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The Ottawa Charter • As a response to the emergence of the new public health approach towards health, in 1986 the first International Conference on Health Promotion took place in Ottawa, Canada. The conference built upon previous progress in health relating to the Declaration on Primary Health Care at Alma-Ata, the publication WHO Targets for Health for All, and an intersectoralapproach for health. The Ottawa Charter Framework for Health Promotion underpins all work surrounding health promotion, as it addresses not only the social and cultural factors that can alter an individuals behaviour to make positive health choices, but also ensures equity—as achieving good health is attainable • for all individuals. The Ottawa Charter recognises that these factors must work together to improve the health status of individuals and communities through five areas: • developing personal skills • creating supportive environments • strengthening community action • reorienting health services • building healthy public policy
Acronym Dumb-developing personal skillsCharter-creating supportive environmentsSucks-strengthening community actionReally-reorienting health servicesBad-building healthy public policy.
Developing personal skills In order for individuals to achieve good health, they must develop the personal skills and abilities, so they can make the positive behaviour changes to meet the demands of everyday life. Individuals need to refine and modify poor health behaviours to improve their health. Providing individuals with information, education and life skills enables them to exert control over their actions and increases the options available to them. Enabling or empowering people to develop skills that will assist them in preventing or treating disease or illness, is a positive step towards individuals achieving good health. Developing personal skills such as decision making, problem solving, self-awareness, critiquing information, planning for change, developing time-management skills, and refining communication and assertiveness skills will assist individuals to make positive health decisions.
Examples of Developing Personal Skills • Enabling people to make positive behaviour changes can be achieved • through: • compulsory PDHPE lessons in schools from kindergarten to Year 10 where • skills on coping with change, resilience and lifestyle diseases are taught • television and radio commercials that encourage individuals to make • positive health choices • making sure brochures on accessing health services are provided in a • variety of languages to cater for the diversity of communities • time-management seminars to develop skills around organising time to • look after your health • development of communication skills, such as assertiveness skills • developing health literacy skills to enable individuals to understand • different health products and services • English-speaking courses for new migrants to Australia.
Creating supportive environments This action area focuses on the places where people live, work and play. It also focuses on increasing people's ability within these settings to make health-promoting choices. It is concerned with our social and physical environments. We need to take care of, protect and support each other, our community and our natural and built environments from threats to health. The organisation of work and leisure and the use of technology should enhance health and provide a safe, stimulating, satisfying and enjoyable environment. Workplaces, support groups, health services, schools, the media and families can all help to provide supportive environments.
Examples of Creating Supportive environments • Creating supportive environments can be achieved through: • childcare centres in workplaces • needle exchange programs • safety electrical switches in the home • speed humps, roundabouts and speed limits • sun protection for outdoor areas • modifying sports for young children e.g. kanga cricket, netta netball • providing counsellors where needed e.g. in schools.
Strengthening community action When communities join to take action for their health, we can see positive improvements. Communities who make decisions, plan strategies and implement them to improve health for their population generally see improved health benefits. When communities take ownership of the health issues they face and advocate for change, they are more likely to embrace these changes. Empowering communities to take control of their needs and decide how they can best work towards meeting these needs is essential for positive health behaviour change. In order for communities to take action, forming partnerships with health agencies or government or non-government agencies can assist them to implement strategies, access and gain information, and create opportunities to improve their community’s health.
Examples of Strengthening Community Action • Strengthening community action can be achieved through: • family planning and HIV/AIDS clinics in communities • community events such as the City2Surf • events such as ‘Clean up Australia Day’ • communities lobbying for improvements to their environment, for • example, overhead bridges for students to cross busy roads near schools • encouraging traditional cultural activities within various ethnic groups for • the community, such as Chinese New Year and Greek Easter celebrations • single-parent support groups • YMCA or drop-in centres for young people • Health Promoting schools • text messages to young people to remind them to eat healthy and to exercise.
