health, and facilitation of an adequate infrastructure for health promotion. This
will require:
democratic processes which emphasise decentralisation of power, resources and
responsibilities tor health;
❖ continued social and political activism where this is needed to influence government
policies and to strengthen powers and responsibilities of communities to determine their
21
t1
own health;
❖
use of a system of equity-oriented health impact assessment particularly of public
policies at all levels of government, and of private sector policies and practices. This is a
concrete mechanism to underpin inter-sectoral action for health, and to support social
responsibility for health among governments, the private sector, NGOs and
communities;
*♦*
reorientation of health services towards health promotion and primary prevention, and
to achieve greater equity in health. A “second wave” of health sector reform may offer
an important window of opportunity to achieve this change;
improved interactions between politicians, policy-makers, researchers and practitioners.
This will help ensure that, on the one hand, health promotion actions are informed by
and responsive to prevailing political realities and scientific advances, and on the other,
the importance of investing for health, and in health promotion is well communicated and
widely understood;
❖
)
plans and structures which strengthen existing capacity for implementing health
promotion strategies, and support synergies between different levels (local, national,
international). These structures may be supported by governments, non-governmental
organisations or the private sector. The Vrameivork,for Countrywide Plans ofAction for Health
Promotion may be helpful in guiding these actions.
Participants at the conference recognized the need to make progress in advancing the science,
the art, and the politics of health promotion. The challenges identified above represent a
substantial agenda which is far beyond the responsibilities of any single international
organization, government, non-governmental agency, institution, or community. Participants at
the conference committed themselves to actions to address these challenges in wavs that arc
feasible and relevant to their circumstances. Participants also recognised that addressing many of
these challenges will require continued concerted action and solidarity between the different
health promotion actors represented at the meeting.
To ensure progress, participants recommended that WHO, in accordance with the 1998 W- ’orld
Health Assembly Resolution on Health Promotion (WHA51.12) take the next steps to establish an
alliance for global health promotion to address these challenges, and work to implement the
Mexico Ministerial Statement for the Promotion of Health: Prom Ideas to Action and other
recommendations from previous international conferences as well as local/regional declarations
on health promotion.
??
(I
9.
Annexes
Annex 1.
Keynote speech given by Dr Gro Harlem Brunddand at Opening Ceremony
Annex 2.
Keynote speech given by Dr George A.O. Alleyne at Opening Ceremony
Annex 3.
Conference Programme
Annex 4.
5GCHP Ad Hoc Working Group on Evaluation in Health Promotion
Annex 5.
WHA 51.12 Resolution on Health Promotion
Annex 6.
Acknowledgements
Speakers at the plenary sessions
Facilitators of the plenary sessions
Rapporteurs and facilitators of the breakout sessions
Report writing team for the technical programme of the 5GCHP
Conference organizers
Annex 7.
Conference Products and Documents
Mexico Ministerial Statement (with list of countries that have signed)
List of 5GCHP case studies presented
List of 5GCHP technical reports presented
>
Please check the following web sites
http:// www. who. in t / hp r/ co n fe re nee
to obtain the documents referred to in this report.
)
23
<!
ANNEX I
!
DrGro Harlem Brundt/and
Director-General
W'orld Health Organisation
ly//h Global Conference on Health Promotion
Mexico, 5 June 2000
Your Excellency, President Ernesto Zedillo,
Secretary of Health, Jose Antonio Gonzalez Fernandez,
Dr Alleyne,
Distinguished Participants,
Colleagues, members of the press.
Last Wednesday, I was at a mass meeting in Bangkok. Standing on a platform I looked out over a sea of
blue caps and white T-shirts, Wave upon wave of slogans against tobacco. Ten thousand health
volunteers from villages all over Thailand had marched or bicycled to the city to mark the World No
Tobacco Day. Health was being promoted on a giant scale. From local level to regional, from regional
level to national, people were mobilised.
The speeches, though, weren’t just about telling people not to smoke. They were not about local, or even
national issues. They were about levels of taxation, about world-wide bans on advertising and the
Framework Convention on Tobacco Control. These global responses support a growing national
movement in Thailand: a movement against a public health disaster now killing someone in our world
every 8 seconds.
What happened that Wednesday morning brought out the essence of health promotion. Promoting health
is about enabling people to keep their minds and bodies in optimal condition for as long as possible.
That means that people know how to keep healthy. It means that they live under conditions where
healthy lifestyles arc feasible. It means that they have the power to make healthy choices. Yes, health
promotion is about making decisions - within the household, within society, and within the nation state.
Its about making decisions within international institutions whether thev are concerned with
development, trade, health or finance.
So much has happened since the last global Conference on Health Promotion in Jakarta in 1997. The
landscape for international health is changing in fundamental ways. More and more people understand
the benefits of good health. We know what needs to be done - in our lives and in our environments. We
now understand the links between health, politics and the economx more clearly than ever before. For
those of use meeting here in Mexico City, dedicated to promoting health, this rcallv is a powerful
moment.
It is a powerful moment because we know how to benefit from the increasing inter-dependence in
our world. Yes, globalisation frightens some people and causes uncertainty to many more. But it also
presents us all with genuine opportunities. New opportunities for global solidarity continue to emerge.
There is great convergence - of values, of ideas and of action.
At the same time the search for equit}- and justice in health now involves more people in effective local
level action than ever before, reflecting our cultural and linguistic diversity.
Bringing the two trends together, we recognise the power of linking global values with local action. This
is our responsibility as workers for health, as health promoters. No group is better placed to ensure that
greater economic integration brings benefits to those who need them the most. Through encouraging
24
ANNEX 1
global solidarity while nurturing diversity, we help to shape events in line with the values of equity and
fairness.
Now to a second reason why this is a powerful moment. Health is very big news - everywhere. It
involves more and more people. Health is no longer a concern only of health professionals. A much
wider constituency is engaged.
Let us reflect on what is happening:
Both national and international health issues arc prominent on the agenda when Heads of State,
including the G8 leaders, debate the major political issues of our time. Just last week, global health
featured prominently within the discussions at the U.S. European summit. (CHECK)
A month ago, Africa's Heads of State assessed the economic impact of malaria for their continent
and their peoples. They took responsibility for a continent wide effort to help people to halve the
impact of malaria on their lives. They undertook to promote a scries of proven interventions, making
them available to people in their homes, when they need them.
❖ More and more governments see good health as a critical element of Fluman Security. In some
nations this combination of human development and national security has become the basis of
foreign policy. It is therefore no surprise that a health issue - HIX’/AIDS in Africa - has been taken
up by the Security Council of the United Nations.
*»• The mobilisation of resources to improve national efforts for promoting health is on the agendas of
finance ministers as they discuss debt relief with the World Bank and IMF.
❖ Sustained improvement in International Health is a key theme in the Millennium Report by the
United Nation’s Secretary-General.
Health has now moved to the heart of domestic and international development agendas. Good health is increasingly
recognised as a pre-reejuisite if communities are to he enabled to fight against poverty.
Hon> can those oj us who promote health take advantage of this powerful moment? \\"e have an unparalleled opportunity to
make a real difference. Our Mission is clear. H e must empower people to make healthy choices for themselves and their
families.
When the World Health Organization set out to improve health 50 years ago, there were hopes that
antibiotics, vaccines and biomedical technology would provide the tools to achieve health for all.
f However, decades of health development have clearly shown that technologies are not enough toC'/
guarantee people's health. \ range of civil, cultural, economic, political and social conditions have to be I
addressed as well.
Many of the major determinants of better health lie outside the health system. Knowledge. Made
available to people. Clean environments. Access to basic services. Fair societies. Fulfilled human rights.
Good government. Enabling people to make decisions relevant to their lives, and to act on them.
Let us agree on the key points: for people to have the power to be healthy, they first need
knowledge. Accurate, reliable knowledge about how to achieve good health, and about the risks to
health that they face in their daily lives. Tliey need knowledge that helps them to make the best choices
and to implement them. They need to know how she or he can achieve good health: how the family can
stay healthy. As we see from the recent trends of reduction in heart diseases and cancers in several
industrialized countries, up to date, applicable knowledge is a pre-requisite for better health.
25
ANNEX 1
Knowledge is necessary, but it is not sufficient. For people to have the power to be healthy, they
must be in a position to choose better health. This means making the right choices, and putting them
into practice. If people are not able to do so, the new knowledge leads to frustration. That is why health
promotion has focussed extensively on the issues of hcalthv cities, healthy schools, healthy workplaces
and healthy homes. Environments within which people can choose to be healthy, and implement their
choices in their daily lives. A good example is this citv, winch has made great strides to improve its
environment over the past decade.
>
Yet, the combination of knowledge and a healthy environment may not be enough. Many people will still
not feel that the power to be healthy is in their hands. The third element is their being empowered to
make the healthy choices for themselves - and stick to them. Tins means local, national - and even
international — policies that give them the freedom to do what they want, and need, to do.
❖ Promoting sexual health, among teenagers, often requires those responsible for local or national
government to adopt policies that fly in the face of deeplv-held beliefs
❖ Enabling people at risk to protect themselves and their families from the risks of malaria may call for
liberalised access to mosquito nets, insecticides with which to coat them, treatment for those affected
by malaria.
•:*
Empowering young people to avoid tobacco use involves global action to limit the tobacco industry's
attempts to lure children and youth into smoking: knowledge and encouragement are, on their own,
insufficient to protect those under 20 from nicotine addiction.
Promoting health means transcending the narrow slot traditionally labelled llhealtbpromotion". That is why, when I am
asked who is in charge ofhealth promotion at WHO, 1 answer. “J am. " All departmental staff, be they in Geneva, the
regional or the country offices, have explicit health promotion responsibilities.
Promoting health means reducing risks to health and modifying behaviour that affects it. Our contribution is dear. If 'e help
to provide knowledge about determinants ofhealth, and ensure that it is made widely available, lie help to build consensus
around ways in which this knowledge can be put into practice - in different settings, among different communities. We
encourage public policies that help people themselves to take the action necessa/y to put this knowledge into practice.
II e recognise that this irork poses important challenges:
[~\oiv to balance the role ofgovernments in pursuing healthy public policies while, at the same time, enabling individuals
to choose what they want to do for themselves as long as it does not harm others?
I low can we be sure that the complex debates about interactions between different risks to people s health are
comprehensible to the majority who lack specialised knowledge, wherever they live, whatever their circumstances?
•>
How can we help health systems evolve into organisations that work on behalfofallpeople, reflecting the complex
interplay oj risks to people's health, and offering advice to individuals, to communities and to local authorities that
promote health-seeking and care-seeking behaviour?
❖
Which mechanisms are appropriate - and effective - to takeforward trans-national interventions against global health
threats, such as tobacco?
❖
W 'hat approaches can we use to promote access to publicgoods - such as essential drugs - when people are unable to
access them because ofsystematic market failures?
❖
How do we ensure that minimum environmental labour and health standards are followed in a world where investors
move assets in a matter oj months and capital in a matter of seconds to ensure maximum short-time gains?
26
<1
ANNEX I
Yom will be discussing such questions over the coming days. The member states and secretariat of the W 'or/d Health
Organisation have a key role to play in helping to find answers.
WHO’s overall strategy helps to set priorities. It lays out four strategic directions: reducing excess
mortality and disability, reducing risks to human health, developing health systems that equitably improve
health outcomes, and putting health at the centre of economic and development policv.
AU these four directions have elements of health promotion. Each involves us in disseminating
knowledge, establishing consensus about how the knowledge can be implemented, and encouraging
healthy public policies that encourage people to implement the knowledge for themselves.
In serving as the international technical agency for health, WI IO has several core functions through
which the directions are pursued.
WI IO will set standards and bring forward the evidence. Take the issue of food safetv. Our core function
is to act as an independent provider of knowledge and evidence.
Yet, providing knowledge is not enough. Evidence must translate into action. We must speak out about
the information we possess. Broaden the constituency of organizations thai have the power to act. Build
coalitions of different partners — nationally and internationally. Working with others will translate ideas
and commitments into better and more effective health systems.
Then we must help policy-makers, regulatory authorities and trade bodies make the best decisions
possible. The tougher the issue for society, the greater the need for WHO to help decision-makers reach
informed judgements.
We in WHO have learnt that programmes and policies are most likely to be sustained and successful if
the people they are meant to serve are engaged in their design and implementation. Initiatives that rely on
one sector alone are less likely to be effective than multi-sectoral efforts. Local initiatives arc more likely
to be effective when supported through global efforts.
I he issue M tobacco illustrates this. The current annual toU of 4 million tobacco deaths world-wide wiU
rise to 10 million by 2030. Seventy per cent of the increase will damage developing countries. The WHO
Framework Convention on Tobacco Control wiU become one of the most powerful tools to promote
health.
