In recent years there has been a growing expectation of new strategies concerning Health Promotion and a number of conferences have been held around the world. One such conference on Health Promotion was held on the 21st day of November 1986 in Ottawa. The objectives of the conference centred on the needs in industrialised countries, and their main concerns were the Declaration on Primary Health Care at Alma-Atta, the World Health Organisation’s targets for all document, and discussions at World Health Assembly regarding intersectoral actions for health as well as taking into accounts similar concerns in all other regions (WHO 1986). This assignment will explore the literature to assess whether the Ottawa Charter continues to influence the values and practice of health promotion in the 21st century. Discussions will include the concept of health and definition of Health Promotion, factors influencing health, approaches for promoting health and evaluation for health promotion practices against national guidelines.
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Health Promotion could be defined as a miscellaneous approach to encourage health related life-style behaviours within communities and individuals (Laverack 2007). The aims of Health Promotion, is to allow people to gain control over the determinants of health and thereby improving their health as well as the factors influencing it (WHO 1986, 2005). The most common definition of health, states that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (WHO 1946). However, although this definition has been accepted widely as a holistic and positive explanation of health, it has been criticised for not considering the spiritual and emotional aspects of health (Eweles and Simnett 2003).
According to Laverack (2007) the definition of health is subjective and depends entirely on the experiences and the life styles of a person and has become necessary that healthcare professionals should be aware of the fact that explanations of health are highly understood differently from one individual to the other with regards to issues militating against them such as self-esteem, social support, individual control and social status (Laverack 2007), so that in addressing health issues people should be ready to embrace and undertake interventions of health promotion to achieve realistic goals.
The key issues influencing health predominantly include food, shelter, peace, income, education, a stable ecosystem, a sustainable resources, social justice and equity. These have been affirmed as the key fundamental human rights of an individual as emphasised in the Ottawa charter (WHO 1986). Above these health problems, poverty has been the source of danger to health (WHO 1997). Other factors that affect health indirectly are the global economy, financial market and trade, accessibility to media and communication technology as well as environmental degradation as a result of irresponsible way of using resources (WHO 1997). In order to address these issues to attain an ultimate goal and to increase a high level of health expectancy as well as to narrow the gap in health expectancy between countries and communities as a group, there should be the need to focus critically on the visions of The Jakarta Declaration on Health Promotion to derive a possible range of different resources to solve the health determinants in the 21st century.
One way of attempting and influencing these values and practices is that, there should be a firm commitment to adopt a Health Promotion strategy that can influence changes in the lifestyles of countries or groups of people living in a geographical area and also changes that can affect the social, economic and environmental conditions that determine health.
In order for the promotion of health to be effective, the Ottawa Charter has recognised three basic plans and these are; advocacy for health to create an atmosphere to achieve the essential conditions for health and this is designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal (WHO, GENEVA, 1995). Secondly an enabling conditions for all people to achieve their full health potential and this is done by individuals or groups to empower them through the mobilization of human and material resources, to promote and protect their health through partnership and thirdly to mediate between the different groups and the pursuit of health (WHO, GENEVA, 1984).
In view of these three basic strategies, there should be a collaborative effort to arrest these health problems globally, due to its depth and breaths of the issues at stack (Scriven 2005). According to Scriven (2005) this is going to prevent duplication and enable the development of strategies involving political, economic and policy initiatives that address the complexity of health determinants. The WHO (2005) affirms that the on- going initiatives towards a healthier world will need a strong political action, broad participation and sustained advocacy. For a long time past a number of important policies have been developed by the WHO in order to make this happen. The Ottawa Charter for Health Promotion which has become the most significant milestone in history today (WHO 1986), also gave birth to the progress that brought about the Declaration of Alma-Ata (WHO 1978). At this conference there was a proposal for the need for health promotion action to: Develop healthy public policy, Create supportive environments, Strengthen community action, Develop personal skill, Re -orientate health services and Move into the future (WHO 1986).
Regardless of the policies formulated at the global level, the Bangkok Charter for Health Promotion in a Globalized World (WHO 2005) put forward for consideration the values, principles and action strategies of health promotion established by the Ottawa charter (WHO 1986). The Bangkok Charter recognizes actions, commitments and pledges required to address the determinants of health in a globalised world through health promotion (WHO 2005). Its focus is the need 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 the health and wellbeing for all.
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In view of the prospective that global policies of Bangkok and Ottawa charters have to implement to achieve global health and offset the health damaging problems world- wide, reality does not always reflect that actions. For example, according to WHO (2005) since the implementation of the Ottawa Charter, a substantial number of resolutions both globally and national level have been signed in support of health promotion, but these actions have not been followed (WHO 2005). There is a persistent gap between policy knowledge at a global level and policy implementation at country level (Magnusson 2007). This explains that the efforts of policy makers and the potential benefits of globalisation are wasted. The implementation gap should be closed if improving global health is to become a reality (WHO 2005).
Despite the implementation and the adoption of the policies proposed in the Ottawa Charter couple with reflections to other series of conferences held globally in the promotion of health, and in addition to different health promotion strategies and the adherence to the values and practices of health promotion, it has become very challenging and impossible to maintain the values and practices set up in the Ottawa charter to achieve the basic fundamental human right towards this 21st century. This is because the world is being confronted with different types of man- made and natural disasters such as wars, earthquake, bush-fires, widespread of pandemic diseases in the disadvantage areas of the world and global warming. Typical of these disasters are the recent floods in Pakistan which started in July this year which inflicted about £5.9 million in damage to properties, crops and infrastructure and has left more than ten million people homeless and affected about 20 million and devastated the economy according to world bank report and in addition to these problems the government is persistently confronted with how to tackle the political tensions in the system such as Muslim militant, suicide bombing, tight budget and the endemic corruption that goes on in government institutions (Ahmed 2010). These problems have made it unrealistic for the values and practice of health promotion achievable towards the 21st century.
What can be done is that, globalisation poses a threat to the health of the world’s population, but it also presents opportunities. Enhanced interconnectivity, including technology and communications, which means that it is easier for countries to work together to tackle the determinants of health. Policies developed at a global level, such as those of the WHO, can promote health provided that they are implemented judiciously. Countries can face the challenge of globalisation by being supported and prepared through relevant policies, research and education. Countries should embrace globalisation and exploit its benefits for promotion of health care across the world (Seloilwe 2005). This implies that countries have responsibility as individuals in relation to globalisation. The health profile of the world is changing and this has an impact on Health Promotion. The implication is that countries now need to think more globally. This might reasonably begin with an understanding of the nature of globalisation and its implications for Health Promotion.
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