Reorienting health services The focus and delivery of health services has moved away from an emphasis on the more traditional aspects of health: diagnosis, treatment and rehabilitation. The reorientation of health services has focused on the well-being of the whole person: promoting health, preventing ill health and supporting well-being. This requires a change in attitude and the organisation of health services, and changes to professional education, training and research. Health promotion can take place in a number of settings, such as schools, workplaces and community health centres, as well as through NGOs, such as the National Heart Foundation of Australia and the Cancer Council.
Examples of Reorienting health services • An example of this reorientation includes: • health professionals working with and supporting schools in health promotion initiatives such as MindMatters, Jump Rope for Heart and the New South Wales Healthy School Canteen Strategy. • Police working in schools to support road safety education • Cardio Vascular surgeons giving presentations on the risks of smoking • companies such as Banana Boat handing out free sunscreen at the beach during summer • Educating nurses in health care promotion practices • Doctors promoting healthy eating
Building healthy public policy • In order to assist individuals and communities to improve their health, • governments, organisations, workplaces and schools need to implement • policies, guidelines and rules that work towards achieving good health. These policies are aimed at providing supportive environments in which individuals and communities can lead healthy lives. Policies enable governments and organisations to be accountable. Policies can assist or hinder an individual’s or community’s health and, therefore, governments and organisations are accountable in ensuring policies are aimed at improving health outcomes. • Policies need to encompass every aspect of an individual’s life, if they are to • be effective in improving the health status of a population. • Some healthy public policies are: • anti-discrimination laws • guidelines on the use of solariums • school anti-bullying policies • age restrictions for drinking alcohol • age restrictions for different levels of driving, • e.g. learner’s permit 16 years, P-plate drivers 17 years • compulsory third-party car insurance, to cover someone • if they are injured
Case study: alcohol abuse in society Alcohol-related issues are prevalent in society and increasing at an alarming rate. Issues such as binge drinking, underage drinking, alcohol-related violence and drink driving have a significant impact not only on the individual consuming the alcohol, but also on society in general. In order to address this health issue, various government and non-government organisations and communities have put strategies in place. As this issue is not in isolation, the use of the Ottawa Charter Framework for Health Promotion has been the backbone in assisting different sectors to work collaboratively with individuals to bring about positive changes in health behaviour. To see how the Ottawa Charter can be used to combat alcohol abuse in Australia, a variety of strategies that have been used across a number of health promotion programs, are applied here to the five action areas of the Ottawa Charter.
Developing personal skills- Alcohol Abuse • Compulsory PDHPE lessons that focus on the short and long-term effects of alcohol on the body. • Healthy Harold vans which visit primary schools to educate young children about the effects of alcohol. • Education through schools’ pastoral care programs on how to party safely if alcohol is available or how to enjoy yourself at a party without alcohol. • Information in magazines such as Woman’s Day and Men’s Health about the impact alcohol can have on the body. • Information in newsletters and university magazines on safe drinking levels for alcohol. • Having students practise role-play scenarios similar to those young people might face around alcohol, so they can practise their problem solving, communication and assertiveness skills. • Knowing how and where to access reputable information relating to alcohol. For example, internet sites such as the Australian Drug Foundation or local community health centres. • Undertaking a first-aid course to develop skills to assist people with alcohol-related injuries. • Creating posters, postcards, coasters, stickers and wallet cards to educate people on the dangers of excessive alcohol consumption.
Creating supportive environments- Alcohol Abuse • Workplaces providing non-alcoholic drinks for after-work drinks. • Creating alcohol-free workplaces. • Companies providing counselling services for employees who are directly or indirectly affected by alcohol-related issues. • Parents supervising teenage parties if there is alcohol. • Parents modelling responsible drinking in front of their children. • Cooperation between police and festival organisers to screen and check people’s bags for alcohol at youth festivals such as V Festival or Good Vibrations. • Fundraising for charities linked with alcohol issues, such as domestic violence charities. • Pubs and clubs changing cups made of glass to plastic cups and enforcing the responsible service of alcohol. • Bouncers at pubs, clubs and parties making sure people behave responsibly around alcohol.