Full negotiation on this item will begin in October, and already we see emerging unprecedented global
support for strong action. Adoption of the Convention, and its implementation, will be a crucial move bv
nations of the world to adopt healthy public policies.
Mr President,
Promoting health is a noble pursuit, but is it a goal in itself? Mam- of you would say yes, and I share that
view. But I would like us to widen our ambitions. Health is important not only for how it lengthens
life and improves its quality — it is also an important contributor to economic and social
development.
Poverty perpetuates ill health.
In all our efforts we have to give special attention to the challenge of reducing poverty. The Nobel
economics prize laureate Amartya Sen defines poverty as “deprivation of capabilityl ie argues that
people arc poor not only because their income is low, but because they do not have access to basic
services, such as health and education, which would have increased their freedom. Poverty, he says,
seriously deprives people of a number of choices they must have available in order to live a satisfying life.
27
4 -
il
ANNEX 1
But improvements in health reduce poverty and enable growth.
As in Europe at the end of the l^1* and beginning of the 20th century, we have seen that
developing countries which invest relatively more, and well, on health are likely to achieve higher
economic growth.
In East Asia, for example, life expectancy increased by over 18 years in the two decades that }
preceded the most dramatic economic take-off in history.
A recent analysis for the Asian Development Bank concluded that fully a third of the
' \
phenomenal Asian economic growth between 1965 and 1997 resulted from investment in people’s
health.
There is solid evidence to prove that investing wisely in health will help the world take a giant leap out of
poverty. We can drastically reduce the global burden of disease. If we manage, hundreds of millions of
people will be better able to fulfil their potential, enjoy their legitimate human rights and be driving forces
in development. People would benefit. The economy would benefit. The environment would benefit.
Our task is no less than this. It is a difficult one. But - at this powerful moment, here in Mexico - we can
commit ourselves to its achievement.
Thank you.
28
ANNEX 2
Dr George A.O. Alleyne
Director PAHO*
HEALTH PROMOTION—BRIDGING THE EQUITY GAP
Mexico, D.F., Mexico, 5 June 2000
Mr. President
Mr. Secretary of Health
Madam Director-General of WHO
Ministers of I lealth
Ladies and Gentlemen.
It is my very pleasant task to join with the Secretary and the Director-General in
i welcoming you
to tins Fifth Global Conference on I lealth Promotion, This is a joyous occasion for me and my
colleagues in the Pan American Health Organization as we welcome you to the Americas for this
Conference.
First, 1 must thank the Government of Mexico for its generosity and having shown us (he
hospitality for which Mexico and Mexicans are famous. There could not have been a better country to
host this Conference, which returns to the Americas for the first time since the historic Ottawa
conference in 1986 that set health promotion firmly as a priority in the minds of all those who arc
concerned with the public's health.
It is also veiy appropriate that this opening ceremony should be held in this museum which has
the world’s greatest ethnographical collection. Mr. President, every time 1 come here I am transported
back in time and the .realism of the exhibits stirs a chord in me. W hen I was here two months ago this
Conference was very much on my mind and for a while I had the strange sensation that the very stones
were rising up and the statues were speaking to me. And indeed they spoke of a past that is very relevant
to the issues before us this week.
They spoke of the great civilization of Teotihuacan and the glory of Tenochtitlan of the Aztecs,
and had me see the latter as a city that was the largest and most beautiful of its time. They spoke of a
public policy that was healthy to the extent that the elected rulers were themselves enjoined to set an
example in their lives and avoid health-damaging behavior. This public policy in the city that was the
umbilicus of the world had public latrines, proper disposal of waste water and public servants who kept
the streets clean. The five lakes were mirrors of the sun and moon. Personal hygiene was at a level onlv
dreamed about in most other places.
Community action and responsibility for the local waterways were in part responsible for them
being so clean. The orientation of the health services was seen in the delivery of medical treatment based
on a welfare system. The network of veterans' hospitals and the quarantine system were fore runners of
current public health practice. Moctezuma I had founded the famous botanical and zoological gardens
and his herbarium had collections of medicinal plants from all parts of middle America.
These stones and statues would tell me of equality of opportunity, of education for all, winch
undoubtedly contributed to good health.
And I could not but think that your Tenochtitlan was indeed a healthy city and exemplified many
of the basic concepts of health promotion that were so well codified in the First Conference in Ottawa
and solidified in other subsequent ones.
Pan American I Icalth Organization, Pan American Sanitary Bureau. Regional Office tor the Americas for
rhe Americas of the World I Icalth Organization.
Presented at the I ’ifth Global (ainference on I Icalth Promotion. Mexico, I). I
)
29
Mexico, 5-9 |unc 2000.
ANNEX 2
I came back to reality with the hope and conviction that this Fifth Conference would indeed light
a new fire for health promotion. It would seek to show that equity in health was indeed important and
that the strategies for health promotion are essential to bridge the gaps and decrease the disparities that
are unjust and unfair and therefore represent inequity.
But why should we be so fixed on the concept of equity in health? Docs tins idea that is behind
the noble goal of Health For All still have currency toda)-? I say it docs.
does. There are two concepts that
must guide us in our discussions. First there are disparities of health outcomes or disparities in health
status, but they are not manifestations of inequity unless we can say that they are unjust or unfair. It is
almost intuitively apparent that a good such as health that is universally prized as among the most
important attributes in life should not permit of disparities that arc unfair. In our lexicon, the concept of
equity is translated to mean that the difference that exists should be avoidable, should be beyond the will
or volition of the individual or group and ideally there should be an agent to which responsibility can be
assigned.
It is not enough to look at the health outcomes. One must look at those social conditions that
determine health outcome—the determinants of health. Many of the constitutions of our countries speak
to the right to health or as better put by the American Declaration on the Rights and Duties of Man. It is
of fundamental importance that in discussions on equity we understand the difference between disparities
in health status and disparities in the determinants of health that cause these health inequalities oMW
inequities.
~
-rl
This Conference will address the possibility' that the strategies of health promotion will reduce
the health disparities that we deem inequities. I have no doubt that you will have examples to share of
how public policy has been or can be shaped such that the disparities in health determinants be reduced.
One important aspect of such policy relates to the proper balance between maintaining a .strong cciitral) I
s^ate authority and yet decentralizing many operations to a more peripheral level. I am pleased to note '1
the progress Mexico has made in this regard and we in the Pan American Health Organization have been
witnesses to the universality ofcoverage in many of your states to which much of the execution has been
decentralized.
I hope that this Conference will not ignore (he possibilit\
nav imperious necessity that
attention be paid to gender equity. Gender discrimination as a cause of ill health is all too often ignored
because its manifestations are so subtle.
1 he call for re-orienting the health services has been heard clearly in this Region and almost
ever}' country is engaged in some reform of the health sector. Every one of them has equity as a
desideratum in addition to efficiency and effectiveness. There will be opportunities during this
Conference to reflect on how the main constituents of the reform process are being played out in
national contexts.
Equity is one of the basic value principles I have espoused loudly and vigorously in the Pan
American Health Organization and it represents a basic focus of our technical cooperation. \X c ask if
there are gaps in health outcomes or determinants and can our technical cooperation address them. \Xc
have concrete examples to demonstrate that this is possible.
Mr. President, these Conferences are global rather than international and this implies that the
business of promoting the public's health is a matter that involves nations yes, but involves a wider
constituency. The call for partnership is as clear today as when it was issued in Jakarta at the Fourth
Conference and I am pleased to note the many examples of such partnerships that have flourished
globally and regionally in favor of health.
Mr. President, Mr. Secretary, let me thank you again for your hospitality and as we go out from
this place, I hope that we will indeed hear the voices of some of your gods of years past. And I trust they
will give us some of their wisdom such this Fifth Conference will fulfill the high aspirations of those who
)
30
5.^
■2- 8
f oS g
g
p
I ?
I pi a
“■
§a t
Ii
5• c
II
H
e-
I
o
i
>
z
z
PI
X
(I
!
ANNEX 3
MINISTERIAL PROGRAMME
Sunday 6th June
When
What
14:00 onwards
Participant registration
Late afternoon
Welcome reception
18:00
Briefing of the Ministerial delegations
Monday 5th June
When
What
9:00-10:30
Opening Ceremony
Speakers:
Lie. Jose Antonio Gonzalez Fernandez, Minister of Health, Mexico
Dr Gro Harlem Brundtland, Director General, WHO
Dr George A.O. Alleyne, Director, PAI IO
Signature of the Mexico Ministerial Statement for the Promotion of Health
>
Welcoming Message:
Dr Ernesto Zedillo Ponce de Leon, President of Mexico
10:30- 11:00
Return to Sheraton Hotel and I lealthy Break
11:00- 12:30
Joint Technical-Ministerial session - Setting the Stage
Overview of Past Accomplishments and Present Challenges
Chairpersons: Lie. Jose Antonio Gonzalez Fernandez, Minister of Health, Mexico
Dr Gro Harlem Brundtland, Director General, WHO
Dr George A.O. Alleyne, Director, PA HO
Introduction:
Dr. Achmad Sujudi, Minister of Health, Indonesia
Speakers:
Dr Michael Marmot, Department of Epidemiology, University College,
London
Dr Alexandre Kalache, Acting Director, Department of Health
Promotion, WHO
Facilitator:
Dr. Roberto Tapia C.
12:30- 14:00
Lunch
14:00 - 16:00
r( Ministerial Session: Healthy Public Policies Equity, Investment on Health
and Development
16:00-16:30
Chairperson:
Dr Gro Harlem Brundtland, Director General WHO
Secretary:
Lie. Mario Luis Fuentes Alcala, General Director ot the Mexican
Institute of Social Security, Mexico
Healthy Break
J
ANNEX 3
16:30- 18:30
2,,d Ministerial Session: Social Responsibility for Health Promotion:
Community Participation and the Involvement of all Sectors
20:00
Chairperson:
Dr George A. O. Alleyne, Director PAI IO
Secretary:
Lie. Socorro Diaz Palacios, General Director, Institute of Social
Security and Sendees for State Workers, Mexico
Special Performance of the Mexican Ballet
Tuesday, 6th June
When
What
9:00- 11:00
3rd Ministerial Session: Reorienting Health Systems and Services
Chairperson:
Dr David Satcher, Surgeon General of the United States of America
Secretary:
Lie. Enrique Burgos Garcia, General Director of the Programme for
the Integral Development of the Family, Mexico
11:00-11:30
Healthy Break
11:30 - 13:30
4'1' Ministerial Session: Mental Health and Healthy Life Conditions: Major
Challenges for Health Promotion
)
Chairperson:
Dr Manuel Urbina Fuentes, Undersecretary, Ministry of Health, Mexico
Secretary:
Dr Enrique Wolpert Barraza, President of the National Academy of
Medicine, Mexico
13:30-15:00
Lunch - Buffet
15:00
Joint Technical-Ministerial Session: Sharing the Conclusions of Two Days’
Work
16:30
Minister Tim Menakaya, Nigeria
Minister Hamza Rafeeq, Trinidad and Tobago
Minister Aaron D. Chiduo, Tanzania
Minister Fr. Savvides, Cyprus
Prof Don Nutbeam — Technical report
Synthesis & Facilitator:Dr Julio Frenk, WHO
20:00
Ministers’ Closing Dinner
1
34
<1
i
r*)
X
M
Z
z
<
>
□
c
5
5
i-
>
p"
1J 4
>
I fl ’
I
VsA
«
CJ
c
C5
’So
s
si
>■
!
w
CS
CD
£
£
So
o
£
<u
CJ
a
a
o
U
i—H
c5
U
•iH
111
>
F
■
S
h
i
a
I
I
•r)
en
I %n
>
I
s
3
->
88:’
I K.
1
a
CJ
<u
H
I
n
i
i
>
I
1
)
J
I
J
’I
<1
J
ANNEX 4
5GCHP Ad Hoc Working Group on Evaluation in Health Promotion16
The following text is taken from a summary report by May Hall, the working group rapporteur, the major points
and recommendations ofwhich were presented to the 5GCI IP conference by Daria'McQueen.
1.
There was general agreement on the distinction between purposes for evaluation, and the types
of evidence one collects for each. One purpose is for t he benefit of the program and its
stakeholders. The evidence gathered in this type of evaluation is used to guide the program and
Fo make improvements. Process measures are used as evidence for this purpose. A second
purpose for evaluation is to provide proof to funders and policy makers that the program has an
e^ecb a value. The types of evidence collected for this purpose are outcome
measures that demonstrate the impact of the program or policy.
2
Many voices are still missing from the discussion/debate on evidence. These may be
representatives from developing nations, or people who arc not typically included in such
discussions as they do not tend to hold the type of government offices that allow them at the
(able. The workgroup must find a way to uncover these voices, and the approaches used by
developing nations that are meaningful. These voices and methods must be incorporated into
the existing body of evidence.
3.
Participants requested further definition of rhe core techniques
techniq
for conducting health promotion
evaluation. I lowever, before this core can be agreed upon, it is essential to more closely define
the term “health promotion.” Il it is agreed that the heart of health promotion is community
and policy change, then health promotion evaluation should include techniques~on~~ITd\v to
measure that complex system of change.
4. Whatever the context for health promotion evaluation, such evaluations must be conducted in
partnership with stakeholders and/or the communities in which programs arc taking place. 1 his
requires that stakeholders are also involved in program planning, and that evaluation measures
chosen will be meaningful to stakeholders/communities. Evaluations should be conducted
equitably, both in the process and in applying the outcomes. Resources for evaluation should
also be applied equitably.
Recommendations:
WHO should establish an Evaluation Development Workgroup that will be responsible for
creating a plan for the development of evaluation globally.
♦> This Workgroup, which should build on work previously done by the European Workgroup,
should consider existing work in this area, and should integrate unpublished work into current
evaluation knowledge.
16 Co-chairs: Ligia de Salazar (Colombia): David Me Queen (United States) - Core group set up by the Sgchp
organisers: the co-chairs of the WG; representatives of major leading initiatives on HP evaluation; the members of
the 5GCHP technical review and support group; - WG Participants: invited and welcomed experts from developed
and developing nations
36
1
ANNEX 4
•** Evaluation approaches should recognize the importance of equity in conducting locallydetermined evaluation, and should emphasize the use of participatory approaches and
multisectorial involvement in evaluation.
❖ This Workgroup should have equal representation from developed and developing countries,
and diverse_ cultural representation. Members, to be selected in collaboration with global
partners, should have expertise and experience in evaluation and health promotion. The
Workgroup should complete its work within one year of being convened.
37
i!
1
ANNEX 5
World Health Assembly Resolution on Health Promotion
1
1
>
FIFTY-FIRST WORLD HEALTH ASSEMBLY
WHA 51.12
Agenda item 20
16 May 1998
Health Promotion
The Fifty-first World Health Assembly,
Recalling resolution WHA42.44 on health promotion, public information and education for
health and the outcome of the four international conferences on health promotion (Ottawa, 1986;
Adelaide, Australia, 1988; Sundsvall, Sweden, 1991; Jakarta, 1997);
Recognizing that the Ottawa Charter for Health Promotion has been a worldwide source of
guidance and inspiration for health promotion development through its five essential strategies to build
healthy public policy, create supportive environments, strengthen community action, develop personal
skills, and reorient health services;
Mindful of the clear evidence that: (a) comprehensive approaches that use combinations of rhe
five strategies are the most effective; (b) certain settings offer practical opportunities for the
implementation of comprehensive strategies, such as cities, islands, local communities, markets, schools,
workplaces, and health services; (c) people have to be at the centre of health promotion action and
decision-making processes if they are to be effective; (d) access to education and information is vital in
achieving effective participation and the “empowerment” of people and communities; (e) health
promotion is a “key investment” and an essential element of health development;
Mindful of the new challenges and determinants of health and that new forms of action arc
needed to free the potential for health promotion in many sectors of society, among local communities,
and within families, using an approach based on sound evidence;
Appreciating the potential of health promotion activities to act as a resource for societal
development and that there is a clear need to break through traditional boundaries within government
sectors, between governmental and nongovernmental organizations, and between the public and private
sectors;
)
Noting the efforts made by the 10 countries with a population of over 100 million to promote
the establishment of a network of most-populous countries for health promotion;
Confirming the priorities set out in the Jakarta Declaration for Health Promotion in the
Twenty-first Century,
38
WHA 51.12
<1
ANNEX 5
1.
1
URGES all Member States:
(1)
to promote social responsibility for health;
(2)
io increase investments for health development;
(3)
to consolidate and expand “partnerships for health”;
(4)
to increase community capacity and “empower” the individual in matters of health;
(5)
to strengthen consideration of health requirements and promotion in all policies;
to adopt an evidence-based approach to health promotion policy and practice, using the full
(6)
range of quantitative and qualitative methodologies;
2.
3.
CALLS ON organizations of the United Nations system, intergovernmental and nongovernmental
organizations and foundations, donors and the international community as a whole:
(1)
to mobilize Member States and assist them to implement these strategies;
(2)
to form global, regional and local health promotion networks;
CALLS ON the Director-General:
(1)
to enhance the Organization’s capacity with that of the Member States to foster the development
of health-promoting cities, islands, local communities, markets, schools, workplaces, and health services;
(2)
to implement strategies for health promotion throughout the life span with particular attention
to the vulnerable groups in order to decrease inequities in health;
4.
REQUESTS the Director-General:
(1)
to take the lead in establishing an alliance for global health promotion and in enabling Member
States to implement the Jakarta Declaration and other local/regional declarations on health promotion;
(2)
to support the development of evidence-based health promotion policy and practice within the
Organization;
(3)
toj-aisc health promotion to the top priority list of W HO in order to support the development
of health promotion within the Organization;
to report back to the 105th session of the Executive Board and to the Fifty-third W orld Health
Assembly on the progress achieved.
Tenth plenary meeting, 16 May 1998
A51/VR/10
39
WIIA 51.12
<1
ANNEX 6
Acknowledgements
The conference organizers. World Health Organization, Pan American Health Organization and the
Mexico Ministry of Health, wish to express their warm appreciation of all those who actively
contributed to the Fifth Global Conference on Health Promotion.
In this annex to the report of the technical programme special thanks are extended to the following
groups of persons whose contributions were essential to the success of the conference.
Speakers at the plenary sessions
Rina Alcalay
Keziah Awosika
Parveen Azam Khan
Elizabeth Casey
Indira Chakravarty
Mirai Chatterjee
Gerard d’Abreau
Michael Drupp
Jonathan Fielding
Mariana Galarza
Alonso Garcia Acosta
Mariano Garcia Viveros
Rodolfo Garzon Mendizabal
Pat Graham-Casey
Rebecca Holmes
Alexandre Kalache
Rolf Altmann
Daniel Lopez-Acuna
Michael Marmot
Enrique Martinez
David McQueen
Maurice Mittelmark
Rob Moodie
Antoinette Ntuli
Martin Pacheco
Scott Ratzan
Helena Restrepo
Jonathan Rosenberg
A own Shawa
\X a ng S huge ng
Achmad Sujudi
Zhang Zeshu
Erio Ziglio
Elizabeth Zonneveld
Facilitators of the plenary sessions
John Batten
Bryna Brennan
Somsak Chunaras
Gillian Durham
Julio Frenk
Uton Much tar Rafei
Roberto Tapia
Rapporteurs and facilitators of the breakout sessions
Robert Anderson
Tariq Bhatti
Malinee Chulavachana
Halina Cyr
Richard Horst Noack
Martin Pacheco
Fran Perkins
Bosse Pettcrsson
40
ANNEX 6
Gerard D'Abreau
Ligia de Salazar
Doris Gillis
Martha Lucia Gutierrez
Nancy Hailey
Piedad Huerta
Josefa Ippolito-Shepherd
Sergio Ma res man
Guillermo Mendoza
Angel Roca
Irving Rootman
Paulina Salamo
Lourdes E. Soto de Laurido
ICC Tang
Maria Luisa Vazquez Navarrete
Marilyn Wise
Liesbeth Zonneveld
Report Writing Team for the Technical Programme of the 5GCHP
Don Nutbeam, National Centre for Health Promotion, University of Sydney, Australia
(Conference rapporteur)
Ursel Broesskamp-Stone, WHO
Maria-Teresa Cerqueira, PAHO
Jane Springett, Liverpool John Moores University, United Kingdom
Conference Organizers
Marcela Acuna, Mol I, Mexico
Isolde Birdthistle, WHO
Ursel Broesskamp-Stone, WHO
Desmond O’Byrne, WHO
Maria Teresa Cerqueira, PAHO
Carol Collado, PAHO
Ingrid Cox, WHO
Julio Gonzalez, PAHO/WHO Mexico Office
Pamela Hartigan, WHO
Eduardo Jaramillo, MoH, Mexico
Henri E. Jouval, PAHO/WHO, Mexico Office
Amy Maines, WHO
Maria Fernanda Merino, MoH, Mexico
Patricia Owen, PAHO
Angela Paraluppi-Raviglione, WHO
Paola Piazza-Vincent, WHO
Lucero Rodriguez, MoH, Mexico
lose Antonio Solis, PAHO
Roberto Tapia, MoH, Mexico
Javier Urbina Soria, MoH, Mexico
Lisa Veron, Wl IO
41
d
FIFTH GLOBAL CONFERENCE ON HEALTH
PROMOTION
Health Promotion: Bridging the Equity Gap
Mexico City, June 5'1', 2000
Mexico Ministerial Statement for the Promotion of Health : From Ideas to Action
Gathered in Mexico City on the occasion of the I ifth Global Conference on I leal th
Promotion, the Ministers of Health who sign this Statement:
1.
Recognize that the attainment of the highest possible standard of health is a positive
asset for the enjoyment of life and necessary for social and economic development
and equity.
9
Acknowledge that the promotion of health and social development is a central duty
and responsibility of governments, that all sectors of society share.
3. Are mindful that, in recent years, through the sustained efforts of governments and
societies working together, there have been significant health improvements and
progress in the provision of health services in many countries of the world.
4. Realize that, despite this progress, many health problems still persist which hinder
social and economic development and must therefore be urgently addressed to
further equity in the attainment of health and well being.
5. Are mindful that, at the same time, new and re-emerging diseases threaten rhe
progress made in health.
6.
Realize that it is urgent to address the social, economic and environmental
determinants of health and that this requires strengthened mechanisms of
collaboration for the promotion of health across al sectors and at all levels of society-.
7.
Conclude that health promotion must be a fundamental component of public
policies and programmes in all countries in the pursuit of equity and better health for
all.
8. Realize that there is ample evidence that good health promotion strategies of
promoting health are effective.
42
b1
Considering the above, we subscribe to the following:
ACTIONS
A. To position the promotion of health as a fundamental priority in local, regional.
national and international policies and programmes.
B.
To take the leading role in ensuring the active participation of all sectors and civil
society, in the implementation of health promoting actions which strengthen and
expand partnerships for health.
C. To support the preparation of country-wide plans of action for promoting health, if
necessary drawing on the expertise in this area of WHO and its partners. These plans
will vary according to the national context, but will follow a basic framework agreed
upon during the Fifth Global Conference on Health Promotion, and may include
among others:
•
The identification of health priorities and the establishment of healthy public policies
and programmes to address these.
•
Fhe support of research which advances knowledge on selected priorities.
•
Fhe mobilization of financial and operational resources to build human and
institutional capacity for the development, implementation, monitoring and
evaluation of country-wide plans of action.
D. To establish or strengthen national and international networks which promote health.
E. To advocate that UN agencies be accountable for the health impact of their
development agenda.
F. To inform the Director General of the World Health Organization, for the purpose
of her report to the 107th session of the Executive Board, of the progress made in the
performance of the above actions.
Signed in Mexico City, on June 5'1' 2000, in Arabic, Chinese, English, French, Portuguese,
Russian, and Spanish, all texts being equally authentic.
1
43
’<1
Mexico Ministerial Statement for the Promotion of Health : From Ideas to Action
This Ministerial Statement was signed by the following countries:
Algeria
Angola
Argentina
Aruba
Australia
Austria
Bangladesh
Belize
Bhutan
Bolivia
Brazil
Bulgaria
Cameroon
Canada
China
Colombia
Costa Rica
Cuba
Czech Republic
Denmark
Dominica
Dominican Republic
Ecuador
El Salvador
Egypt
Finland
France
Gabon
Germany
Guatemala
Haiti
Hungary
India
Indonesia
Iran
Israel
Jamaica
Korea
Kuwait
Lao PDR
Lebanon
Madagascar
Malaysia
Maldives
Malta
Marshall Islands
Mexico
Morocco
Mozambique
Myanmar
Namibia
Nepal
Netherlands
New Zealand
Nicaragua
NigerNorway
Oman
Pakistan
Panama
Paraguay
Poland
Portugal
Puerto Rico
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Samoa
Slovakia
Slovenia
South Africa
Spain
Sudan
Swaziland
Sweden
Switzerland
Thailand
Turkey
United Kingdom
United States
Uruguay
Vanuatu
Venezuela
Yugoslavia
Zambia
Zimbabwe
44
.1
!
Case Studies presented during the Conference
INCREASING INVESTMENT FOR HEALTFI DEVELOPMENT
1 he case study "Igniting the Fires of Hope", presented by Martin Pacheco and Gerard
d'Abreau, told the story of SERVOL, an NGO from Trinidad & Tobago which offers
child and youth programmes in community centres.