Strengthening community action- Alcohol Abuse • Supporting Alcoholics Anonymous groups. • Providing support groups for families who have lost loved ones to alcohol-related issues such as domestic violence and road accidents. • Police offering and supervising Blue Light events, such as hosting alcohol-free dances for young people. • Pubs and clubs having a ‘2 am lock out’ policy to prevent drunken people from entering the premises. • Pubs and clubs offering free bus services to take patrons home. • Offering support groups for victims of sexual assault, which may be fuelled by alcohol abuse. • Church communities offering food and shelter to victims of alcohol-related crimes. • Local community activities to engage young people to be active citizens and prevent boredom issues leading to the consumption of alcohol. • Communities providing statistics to support the submission for alcohol reforms to the local government in their area.
Reorienting health services-alcohol abuse • Increased funding for health promotion initiatives to target underage and binge drinking. • Registering parties with police to prevent gate crashers. • Wheelchair basketball guest speakers to talk about injury prevention relating to alcohol. • NRMA Road Trauma Forums for young people to prevent drink driving. • Increased funding for health promotion programs relating to alcohol, particularly for young people. • The Police Citizens Youth Clubs (PCYC) offering activities at night to remove boredom for young people. • Seminars run by Rotary on harm minimisation for adolescents and parents. • Free water handed out at youth festivals such as the V Festival and Good Vibrations.
Principles of social justice Access to good health should be available to all individuals. While most people generally have good health, the gap is widening in many areas of the Australian population. Health inequalities that exist have significant negative health impacts. Marginalised groups such as those with low socioeconomic status, Indigenous Australians, people living in rural and remote areas, people from non-English speaking backgrounds and older people, generally face poorer levels of health. Health inequalities are usually the result of an individual being in a disadvantaged social position; of inability to access information, services and resources; overexposure to various risk factors such as fast-food outlets and poor living conditions; lack of control over their own circumstances and a health care system that may be unaffordable
Equity In order for all individuals to achieve good health, access to health care services and information must be fairly distributed. Ensuring communities have the necessary infrastructure to provide quality health care for a free or low cost and have the ability to seek out health services regardless of age, gender or ethnicity is essential for individuals to achieve good health. Individuals have the right to good health, and governments need to ensure that all individuals have access to the same health care services and treatments. For example, people living in rural communities should have access to a dietician just as people living in the city do. As certain communities have higher health inequities than others, additional resources may be provided to reduce these health inequities. This could be through an increase of health services such as counsellors or through building more infrastructure such as nursing homes or hospitals. This would ensure greater equity of resources to those communities in greatest need. In order to reduce inequities, individuals should be able participate in the decision-making process within their community in relation to health needs. Individuals should be active participants in their own lives, planning for and making decisions about their own health.
Diversity Australia continues to grow into a diverse nation. From the physical diversity of the land to the social diversity of its cultures, Australia needs to consider many factors when addressing various health issues. Ensuring population groups within society are not discriminated against in terms of age, gender, sexuality or location is important in achieving good health for individuals. Providing health information in various languages, placing health services in places easy to access by public transport, celebrating various cultures and understanding the different health issues for the various population groups is essential in ensuring all individuals have the opportunity to achieve good health.
Supportive environments Providing environments where people are supported is essential to achieving good health. Homes, workplaces, schools and communities play a vital role in ensuring all people, regardless of their background, have the opportunity to be valued and make positive contributions to society. When the environment around a person supports positive health habits, it is easier for an individual to make positive choices. Ensuring environments in which people live are conducive and supportive for positive health is crucial for improving the health status of individuals. Celebrating the diversity of a community, empowering individuals and communities to take action on a health issue close to their heart and enabling people to improve environments is essential in achieving good health.