"Three months after Father Gerard Pantin, walked into Lavcntille in 1970 he confessed
to one of the residents called Chaca that he was getting nowhere and was thinking of
giving up. Chaca vehemently protested, 'You cannot do that! It is true that you have
done nothing more than get jobs for a few dozen kids; but what you have really done is
to bring HOPE to the area. Every morning you walk up the hill, those watching you
think: maybe tomorrow it will be my turn to get a job. And once people have hope they
will continue the struggle.' "
The case study "Environmental Health Promotion and Solid Waste Management in Gaza
City", presented by Mr Aown Shawa, Mayor of Gaza City, and Ms Liesbeth Zonneveld,
described how the Gaza City municipality, with El1 funding and enthusiastic community
participation, cleaned up its garbage- and sewage-filled streets.
" ... the aim was not just regular and affordable waste collection and disposal - project
sought to involve citizens and municipal staff in a wider dialogue on 'how to improve
living conditions in our city - how to make our city a healthy one', and to engage the
entire Palestinian community in the battle to improve their environmental health
conditions...."
Phe case study "Enterprise for Health", presented by Dr 1 lerren Landig and Dr Michael
Drupp, described a WHO/EURO-funded initiative on worker health promotion in
Lower Saxony, Germany.
"WHO partnered with the regional association of Local Sickness Funds of Lower Saxony
to create an incentive for private enterprises to invest in health. Granted 'bonuses’ in the
amount of one month's payment to the government’s social security health insurance (for
both employee and employer payments), for those companies willing to commit to
comprehensive workplace health promotion."
SOCIAL RESPONSIBILITY FOR HEALTH
>
I he case study "SEWA: Self-Employed Women's Association, Gujarat, India", presented
by Mirai Chatterjee described the work of a trade union for poor, self-employed women
workers who earn a living through their own labour or small businesses.
"... a Union of 220,000 women workers of the unorganised sector. Self-employed
workers constitute 93 percent of the Indian workforce. They do not have regular salaried
employment with welfare benefits: no weekly
day off, sick leave, pension, nor any maternity benefits. They are the poorest of workers,
and yet, they ... account for 63 percent of gross domestic product in India."
45
<1
The case study "Street Food Project, Calcutta", presented by Professor Indira
Chakravarty, described how Calcutta authorities brought together the mayor, citv and
police authorities, community workers and street food vendors to improve the safetv and
nutritional value of street food.
"Street food vendors could be called the nutritionists of the poor. An individual's dailv
nutritional needs can be met with just a few rupees. However, street food can pose a
significant health risk for consumers. Often ignored or tolerated bv food control and
public health officials, street food in many cities has become a critical concern..."
The case study "Latrine Revolution in the Henan Province", presented by Zhang Zeshu
and Wang Shugeng described the project that introduced double-urn latrines to turn
human excrement into non-hazardous, high quality fertiliser for use tn agriculture.
"... the use of human nightsoil as fertilizer for farming is a fundamental aspect of Chinese
culture. The exposed excreta emit offensive smells and serve as a favourable habitat for
flies... Unhygienic conditions caused diarrhea and intestinal parasitic infections to run
rampant in rural towns and villages. ... Professional health and agricultural workers
invented the double-urn, funnel-shaped latrine...The new design allows human excreta
to become non-hazardous fertilizer."
INCREASING COMMUNITY CAPACITY AND EMPOWERING THE
INDIVIDUAL
The case study "Building Linkages with Democracy and Health" was presented bv Ms
Rebecca Holmes and Dr Keziah Awosika and described a partnership between 19
Nigerian NGOs and Johns I lopkins University to promote women's empowerment and
participation in politics.
"Promoting the active involvement of women in public decision-making processes helps
to ensure that practical gender interests arc adequately addressed through appropriate
policies and programs [including] reproductive and child health, literacy, access to clean
water and sanitation, food supplies and prices, increased opportunities for income
generation, early marriage, rights to inheritance and property, access to quality health
services..."
I he case study "Versalles: Healthy Municipality tor Peace", presented by Dr Gilda Stella
Millan and Mr Alonso Garcia Acosta, Mayor of Versalles, described programmes
implemented by (his Colombian municipality to address health, education, conservation
and development.
"... local development occurs within a health promotion framework and involves the
active participation of community members in determining priorities for action as well as
the appropriate strategies for addressing the identified needs. Using a methodology that
combines analysis, action, and reflection, diverse sectors work jointly for education,
community participation, equity, and sustainability."
The case study “Against the odds — Waiterton and Elgin, From Campaign to Control”
(United Kingdom), presented by Jonathan Rosenberg, described a North London
community campaign in the 1980s which fought to prevent the local authority from
46
(I
redeveloping the area as private housing for sale at prices beyond the reach of local
people.
"WECH, a resident-controlled housing association, campaigned to prevent the local
authority from redeveloping the area as private housing for sale at prices beyond the
reach of local people. The two tower blocks were built out of steel, concrete and fibre
glass. 'The lifts regularly broke down, the rubbish chutes blocked, and residents suffered
flooding and water penetration. The worst problem was the wide range of asbestos
products used as fire protection."
SECURING AN INFRASTRUCTURE FOR HEALTH PROMOTION
1 he case study “ The Global Embrace: A World-Wide Walk Event for Active Ageing”,
presented by Dr Alex Kalache, described the highly visible one-day event consisting of a
chain of locally organised celebrations and walks in 96 countries, occurring consecutively
around the globe over a period of 24 hours.
” The vast majority of people, as they age, continue to live within their local communities.
Grass-roots and community-based activities are a natural focus to promote healthy and
active ageing. ... walking is not only an excellent form of physical exercise but also
enhances social integration as it is a good way to meet people or enjoy the
companionship of friends and family.”
The case study “Equity Gauge — a tool for monitoring equity in health and health care in
South Africa”, presented by Antoinette Ntuli, described a project which supports
improvement and reorientation of health services with the help of national and provincial
lawmakers by setting up benchmarks to measure progress toward equity in health and
health care.
”... a national project to help South Africans know if then health is improving and
measure progress toward equity in health care provision. A partnership between South
African Legislators and the Health Systems Trust to support the transformation of the
health system.”
I he case study “Integration Of The Consensus-Action Group: A Network Of Academic
And Social Institutions For Community Health Promotion And Education (Mexico)”,
presented by Dr. Mariano Garcia Viveros, described the work of an action group formed
to strengthen health promotion activities by mobilizing academic institutions to provide
scientific support for health priority areas.
"... a network of investigators and educators to provide support to those working in
health promotion, closing the gap between theory and practice. Network includes a
variety of institutions with established infrastructure and significant potential for
mobilizing to strengthen community capacity ...”
47
<1
REORIENTING HEALTH SERVICES AND SYSTEMS
Fhe case study “Association Vivir: Promoting Daily I lealth With Community
Participation”, presented by Dr Mariana Galarza, described how, in response to
inadequacies of the existing health system, a private NGO, provides primary and
preventive services and training.
”... a non-governmental organization that opened the door to alternative forms of health
care in Ecuador. According to Dr. Galarza, the predominant curative approach to health
care fails to see the human being in a comprehensive light; ignoring the social, emotional,
and environmental causes of illness.”
'Fhe case study “Community Care Network (CCN) Evaluation Program: A Case Study of
An Expanding Private/Public Partnership in Rural United States”, presented by
Elizabeth Casey and Pat Graham-Casey, described how CCN addresses community
health improvements via public/private partnerships to determine community needs,
ensure continuum of care, and effectively manage resources.
” ... initially focused on improving cancer screening services for the underseived. It has
now effectively expanded its service to include more comprehensive efforts to prevent
chronic disease and improve all aspects of health care for the residents of west Texas."
The case study “Drug Abuse Prevention with Young People in Peshawar, Pakistan”,
presented by Dr Parveen Azam Khan, described the work of the DOST Welfare
Foundation in the treatment and rehabilitation of drug addicts and their families and
prevention of drug abuse in the community.
"DOST Welfare Foundation responds to the need for effective rehabilitation based on
whole person recovery, i.e. physical, psychological, social and spiritual. Treats and
rehabilitates drug addicts and, in parallel, works for drug abuse prevention in the
community’, by strengthening young people to resist the lure of drugs and develop
healthy alternatives...."
48
il
Technical Reports written for the Fifth Global Conference on Health
Promotion
"Strengthening the Evidence Base for Health Promotion”
By Dr David McQueen, USA.
"Investment for Health"
By Dr Erio Ziglio, WHO Regional Office for Europe; Prof. Spencer Hagard, UK;
Prof. Laurie McMahon, UK; Dr Sarah Harvey, UK; Prof. Lowell Levin, USA.
’’Promoting Social Responsibility for Health: Progress, Unmet Challenges and
Prospects”
By Dr Maurice Mittelmark, Norway.
’’Increasing Community Capacity7 and Empowering Communities for Promoting
Health”
By Dr Helena Restrepo, Colombia.
’’Infrastructure to promote health: the art of the possible”
By Dr Rob Moodie, Australia; Dr Elizabeth Pisani, Australia; Monica de
Castellarnan, Australia.
’’Reorienting Health Systems and Services with Health Promotion Criteria”
By Drs Daniel Lopez-Acuna, PAHO, WHO/AMRO; Patricia Pittman, USA;
Paulina Gomez, Chile; Hcloiza Machado de Souza, Brazil; Luis Andres Lopez
Fernandez, Spain.
49
u
Review/2005/I
3
Page 1 of 3
x| Review/2001/1
RHP&EO is the electronic journal of the International Union for Health Promotion and Education
II iWDP
Prlit/^ricd
t . . I
OowiatAic
- I
Doiiiamc
{’“'I
I IMO flrti.-l.
The dynamics of health promotion: from Ottawa to Bangkok
by Ilona Kickbusch, Senior advisor on health policy, Federal Office of Public health, Bern, Switzerland
Kickbit,di. lloiui. The dynamics of health promotion: from Ottawa lo Bunpkpk. 'Reviews oi ll<
Education Online, 2005. I ;RL:http: . 'vww.rhpca.ai'i'. reviews 200?•! index.him.
The fact, that WHO together with the Thai organizers of the Bangkok Conference has signaled the intention lo
produce “a Bangkok Charter on health promotion” has sent storms, waves and ripples through the health promotion
community. Suddenly, the uniqueness of the Ottawa Charter - a warm blanket that we had come to live with was
questioned. Various options emerged: it could be dismantled, it could be updated and even - as some implied
improved, or Bangkok could lead us to a new vision of public health in the 21st century. Meanwhile the first draft
is available for commentary.
I like the fact that the World Health Organization is beginning to take health promotion seriously^again and (hat the
process of the Bangkok Conference engages the health promotion community in a dialogue over the value of the
Ottawa Charter and any new approaches and innovations that may be necessary. And I am delighted to have been
asked to be a part of this process. This is indeed a rare opportunity in a professional career.
Twenty years have passed since those cold days of creation in a conference hotel in Ottawa in 1986 and in looking
back I am proud of what we achieved. WHO showed clear leadership and the Charter contributed significantly
towards a new public health. The Charter has held up incredibly well in these twenty years partly because it
reflected the many changes that were in the air, partly because it was based on sound research, partly because it was
clear about its values and partly because it was very participative in its production. But there is a new world and a
new policy environment out there and a new generation of health professionals needs lo take over the torch from
the Ottawa pioneers in order to move the field forward.
I would like to comment on five issues that I feel vve must consider in this process:
Developed - developing countries
Much has been made of the fact that the Ottawa Charter (OC) was for the developed world only and that we now
need “something global”. Yet the challenge thrown out by Dr. I lalfdan Mahler, the then Director General of the
WHO, was to make the principles of the Alma Ata Declaration applicable to the developed world in particular the
notion of empowerment. Indeed that concept came as much out of the experiences of the developing countries
Paolo Freire’s approach to conscientization to1 name one of the most influential - as it mirrored the global social
movements of the times. That has also been reinforced through that fact that it was easier to gain understanding for
health promotion and its strategies in many developing countries and with indigenous societies than in the
medicalized developed world.
The deliberations at Bangkok could help free the OC and health promotion from /A/.S’ misconception andfalse
dichotomy. In a global world there is no us and (hem - only us.
Integration - specific areas of action
Others like to indicate that there are big chunks missing from the Ottawa Charter an area that is mentioned
frequently is mental health. Yet the challenge of the OC was to provide an integrative strategy for Al I. the
dimensions of the WHO definition of health (physical, menial and social in the debate there was also frequent
reference to the spiritual) and to recognize that in real life the three are hardly separable. A simple case in point was
the heart disease research of the day which showed that the mental health effects of exercise groups were as
file:/A\Library\d\Health Promotion\from Ottawa to Bangkok.htm
25-May-05
Revie w/2005/1
Page 2 of 3
important as the physical. Another key influence on the OC was the research on social support and health, which,
given the medicalized mental health approach of the day. needed to find a strategic home as far away from mental
health as possible/Even though the OC did all it could to suggest that its five action areas could be applied to more
or less any health problem in any part of the world it seems there is a deep psychological need to find “my health
issue or problem" or “my vulnerable population group" in policy documents.
/ hope (he deliberations in Bangkok will be able to steer clear oflong lists and reinforce the clear strategic
directions of the OC.
The essential core
Health promotion practice has faced many difficult challenges, last not least to find recognition and funding for the
kind of approaches it stands for. In consequence many deals have been made pragmatically along the way. The OC
became the mantra while practice was something toned down to 111 reality. Increasingly the evidence that theOC
took from the knowledge base in the social sciences has arrived in the health arena through the research on social
determinants, social capital and even macroeconomics. I hardly dare mention that health promotion spoke about
investment in health even before the 1993 World Bank report was published.
The deliberations at Bangkok could help clear (he air a bit again and bring us back to the essentials: the focus on
health not disease, on resources not problems, on social determinants not symptoms, on people not professionals.
This includes (hose new determinants (hat are now global in reach and need new strategies of response.
The WHO role
WHO has not always been a reliable champion and partner in health promotion. Despite World Health Assembly
resolutions as to its importance the organization has had problems with assigning it the importance and budget that
the policy documents would indicate and ensuring an ofgamzation wide commitment. Changes in staffing and
Outlook as well as personal preferences (based on the Not-invented-here Syndrome) have led to many up and
downs the most far reaching being the near equation (and al limes replacement) of health promotion with noncommunicable disease control.
!
I hope the deliberations in Bangkok can give a clear message to (he WHO as to the relevance and scope of health
promotion and (he very strong contribution it can give to the WHO Commission on Social Determinants. It is a
core function of public health and health policy and should be a core function ofevery government and of a global
health organization.
The other partners
The OC is very “nation-state focused" in its approach because it wanted to underline that governments have a
responsibility for the health of their people - particularly in (he then new area of “lifestyles". The challenge of
healthy public policy is now becoming increasingly recognized within governments and in the global arena. I lealth
promotion has also frequently been at the cutting edge of public health thinking beyond the state - for example in
relation to civil society involvement in health or public private partnerships. This has not always been well received
initially. Health promotion developed this capacity for innovation through its work in the community with people
in short the untidy processes of real life. It remains true that "health is everybody's business" and that we should
make “the healthy choice the easier choice" - finally it seems that this message is reaching more and more policy
makers and is being turned into concrete strategies - witness the actions on tobacco or on obesity as well as some
of the new health policy initiatives in countries. Finally many strategic approaches heralded by famous
management gurus have - for example been practiced every day in the “settings projects". Indeed health
promotion has been a great social laboratory, not only of health but of participation and democracy.
/ hope the deliberations in Bangkok will include many of these other partners -from the public, the private and the
NGO sector and that any document that emerges will reflect their commitment to health and health promotion.
Finally:
In my view there is no need to dismantle, revise or improve the Ottawa Charter - it is a living document with deep
vision and practical orientation. We should let it stand.
But at the same lime we should look forward. Let us work towards a conference outcome that is both as visionary
and as resilient as the Ottawa Charter and complements it in important dimensions. What is should be called is part
of the democratic process at the conference.
file:/A\Library\d\Health Promotion\from Ottawa to Bangkok.htm
25-May-05
Review/2005/1
Page 3 of 3
Beyond a document I hope that a group of committed partners^wdl comejogether to support the WHO in its work
on health promotion - so as to ensure continuity of effort. Many of the disease!peciffc areasTiave"seen the forging
of important focused alliances with a good funding base - health promotion should aim to create a global
partnership that will support the results of the conference and the implementation of whatever the key action areas
of a Bangkok Charter might be.
I hope that by the time we then come together at the IUHPE Conference in VancouverJ.n 2007jhe first policy
impacts of such a partnership can be reported.
You want to react to this text? ('lick here!
rm
iiimdp
CopYrii.-!!! '
r~l n.-rMiccinn
I „
I
Prlitrxriol
$ --t
OairiotArc
I _„ I
Do« riot Arc
IT.~I
I IUD Arlinlzac
^'A’-zOO-l Reviews of Health Promotion and Education Online
Internet Explorer 5.0 or later version gives (he optimal visual effect of this website
r- Jr-iU
/’‘O
|
pnH
T
,
Kz
J
kzajL-M
tz-_ Cy-
■
5
cAJ?--7
r
e
t
U-7
I J
,0
A)
file:/A\Library\d\Health Promotion\from Ottawa to Bangkok.htm
25-May-05
^5
The Bangkok Charter for Health Promotion
in a Globalized World
Introduction
Scope
The Bangkok Charter identifies actions, commitments and pledges required to
address the determinants of health in a globalized world through health
promotion.
Purpose
The Bangkok Charter affirms that policies and partnerships to empower
communities, and to improve health and health equality, should be at the centre
of global and national development.
The Bangkok Charter complements and builds upon the values, principles and
action strategies of health promotion established by the Ottawa Charter for
Health Promotion and the recommendations of the subsequent global health
promotion conferences which have been confirmed by Member States through
the World Health Assembly.
Audience
The Bangkok Charter reaches out to people, groups and organizations that are
critical to the achievement of health, including:
• governments and politicians at all levels
• civil society
• the private sector
• international organizations, and
• the public health community.
Health
promotion
The United Nations recognizes that the enjoyment of the highest attainable
standard of health is one of the fundamental rights of every human being
without discrimination.
Health promotion is based on this critical human right and offers a positive and
inclusive concept of health as a determinant of the quality of life and
encompassing mental and spiritual well-being.
Health promotion is the process of enabling people to increase control over their
health and its determinantsTand thereby improve their health. It is a core
function of public health and contributes to the work of tackling communicable
and noncommunicable diseases and other threats to health.
1
Addressing the determinants of health
Changing
context
The global context for health promotion has changed markedly since the
development of the Ottawa Charter.
Critical factors
Some of the critical factors that now influence health include:
• increasing inequalities within and between countries
• new patterns of consumption and communication
"• commercialization
global environmental change, and
• urbanization.
Further
challenges
Other factors that influence health include rapid and often adverse social,
economic and demographic changes that affect working conditions, learning
environments, family patterns, and the culture and social fabric of communities.
Women and men are affected differently. The vulnerability of children and
exclusion of marginalized, disabled and indigenous peoples have increased.
New
opportunities
Globalization opens up new opportunities for cooperation to improve health and
reduce transnational health risks; these opportunities include:
• enhanced information and communications technology, and
• improved mechanisms for global governance and the sharing of experiences.
Policy
coherence
To manage the challenges of globalization, policy must be coherent across all:
• levels of governments
• United Nations bodies, and
• other organizations, including the private sector.
This coherence will strengthen compliance, transparency and accountability with
international agreements and treaties that affect health.
Progress made
Progress has been made in placing health at the centre of development, for
example through the Millennium Development Goals, but much more remains to
be achieved; the active participation of civil society is crucial in this process.
2
Strategies for health promotion in a globalized world
Effective
interventions
Progress towards a healthier world requires strong political action, broad
participation and sustained advocacy.
Health promotion has an established repertoire of proven effective strategies
which need to be fully utilized.
Required
actions
To make further advances in implementing these strategies, all sectors and
settings must act to:
• advocate for health based on human rights and solidarity
• invest in sustainable policies, actions and infrastructure to address the
determinants of health
• build capacity for policy development, leadership, health promotion practice,
knowledge transfer and research, and health literacy
• regulate and legislate to ensure a high level of protection from harm and
enable equal opportunity for health and well-being for all people
• partner and build alliances with public, private, nongovernmental and
international organizations and civil society to create sustainable actions.
3
Commitments to Health for All
Rationale
The health sector has a key leadership role in the building of policies and
partnerships for health promotion.
An integrated policy approach within government and international
organizations, as well as a commitment to working with civil society and the
private sector and across settings, are essential if progress is to be made in
addressing the determinants of health.
Key
commitments
The four key commitments are to make the promotion of health:
1.
2.
3.
4.
1. Make the
promotion of
health central
to the global
development
agenda
central to the global development agenda
a core responsibility for all of government
a key focus of communities and civil society
a requirement for good corporate practice.
Strong intergovernmental agreements that increase health and collective health
security are needed. Government and international bodies must act to close the
health gap between rich and poor. Effective mechanisms for global governance
for health are required to address all the harmful effects of:
J
• trade
• products
• services, and
• marketing strategies.
Health promotion must become an integral part of domestic and foreign policy
and international relations, including in situations of war and conflict.
This requires actions to promote dialogue and cooperation among nation states,
civil society, and the private sector. These efforts can build on the example of
existing treaties such as the World Health Organization Framework Convention
for Tobacco Control.
2. Make the
promotion of
health a core
responsibility
for all of
government
All governments at all levels must tackle poor health and inequalities as a
matter of urgency because health is a major determinant of socioeconomic
and political development. Local, regional and national governments must:
• give priority to investments in health, within and outside the health sector
• provide sustainable financing for health promotion.
To ensure this, all levels of government should make the health consequences
of policies and legislation explicit, using tools such as equity-focused health
impact assessment.
7
Continued on next page
4
Commitments to Health for All, continued
3. Make the
promotion of
health a key
focus of
communities
and civil society
Communities and civil society often lead in initiating, shaping and undertaking
health promotion. They need to have the rights, resources and opportunities to
enable their contributions to be amplified and sustained. In less developed
communities, support for capacity building is particularly important.
Well organized and empowered communities are highly effective in determining
their own health, and are capable of making governments and the private sector
accountable for the health consequences of their policies and practices.
Civil society needs to exercise its power in the marketplace by giving preference
to the goods, services and shares of companies that exemplify corporate social
responsibility.
Grass-roots community projects, civil society groups and women’s organizations
have demonstrated their effectiveness in health promotion, and provide models
of practice for others to follow.
Health professional associations have a special contribution to make.
4. Make the
promotion of
health a
requirement for
good corporate
practice
The corporate sector has a direct impact on the health of people and on the
determinants of health through its influence on:
• local settings
• national cultures
• environments, and
• wealth distribution.
The private sector, like other employers and the informal sector, has a
responsibility to ensure health and safety in the workplace, and to promote the
health and well-being of their employees, their families and communities.
The private sector can also contribute to lessening wider global health impacts,
such as those associated with global environmental change by complying with
local national and international regulations and agreements that promote and
protect health. Ethical and responsible business practices and fair trade
exemplify the type of business practice that should be supported by consumers
and civil society, and by government incentives and regulations.
5
J
A global pledge to make it happen
All for health
Meeting these commitments requires better application of proven strategies, as
well as the use of new entry points and innovative responses.
Partnerships, alliances, networks and collaborations provide exciting and
rewarding ways of bringing people and organizations together around common
goals and joint actions to improve the health of populations.
Each sector - intergovernmental, government, civil society and private - has a
unique role and responsibility.
Closing the
implementation
gap
Since the adoption of the Ottawa Charter, a significant number of resolutions at
national and global level have been signed in support of health promotion, but
these have not always been followed by action. The participants of this Bangkok
Conference forcefully call on Member States of the World Health Organization
to close this implementation gap and move to policies and partnerships for
action.
Call for action
Conference participants request the World Health Organization and its Member
States, in collaboration with others, to allocate resources for health promotion,
initiate plans of action and monitor performance through appropriate indicators
and targets, and to report on progress at regular intervals. United Nations
organizations are asked to explore the benefits of developing a Global Treaty for
Health.
Worldwide
partnership
This Bangkok Charter urges all stakeholders to join in a worldwide partnership
to promote health, with both global and local engagement and action.
Commitment to
improve health
We, the participants of the 6th Global Conference on Health Promotion in
Bangkok, Thailand, pledge to advance these actions and commitments to
improve health.
11 August 2005
Note:
This charter contains the collective views of an international group of experts, participants of the 6,h Global
Conference on Health Promotion, Bangkok, Thailand, August 2005, and does not necessarily represent the
decisions or the stated policy of the World Health Organization.
6
Community Dental Health (2010) (Supplement 1) 27, 129-136
© BASCD 2010
doi: 10.1922/CDH 2643PetersenO8
The 7th WHO Global Conference on Health Promotion
- towards integration of oral health (Nairobi, Kenya 2009).
PE Petersen and S Kwan
World Health Organization, Global Oral Health Programme, Geneva, Switzerland, and WHO Collaborating Centre for Research and
Development tor Oral Health, Migration and Inequalities, University of Leeds, Leeds UK
Since the first World Health Organization (WHO) Global Conference on Health Promotion (GCHP) that produced the Ottawa Charter for
Health Promotion, subsequent GCHPs were held in different continents. It was Africa’s turn to host the 7,h GCHP in Nairobi in October
2009, organised by WHO and Kenya Ministry of Health. The theme of the meeting was Promoting Health and Development: Closing
the Implementation gap. It was the first time in the GCHP history that oral health received such a high profile and featured in one of the
12 special sub-plenary sessions. This report summarises the proceedings of the sub-plenary session on social determinants of oral health.
Strategies for tackling social determinants of oral health and closing the implementation gap were considered, together with specific examples
from developed and developing countries from different WHO regions. Oral health promotion implications were discussed based on public
health experience and operational research. At the end of the session, input on oral health related issues was prepared for the Nairobi Call
to Action adopted by the conference. In follow-up, the WHO Global Oral Health Programme contributes to the newly established WHO
initiative Mainstreaming Health Promotion, which particularly seeks to build capacity in health promotion in low- and middle income
countries. This work is carried out in support of the World Health Assembly Resolution (WHA60.17) on oral health.
Key words: Capacity building, community empowerment, health policy, health promotion, social determinants, strategies for ora! health
Introduction
In 1986, the Canadian city Ottawa hosted the first World
Health Organization (WHO) Global Conference on Health
Promotion (GCHP) that established the Ottawa Charter
for Heath Promotion (WHO, 1986), building on the spirit
of Alma Ata (WHO, 1978). The values and principles
were consolidated in subsequent meetings on Healthy
Public Policy in 1988 in Adelaide, Australia (WHO,
1988); Supportive Environments for Health in 1991 in
Sundsvall, Sweden (WHO, 1991); New Players for a New
Era - Leading Health Promotion into the 21st Century in
1997 in Jakarta, Indonesia (WHO, 1997); Health Promo
tion: Bridging the Equity Gap in 2000 in Mexico City,
Mexico (WHO, 2000) and Policy and Partnership for
Action: Addressing the determinants of Health in 2005
in Bangkok, Thailand (WHO, 2005a). These conferences
contributed significantly to the development of concepts,
approaches and strategies in health promotion and several
countries have adopted health promotion principles as
part of national health policies and programmes.
However, the need persists for strengthening of health
promotion globally. Global health is facing unprecedented
challenges. These include the threat of global pandemics
as well as the inexorable growth of non-communicable
conditions in lower and middle income countries (WHO,
2005b). The financial crisis threatens the viability of na
tional economies in general and the financing of health
systems in particular. These new challenges compound
the problems many countries still have in the attainment
of the internationally agreed development goals such as
the United Nations Millennium Goals (WHO, 2005c).
The burden of ill-health is increasingly recognized to
be inequitably distributed, between and within countries,
leading the Commission on Social Determinants of Health
to conclude that “Social injustice is killing people on a
grand scale’' (WHO, 2008a). In the face of these new
challenges, the attainment of health equity depends on an
effective health promotion approach: on individual and
community empowerment, on health system leadership
and on intersectoral action to build healthy public policy.
In this context, health promotion has never been time
lier, or more needed. Over the period from the Ottawa
Conference (1986) through to the sixth global conference
in Bangkok (2005), health promotion has accumulated
a large body of knowledge, evidence and experience as
an integrative, cost-effective public health strategy and
approach, and an essential component of health systems.
The implementation gap
Global health urgently needs to apply the body of evi
dence based policies, strategies and approaches of health
promotion developed over the past twenty years. Two
global health promotion charters (Ottawa and Bangkok),
conference declarations and WHO Regional Committees
and World Health Assembly (WHA) resolutions endorse
the importance of health promotion; yet the evidence for
their implementation in countries is lacking. These along
with a rich body of research and experience from around
Correspondence to: Dr Poul Erik Petersen, World Health Organization, Chronic Disease and Health Promotion, Global Oral Health Pro
gramme, 20 Avenue Appia, CH-1200 Geneva 27, Switzerland. E-mail: petersenpe@who.int
I
the world provide a resource for guidance and direction
for the implementation of health promotion, which is
essential in order to achieve health for all and to tackle
the issue of inequities in the distribution of health by
gender, social class, income level, ethnicity, education,
occupation, and other categories. As emphasized in the
World Health Report 2008, Primary Health Care (PHC)
is essential element in health promotion (WHO, 2008b);
the PHC approach was renewed by setting four broad
policy directions: 1. dealing with inequalities by moving
towards universal coverage; 2. putting people at the centre
of service delivery; 3. multisectoral action and health in
all policies; 4. inclusive leadership and effective governors
for health. Furthermore, the World Health Assembly
2009, in its resolution on primary health care, including
health systems (WHO, 2009a), urged Member States to
tackle the health inequities within and across countries
through political commitment on the main principles of
“closing the gap in a generation” as a national concern,
as is appropriate, and to coordinate and manage inter
sectoral action for health in order to mainstream health
equity in all policies, where appropriate, by using health
and health equity impact assessment tools. Meeting these
challenges cannot be reduced to a technical problem, for
example, of finding cases of a specific disease and treat
ing them. These are also significant political challenges.
How to ensure that development policies effectively
promote health? How to ensure that the work of all
sectors contributes to a healthy policy environment that
improves the daily living conditions of disadvantaged
populations? How can civil society itself help to hold
governments and international agencies accountable for
their impact on health? What is the role of communities
and individuals? How can societies promote positive
health and offer social protection? Where, in all this, is
the role of the private sector?
Challenges to oral health promotion
The rapidly changing development in the world, inten
sified by globalisation and urbanization, triggers urgent
responses to rising public health challenges to oral health.
Evidence-based oral health promotion policy and practice
are essential to effectively tackle oral health problems,
addressing the widening inequalities in oral health within
and between countries (WHO, 2003; Kwan & Petersen,
2010; Petersen 2008, 2009). While action strategies
have been identified in previous global health promotion
meetings (Tang et al, 2006), critical implementation gaps
remain, particularly in developing countries with limited
infrastructure and financial resources. There are gaps in
health promotion programmes where evidence is not effec
tively incorporated into public health practice. Evidence
on the oral health impacts of social determinants is not
adequately considered in public policies. Moreover, there
is a lack of capacity in the health systems to promote oral
health, particularly in developing countries and countries
with economies in transition (Petersen, 2008, 2009).
7th Global Conference on Health Promotion 2009
Against this background, the seventh GCHP Promoting
Health and Development - Closing the Implementation
130
Gap was convened in October 2009 in Nairobi, Kenya,
the first ever global health promotion conference that
took place in Africa. Over 600 delegates representing
more than 100 countries attended the five-day meeting,
together with a large number of virtual participants via
a social networking site www.conneet2change.org.
The programme - including workshops, case studies
and keynotes and sub-plenary sessions - was organised
in five tracks addressing major strategic areas of health
promotion that promote healthy development (Box Z).
For the first time in the history of GCHP, oral health
promotion was given special attention with a dedicated
sub-plenary session, one of the twelve sub-plenary ses
sions with special themes that cut across tracks and cover
a range of application areas. This report summarises
the proceedings of the Sub-Plenary Session on Social
Determinants of Oral Health.
Box I. Five key tracks of the 7th Global Confer
ence on Health Promotion
Track 1: Community empowerment
Track 2: Health literacy and health behaviour
Track 3: Strengthening health systems
Track 4: Partnership and intersectoral action
Track 5: Building capacity for health promotion
Social determinants in oral health:
building capacity for oral health promotion
Oral health is important component of general health and
quality of life. Meanwhile, oral disease is still a major
public health problem in high income countries and the
burden of oral disease is growing in many low- and
middle income countries. Significant numbers of people
around the globe suffer from illness and pain related
to the mouth. The disadvantaged and poor people suf
fer most and they often do not receive appropriate oral
health care. In addition, disease prevention and oral health
promotion are widely neglected area in public health.
This is particularly the case in middle and low income
countries. In the World Oral Health Report 2003 issued
by the World Health Organization (WHO, 2003), and
further in a series of WHO publications (WHO, 2005d;
Petersen, 2008, 2009; Petersen and Kwan, 2004; Kwan
and Petersen, 2010), policies and the necessary actions to
the continuous improvement of oral health are formulated.
The global strategy is that oral disease prevention
and the promotion of oral health needs to be integrated
with chronic disease prevention and general health pro
motion as the risks to health are linked. Integration of
the prevention of specific oral disease manifestations
with the control of infectious diseases is particularly
relevant in the case of HIV AIDS (Petersen, 2006). The
new approaches form the basis for future development
or adjustment of oral health programmes at country
and community levels. The good news is that most oral
diseases are avoidable. Public health research has shown
that a number of individual, professional and community
preventive measures, and community oriented oral health
promotion are effective in control of oral disease and
promoting oral health. However, advances in oral health
science have not yet benefited the poor and disadvan
taged populations worldwide. Inequalities in oral health
still exist. The major challenges of the future will be
to translate knowledge and experiences in oral disease
prevention and health promotion into action programmes.
Directions as regards to strengthening health promo
tion, incorporating oral health, and orientation of oral
health services towards health are emphasized to countries
and communities (Petersen 2008, 2009). Particular atten
tion is given to the following assumptions:
Increasing the global awareness of the significance of
oral health to general health and quality of life,
and the importance of social determinants to oral
health.
National capacity building in oral health promotion
and integrated disease prevention is a major plat
form for public health.
Strengthening of primary health care is vital to closing
the gap in oral health and general health between
the rich and the poor within countries and across
countries.
The sub-plenary session on Social Determinants of
Oral Health focussed on the analysis of negative and
positive factors in building programmes and developing
strategies. The implementation gap in oral health promo
tion was discussed, taking into account lessons learnt from
existing community and national oral health promotion
projects and the experience gained by WHO Collaborat
ing Centres (WHOCC) in oral health. In addition to the
participation of WHOCCs, the session was attended by
the two oral health Non-Governmental Organizations in
official relation to WHO, i.e. the International Associa
tion for Dental Research (Professor David Williams) and
the World Dental Federation FDI (Dr Roberto Vianna).
Moreover, Aide Odontologique Internationale, a French
non-governmental organization having extensive work
relations with the WHO Global Oral Health Programme,
took part in the conference.
Dr. Nanna Jurgensen of WHOCC University of Co
penhagen, Denmark was appointed Chair for the session
and Dr Jayanthi Stjernsward of WHOCC Malmo, Sweden
as reporter. Dr Petersen introduced on the background,
the philosophy and the structure of this special WHO
session on oral health; seven contributions were then
presented with examples from different countries in
different regions.
Contribution 1: Social determinants in oral health
-strategies for oral health promotion
S. Kwan and P.E. Petersen. WHO Collaborating Centre
for Research and Development for Oral Health, Migra
tion and Inequalities, Leeds, United Kingdom, and World
Health Organization, Global Oral Health Programme,
Geneva, Switzerland.
Good oral health enables people to speak, eat and
socialize without active disease, discomfort or embar
rassment. However, oral disease is a major burden to
populations across countries of the world. According
to the World Health Organization Global Oral Health
data bank and the World Health Survey 2003, widening
social disparities in oral health exist across low-, middleand high income countries. The influence of education,
economic circumstances, material possession, living and
working conditions and the environment on health is
significant. These social determinants are also responsible
for inequities in access to and use of oral health services.
The social determinants of health are largely universal,
affecting a range of oral health outcomes and the exposure
to risk factors. The social gradients appear to be persist
ent over time. Poor oral health is found among people
living in poverty. Proximal risk factors such as unhealthy
lifestyles in relation to diet and nutrition, tobacco and
alcohol, and poor personal hygiene are related to living
conditions as well. The good news is that oral disease
conditions are preventable, and social inequality in oral
health is avoidable. Oral diseases share the common
risk factors of several chronic diseases. Interventions in
relation to the socio-economic environment, settings for
health, and risk factor approaches are important strategies
for promotion of oral health of the whole population.
Moreover, evidence exists on promotion of oral health
and prevention of oral diseases through public health
interventions. Country experiences worldwide show that
community outreach primary health care is essential to
improvement of oral health, however, a lack of health
policy and limited national budgets for oral health are
major barriers for implementation of integrated health
promotion.
Contribution 2: Common risk factor strategies in
oral health promotion for youth - Some experiences
from Tanzania.
F.K. Kahabuka and P.E. Petersen. WHO Collaborat
ing Centre for Primary Oral Health Care, Planning and
Research, Dar-es-Salaam, Tanzania and World Health
Organization, Global Oral Health Programme, Geneva,
Switzerland.
Risk factors to poor oral health include unhealthy
diet and nutrition, inadequate personal hygiene and lack
of regular oral hygiene practices, inadequate sanitation,
and insufficient exposure to fluorides, growing tobacco
and alcohol consumption, and limited availability and
access to dental services. The planning of public health
intervention directed towards modifiable risk factors
shall be based on available evidence, which has been
called upon by the Tanzania Ministry of Health. In a
nation-wide school health survey of adolescents, it was
shown that adolescents had frequent consumption of
sweets, chewing gum with sugar, and sugar containing
drinks. Significant proportions of young people per
formed cigarette smoking and consumed alcohol, and
they seldom consulted a dentist for oral health care. On
the other hand, most children and adolescents had good
general hygiene practices and brushed their teeth daily
with a plastic tooth brush utilizing a fluoride tooth paste.
Risk behaviours relevant to non-communicable chronic
disease are common to oral disease. Experiences from
Tanzania show that oral health risk behaviours of children
131
)
5
and adolescents are modifiable. Sustainable behaviour
modification is possible through oral health promotion
for the young and should start early in life. Risk factors
to chronic and oral disease are common and this may
call for integrated approaches in general health promotion
strategies. Nevertheless, there are several constraints in
relation to public health priorities and consequently to
implementation of oral health promotion which include:
high priority towards prevalent infectious life threatening
diseases; low priority by health authorities to oral health
problems; low literacy level; poverty; poor infrastructure;
incomplete sanitation and clean water; limited number of
health personnel; oral health is conceived isolated and
independent from general health. Against this, there are
positive factors that may facilitate the implementation
process, namely;
Existing school health programmes aimed to combat
infectious diseases may provide a unique context
for incorporation of oral health
The availability of primary health personnel
Contribution 3: Oral health promotion for people liv
ing with HIV AIDS - the example of Burkina Faso.
S. Ouattara and P.E. Petersen. Research Centre Muraz, Bobo-Dioualaso, Burkina Faso and World Health
Organization, Global Oral Health Programme, Geneva,
Switzerland.
HIV AIDS is a disease of poverty which significantly
affects populations of Sub-Saharan Africa. Many people
are currently living with HIV AIDS; they are likely to
suffer from a double burden of disease as they are also
often affected by non-communicable chronic disease.
Prevention of HIV AIDS may be strengthened effectively
through oral health. HIV/AIDS manifest in the oral cav
ity with several oral lesions such as oral ulcers, bacterial
and fungal infections. Oral health promotion and preven
tion of oral disease however need to be integrated with
primary health programmes. Oral health professionals
and primary health workers play important roles in this
process, particularly; they have great potential in early
detection of conditions, provision of essential oral care,
health education, and referral for special care. Primary
health care (PHC) is an appropriate community platform
for control of disease and promotion of oral health. Initia
tives of strengthening community intervention against HIV
AIDS and their oral manifestations currently take place
in Burkina Faso and Tanzania. Community participation
and empowerment of people are important and in relation
to children/orphans the schools and schoolteachers are
essential. The efforts for strengthening of health promotion
are supported by public health research to be translated
for action and capacity building. Practical experiences
from implementing evidence-based community-oriented
oral health promotion are given from Burkina Faso.
Contribution 4: Oral health promotion through
schools - global experiences.
N. Jurgensen. WHO Collaborating Centre for Commu
nity Oral Health Prorammes and Research, University
of Copenhagen, Denmark
132
One of the challenges of health promotion is to
identify effective settings for implementation. Schools
have globally proven to be ideal platforms. Although the
school setting will not be able to reach all children the
primary school setting still covers a considerable large
and diverse part of many child populations. This provides
a unique opportunity to level out the socio-economic and
geographical gradients observed in morbidity as well as
in modifiable risk factors important for oral health; risk
factors such as oral health related knowledge, attitude
and behaviour. The idea of health promotion through
schools has also been introduced in a number of countries
in Southeast Asia. However, developing schools into a
health promoting setting often strongly depends on vision
ary individuals at local level or the support of external
resources. This keeps the number of health promoting
schools limited/low while the project approach makes
them less sustainable. To address this implementation gap
and support the scaling up of health promoting schools
a number of suggestions should be considered:
As a strategy for healthy public policies health pro
motion should be integrated permanently into the
structure of the educational system and mirrored
in teachers training and educational material for all
primary schools
Personnel at all levels should develop necessary skills
and be responsible for supporting the implementa
tion of activities
Parents and local communities should actively be in
volved in the creation of the school as a supportive
setting for health thereby increasing local owner
ship and sustainability
The health sector should be involved to assure correct
technical input and provision of preventive and
basic services
Contribution 5: Barriers and opportunities for
community-based oral health promotion in develop
ing countries - lessons learnt in Africa and Asia.
B. Varenne and B. Decroix.
Internationale, Paris, France.
Aide Odontologique
In many low income countries, oral diseases contribute
substantially to the burden of non-communicable diseases
and injuries. Oral health remains a neglected public health
issue. This is reflected in the lack of organization of oral
health promotion, disease prevention and oral health serv
ices. Both in urban and rural areas, populations have only
limited access to oral health care and the use of fluoride
is not widespread. Apart from national budgets for general
health and in particular for oral health being very limited,
one significant barrier to implementation of community
oral health promotion relates to the gap between training
offered to oral health professionals and the perceived and
real needs of people living in developing countlies. A
comprehensive project has been established in Burkina
Faso and involves the French Non-Governmental Organi
zation Aide Odontologique Internationale. The project is
based on the integration of preventive and curative oral
health components into health promotion and shows
how difficult it is to go from theory to practice if socio
economic and oral health manpower requirements are
not met. The opportunity for organization of oral health
promotion programmes is illustrated from experiences
with capacity building activities. Oral health promo
tion skills of oral health staff may be achieved through
technical, university and institutional networks. Thus, a
programme ongoing in Cambodia shows that one of the
keys to success is the active role played by local oral
health officers capable of implementing and following up
innovative and integrated oral health promotion activities,
i.e. school health education, primary oral health care and
work for population use of affordable fluoridated tooth
paste. Research and practical experiences in numerous
countries have demonstrated that health promotion should
be based on awareness of environmental factors and
healthy lifestyles of people. The example of Laos shows
how the implementation of salt fluoridation will become
an intersectoral programme as planned and developed
at community level. At the end, the experiences gained
call for a better integration of oral health activities into
global health promotion programmes.
Contribution 6: Health Promotion and Oral Health
- Japanese Experiences.
H. Miyazaki. WHO Collaborating Centre for Translation
of Oral Health Science. Department of Oral Health Sci
ence, Graduate School of Medical and Dental Sciences,
Niigata University, Japan.
Because of the failure to tackle social and material
determinants and incorporate oral health into general
health promotion, millions of people still suffer intrac
table toothache and poor quality of life and end up
with few teeth. Health policies should be reoriented to
incorporate oral health using socio-dental approaches to
assessing needs and to apply the common risk factor
approach for health promotion. “Healthy Japan 21” is
a 10-year (2000-2010) national campaign intended to
promote healthy behaviours of the national population
and to build healthy environments through actions of
communities, worksites, health professionals and other
related organizations. National objectives are established
and shared by interested parties. Oral health is included
objective to prolong length of healthy life and improve
quality of life. Objectives are specified within nine areas
for “Healthy Japan 21”: 1) food and nutrition, 2) physi
cal activities, 3) mental health, 4) tobacco, 5) alcohol, 6)
oral health, 7) diabetes, 8) cancer and 9) cardiovascular
diseases. Lessons learnt from the development process of
programmes for oral health promotion in Japan are that
the continuous sharing of local and national experiences
is important factor in effective implementation. Informa
tion about the weakness and strengths in identification
of health determinants and formulation of policies and
action plans are instrumental to oral health intervention.
Contribution 7: Disease prevention, an essential
complement to health promotion.
R. Baez. Former Head, WHO Collaborating Centre for
Translation of Oral Health Sciences into Clinical and
Public Health Practice, San Antonio, Texas, USA.
Health promotion contributes to maintenance of oral
health but efforts must be complemented with preven
tion. In several countries dental caries is on the increase.
Fluoride for caries prevention has been recognized as an
effective agent and various methods are available for use
in public health and private practice.
There are many reasons that these public health
measures are not available to populations, particularly
in developing countries:
Non-existent or inadequate oral health programmes
Lack of oral health policies on public health prevention
Cost or non-availability of fluoride compounds or
equipment
Inadequate human resources
Lack of technical expertise
Absence of on-site training opportunities
Lack of community education and impact of antifluoridationists
Poor economy and cost
For example the introduction of water fluoridation
requires that the country/community has a reasonably
well established economy with a reliable public water
supply system. Also availability of equipment and fluoride
product is essential. Caries levels should be high enough
to justify the cost of the programme and government/
legislative support is essential. Similar issues arise if salt
or milk fluoridation is contemplated. The cost of fluoride
toothpastes can be a barrier to their use; being classified
and taxed as cosmetics in some communities contribute
to their cost. Gels and varnishes require trained personnel
for their application. Finally, use of fluoride supplements
and fluoride mouthrinses require considerable compliance.
Capacity building in planning and administration of fluo
ride programmes is essential. Countries are encouraged
to ascertain the most suitable strategy to incorporate use
of fluoride in community prevention programmes with
the ultimate goal of optimizing oral health in the most
efficient manner with minimum risks.
Summing up and conclusions
The essential points made by the contributors are pre
sented according to the five conference tracks.
Track I: Health Literacy and Health Behaviour
Experiences from Tanzania show that oral health risk
behaviours of children and adolescents are modifiable.
Sustainable behaviour modification is possible through
oral health promotion for the young and should start
early in life.
Risk factors to chronic and oral disease are common
and this may call for integrated approaches in general
health promotion strategics.
Constraints to implementation of oral health promotion
include high priority given by public health administra
tors to prevalent infectious life threatening diseases, low
priority for oral diseases, lower literacy, poverty, sanitation
and clean water and limited health personnel.
Existing school health programmes and the avail
ability of primary health personnel are positive factors
in the implementation process of oral health promotion
for children (Kwan et al, 2005).
133
Track 2: Community Empowerment.
Schools have globally proven to be ideal platforms for
implementation of health promotion.
As a strategy for healthy public policies health promo
tion should be integrated permanently into the structure of
the educational system and mirrored in teachers training
and educational material for all primary schools.
Developing schools into a health promoting setting
often strongly depends on visionary individuals at local
level or the support of external resources.
In several low- and middle income countries dental
caries is on the increase. Fluoride for caries prevention
has been recognized as an effective agent and various
methods arc available for use in public health and clini
cal practice. Automatic fluoridation programmes shall be
considered by countries where fluoride in drinking water
is sub-optimal.
Initiatives of strengthening community intervention
against HIV AIDS and their oral manifestations currently
take place in certain countries of Africa. New approaches
to improving quality of life of people affected by infec
tion and orphans are developed.
Oral health promotion and prevention of oral disease
for people living with H1V/A1DS need to be integrated
with primary health care programmes.
Track 3: Strengthening Health Systems.
Apart from national budgets for general health and in
particular for oral health being very limited, one signifi
cant barrier to implementation of community oral health
promotion relates to the gap between training offered to
oral health professionals and the perceived and real needs
of people living in developing countries.
In the majority of developed countries oral health
systems need reorientation towards prevention of disease
and health promotion. In developing countries oral health
programmes need to be established urgently and policies
shall give priority to health promotion and oral disease
prevention. Human and financial resources are required
to meet the needs for oral health care of the population.
In agreement with the recommendations of the WHO
Commission on Social Determinants (WHO, 2008a),
oral health services need to be financially fair in order
to ensure oral health of poor and disadvantaged people.
Track 4: Partnership and Intersectoral Action.
Oral health promotion skills of oral health staff may be
achieved through technical, university and institutional
networks. Thus, a programme ongoing in Cambodia shows
that one of the keys to success is the active role played
by local oral health officers capable of implementing
and following up innovative and integrated oral health
promotion activities, i.e. school health education, primary
oral health care and work for population use of affordable
fluoridated toothpaste.
The example of Laos shows how the implementation
of salt fluoridation will become an intersectoral pro
gramme as planned and developed at community level.
Track 5: Building Capacity for Health Promotion.
Health policies should be reoriented to incorporate oral
health using socio-dental approaches to assessing needs
134
and to apply the common risk factor approach for health
promotion.
“Healthy Japan 21” is a 10-year (2000-2010) national
campaign which has shown effective to promoting healthy
behaviour of the national population and to build healthy
environments through actions of communities, worksites,
health professionals and other related organizations.
Capacity building in health promotion is essential to
oral health. Countries are encouraged to study the most
suitable strategy to incorporate oral health into national
public health programmes with the ultimate goal of op
timizing oral health in the most efficient manner.
The Nairobi Call to Action
The oral health presentations focussed different dimen
sions of community oral health: social determinants;
modifiable risk factors; poverty and HIV/AIDS; empower
ment of communities for oral health; strengthening of oral
health systems; settings for oral health; integrated disease
prevention and oral health promotion, and development of
oral health promotion in the context of a national health
programme. Following the seven presentations, ideas were
exchanged and, after much deliberation and constructive
discussion, three key oral health messages were drafted for
input to the Nairobi Call to Action (Box 2). The Nairobi
Call to Action, which was developed through expert- and
web-based consultation before and during the conference,
was officially adopted on the last day of the meeting.
It is a strong political statement that urges WHO and
United Nations partners, governments, non-governmental
organisations, civil society, communities and individuals
to consider the key strategies and commitments urgently
required for closing the implementation gap in health and
development through health promotion (WHO, 2009b).
Global commitments are that all countries - govern
ments and stakeholders- are called urgently to use the
untapped potential of health promotion, to make health
promotion principles integral to the policy and develop
ment agenda, and to develop effective and sustainable
delivery mechanisms. According to the call for action,
countries are to build capacity in health promotion, to
strengthen health systems, to ensure community em
powerment, to develop partnerships and intersectoral
actions relevant to addressing the determinants of health,
and to help improvement of health literacy and healthy
lifestyles. Further, the Nairobi Call to Action emphasizes
the need for countries to specify the responsibilities for
implementation of health promotion, such as strengthen
leadership and workforces, mainstream health promotion,
empower communities and individuals, enhance participa
tory processes, and build and apply knowledge. The call
to global commitment is presented in Box 3.
WHO- the way forward for promoting oral health
In follow-up of the 7th GCHP, WHO has strengthened
its work for country capacity building in health promo
tion with a focus on low and middle income countries
and application to priority public health problems. This
initiative includes oral health conditions as well. Main
streaming Health Promotion is a new WHO activity to
Box 2. The three key messages that were formulated in relation to preparation of the Nairobi Call to Action
1.
Oral health is a human right and essential to general health and quality of life.
2.
Promotion of oral health and prevention of oral diseases must be provided through Primary Health Care and
general health promotion. Integrated approaches are the most cost-effective and realistic way to close the gap
in implementation of sound interventions for oral health around the globe.
3.
National and community capacity building for promoting oral health and integrated oral disease prevention
requires policy and appropriate human and financial resources to reduce the gap between the poor and rich.
Box 3. The 7th Global Conference on Health Promotion Call to Action by Governments and stakeholders
GLOBAL COMMITMENT
We, the participants of the 7th Global Conference on Health Promotion, recognising the changing context and acute
challenges, call on all governments and stakeholders to respond urgently to this Call to Action and the strategies
and actions that follow.
TO USE THE UNTAPPED POTENTIAL OF HEALTH PROMOTION
We pledge, as champions, to:
y/Use the existing evidence to prove to policy-makers that health promotion is fundamental to managing nation
al and global challenges such as population ageing, climate change, global pandemic threats, maternal mortal
ity, migration, conflict and economic crises;
Revitalise primary health care by fostering community participation, healthy public policy and putting people
at the centre of care;
□ Build on the resilience of communities by harnessing their resources to address the double burden of noncommunicable and communicable diseases.
TO MAKE HEALTH PROMOTION PRINCIPLES INTEGRAL TO THE POLICY AND DEVELOPMENT
AGENDA
We call on governments to exercise their responsibility for public health, including working across sectors and in
partnership with citizens, in particular to:
Vf Promote social justice and equity in health by implementing the recommendations of the WHO Commission
on the Social Determinants of Health;
□ Accelerate the attainment of national and international development goals by building and redistributing re
sources to strengthen capacity and leadership for health promotion;
□ Be accountable for improving people’s quality of life and well being.
TO DEVELOP EFFECTIVE AND SUSTAINABLE DELIVERY MECHANISMS
We request Member States to mandate WHO to:
□ Develop a Global Health Promotion Strategy and action plans, with regional follow-up that respond to the ma
jor health needs and incorporate cost-effective and equitable interventions;
□ Strengthen its internal capacity for health promotion, and assist Member States to develop sustainably funded
structures and set up accountable reporting mechanisms for investment in the promotion of health;
j/ Disseminate compelling evidence on the social, economic, health and other benefits of health promotion to
key sectors.
135
I
support the development of an evidence-based, outcome
oriented package of health promotion actions. In response
to this initiative, the WHO Global Oral Health Programme
has intensified its actions for assembling the evidence on
community based oral health promotion and integrated
disease prevention; the goal is to strengthen the mecha
nisms for translation of oral health science into country
policies and action programmes for oral health.
Health promotion offers a comprehensive range of
specific and proven actions. Health promotion actions
seek to produce changes in individuals, communities,
health services, and environments. Actions for promoting
health take a series of forms, including:
Dissemination of information, education and com
munication to individuals, to change health related
behaviour, knowledge, attitudes and beliefs.
Using advocacy, mass communication and social mar
keting to shift cultural norms.
Legislation and regulation, to reduce population expo
sure to health risks and encourage health behav
iour.
Empowering and supporting communities to take ac
tion and control.
Orienting health systems towards universal access, pre
vention and early intervention, primary health care
and optimal patient education, and with a peoplecentred focus.
Ensuring sustainable health promotion capacity, includ
ing financing, training, workforce and leadership,
and monitoring the effectiveness of health promo
tion programmes.
Advocacy and development of healthy public policies,
to create healthy physical and social environments.
Such actions are in fact the basis of the WHO global
policies for promoting oral health as being emphasized
recently by the WHO governing bodies. The World Health
Assembly 2007 is a major event in the world history
of oral health. At the annual meeting of the WHA, the
WHO Member States agreed on a unique Resolution
(WHA60.17): Oral health: Action plan for promotion
and integrated disease prevention (Petersen, 2008; Pe
tersen, 2009). Based on a thourogh analysis of the global
oral health situation, new strategies and approaches are
recommended for countries to adopt. The scope of the
Resolution is most comprehensive as it encompasses the
major oral health problems and risk factors relevant to
public health. Principal actions are suggested for tackling
the social determinants in oral health, intervention in rela
tion to risk factors of oral health, disease prevention and
effective control of oral diseases through establishment
of appropriate national oral health systems.
More information about the work carried out by the
WHO Global Oral Health Programme is available on
www.who.int/oral health
136
References
Kwan S. and Petersen P.E. (2010). Oral health: equity and so
cial determinants (pp 159-176). In: Blas E. and Sivasankara
Kurup A.(Eds). Equity, social determinants and public health
programmes. Geneva: World Health Organization.
Kwan S.Y.L., Petersen P.E., Pine C.M., and Bonilla A. (2005):
Health-promoting schools: an opportunity for oral health
promotion. Bulletin of the World Health Organization; 83:
677-685.
Petersen P.E., and Kwan S. (2004): Evaluation of community
based oral health promotion and oral disease prevention
- IVHO recommendations for improved evidence in public
health practice. Community Dent Health; 21 (Suppl 1):
319-329.
Petersen P.E. (2006): Policy for prevention of oral manifesta
tions in HIV/AIDS - The approach ofthe WHO Global Oral
Health Programme. Advances in Dental Research; 9: 17-20.
Petersen P.E. (2008).- World Health Organization global policy
for improvement of ora! health - World Health Assembly
2007. International Dental Journal; 58: 115-121.
Petersen P.E. (2009): Global policy for improvement of oral
health in the 21s' century - implications to oral health
research of World Health Assembly 2007, World Health
Organization. Community Dentistry and Oral Epidemiol
ogy; 37: 1-8.
Tang K.C., Beaglehole R., and de Leeuw E. (eds.) (2006):
The 6,h Global Conference on Health Promotion, Bangkok
August 2005. Health Promotion International 21 (SI), 1-98.
World Health Organization (1978): Primary Health Care. Report
of the International Conference on Primary Health Care.
Alma Ala, USSR, 6-12 September 1978. Geneva: WHO.
World Health Organization (1986): Ottawa Charter for Health
Promotion. Geneva: WHO.
World Health Organization (1988): Adelaide Recommendations
on Healthy Public Policy. Geneva: WHO.
World Health Organization (1991): Sundsvall Statement on
Supportive Environments for Health. Geneva: WHO.
World Health Organization (1997): Jakarta Declaration on Lead
ing Health Promotion into the 21st Century. Geneva: WHO.
World Health Organization (2000): Mexico Ministerial Statement
for the Promotion of Health. Geneva: WHO.
World Health Organization (2003): The World Ora! Health
Report 2003. Continuous improvement of oral health in
the 21st century - the approach of the WHO Global Oral
Health Programme. Geneva: WHO.
World Health Organization (2005a): The Bangkok Charter for
Health Promotion in a Globalised World. Geneva: WHO.
World Health Organization (2005b): Preventing chronic diseasea vital investment. Geneva: WHO.
World Health Organization (2005c): Health and Millennium
Development Goals. Geneva: WHO.
World Health Organization (2005d): WHO Bulletin special
theme on oral health. Geneva: WHO. (www.who.int/
oral_health)
World Health Organization (2008a): Closing the gap in a
generation: health equity through action on the social
determinants of health. Geneva: WHO.
World Health Organization (2008b): The World Health Report
2008: Primary health care- now more than ever. Geneva:
WHO.
World Health Organization (2009a): WHA62.12 Primary health
care, including health system strengthening. Geneva: WHO.
World Health Organization (2009b): The Nairobi Call to Action
for Closing the Implementation Gap in Health Promotion.
Geneva: WHO.
World Health
Organization
MINISTRY OF
SOCIAL AFFAIRS AND HEALTFFinland
The 8th Global Conference on Health Promotion, Helsinki, Finland, 10-14 June 2013
The Helsinki Statement on Health in All Policies
Building on our heritage, looking to our future
The 8th Global Conference on Health Promotion was held in Helsinki, Finland from 10-14 June 2013. The
meeting builds upon a rich heritage of ideas, actions and evidence originally inspired by the Alma Ata
Declaration on Primary Health Care (1978) and the Ottawa Charter for Health Promotion (1986). These
identified intersectoral action and healthy public policy as central elements for the promotion of health,
the achievement of health equity, and the realization of health as a human right. Subsequent WHO
global health promotion conferences1 cemented key principles for health promotion action. These
principles have been reinforced in the 2011 Rio Political Declaration on Social Determinants of Health,
the 2011 Political Declaration of the UN High-level Meeting of the General Assembly on the Prevention
and Control of Non-communicable Diseases, and the 2012 Rio+20 Outcome Document (the Future We
Want). They are also reflected in many other WHO frameworks, strategies and resolutions, and
contribute to the formulation of the post-2015 development goals.
Health for All is a major societal goal of governments, and the cornerstone of sustainable
development
We, the participants of this conference
Affirm our commitment to equity in health and recognize that the enjoyment of the highest attainable
standard of health is one of the fundamental rights of every human being without distinction of race, religion,
political belief, economic or social condition. We recognize that governments have a responsibility for the
health of their people and that equity in health is an expression of social justice. We know that good health
enhances quality of life, increases capacity for learning, strengthens families and communities and improves
workforce productivity. Likewise, action aimed at promoting equity significantly contributes to health,
poverty reduction, social inclusion and security.
Health inequities between and within countries are politically, socially and economically unacceptable, as
well as unfair and avoidable. Policies made in all sectors can have a profound effect on population health
and health equity. In our interconnected world, health is shaped by many powerful forces, especially
demographic change, rapid urbanization, climate change and globalization. While some diseases are
disappearing as living conditions improve, many diseases of poverty still persist in developing countries. In
many countries lifestyles and living and working environments are influenced by unrestrained marketing and
subject to unsustainable production and consumption patterns. The health of the people is not only a health
sector responsibility, it also embraces wider political issues such asUade and foreign policy. Tackling this
requires^olitTcal will to engage the whole of government in health.
'Health in All Policies is an approach to public policies across sectors that systematically takes into account
the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve
population health and health equity. It improves accountability of policymakers for health impacts at all
levels of policy-making. It includes an emphasis on the consequences of public policies on health systems,
determinants of health and well-being.
We recognize that governments have a range of priorities in which health and equity do not automatically
gain precedence over other policy objectives. We call on them to ensure that health considerations are
transparently taken into account in policy-making, and to open up opportunities for co-benefits across
sectors and society at large.
1 Subsequent conferences were held in Adelaide (1988); Sundsvall (1991); Jakarta (1997); Mexico City (2000); Bangkok (2005), Nairobi (2009).
CD
o
(0
C\J
CD
o
_Q
o
c C §
o.o ,
O 'o z
O E
ru CD
01
(U 0
c
O O C\J
( 'X
V-
1
(Or •
_Q±i ■ 05
o co
O)
01 E
£; c .c
CD O CO
CD
0)
E
ro
ru
W)
in O
01
in <U
>
CD
in o c
<u
O Q
- Media
8997.pdf
Position: 985 (8 views)