JAKARTA DECLARATION ON PROMOTION INTO THE 21ST CENTURY

BACKGROUND health. , through invest- Adopted by the ments and actions, acts on the determi- The 4th International conference on Health Fourth International nants of health to create the greatest health Conference on Promotion - New Players for a New Era: Lead- gain for people, to contribute significantly Health Promotion, ing Health Promotion into the 21st Century - to the reduction of inequities in health, to Jakarta, Indonesia, comes at a critical moment in the devel- ensure human rights, and to build social July 1997 opment of international strategies for capital. The ultimate goal is to increase health. It is almost 20 years after the World health expectancy, and to narrow the gap Health Organisation member states made in health expectancy between countries an ambitious commitment to a global strat- and groups. egy of Health for All, and to the principles of primary through the Alma- The Jakarta Declaration on health promo- Ata Declaration. It is ten years after the 1st tion offers a vision and focus for health International Conference on Health Pro- promotion into the next century. It reflects motion was held in Ottawa, Canada. That the firm commitment of participants at the conference resulted in publication of the 4th International Conference on Health Ottawa Charter for Health Promotion which Promotion to draw upon the widest range has been a source of guidance and inspi- of resources to tackle health determinants ration for health promotion since that time. in the 21st century. Subsequent international conferences and meetings have further clarified the rel- Determinants of health: new evance and meaning of key strategies in challenges health promotion including healthy pub- Pre-requisites for health are peace, shel- lic policy (In Adelaide, 1988), and sup- ter, education, social security, social rela- portive environments for health (in tions, food, income, empowerment of Sundsvall, 1991). women, a stable eco-system, sustainable The 4th International Conference on resource use, social justice, respect for Health promotion in Jakarta is the first to human rights and equity. Above all, pov- be held in a developing country, and the erty is the greatest threat to health. first to involve the private sector in sup- Demographic trends such as urbanisation, porting health promotion. It provides an an increase in the number of older people opportunity to reflect on what has been and the prevalence of chronic diseases learned about effective health promotion, pose new problems in all countries. Other to re-examine determinants of health, and social, behavioural and biological changes to identify the directions and strategies such as increased sedentary behaviour, which are required to address the chal- resistance to antibiotics and other com- lenges of promoting health in the 21st monly available drugs, increased drug Century. abuse and civil and domestic violence, Health promotion is a valuable threaten the health and well-being of hun- investment dreds of millions of people.

Health is a basic human right and essen- New and re-emerging infectious diseases, tial for social and economic development. and greater recognition of mental health problems require an urgent response. It is Increasingly, health promotion is being vital that health promotion evolve to meet recognised as an essential element of changes in the determinants of health. health development. Transnational factors also have a significant It is a process of enabling people to in- impact on health. These include the inte- crease control over and to improve their gration of the global economy, financial

63 Healthy Documents • World Alliance for Breastfeeding Action • People’s Health Assembly markets and trade, access to media and essential to achieving effective partici- communication technology, as well as en- pation and the empowerment of peo- vironmental degradation due to the irre- ple and communities sponsible use of resources. These strategies are core elements of These changes shape values, lifestyles health promotion and are relevant for all throughout the lifespan, and living condi- countries. tions across the world. Some have great potential for health, such as the develop- New responses are needed ment of communications technology, oth- To address emerging threats to health, new ers such as international trade in tobacco, forms of action are needed. The challenge have a major negative impact. for the coming years will be to unlock the Health promotion makes a difference potential for health promotion inherent in many sectors of society, among local com- Research and case studies from around the munities and within families. world provide convincing evidence that health promotion works. Health promo- There is a clear need to break through tra- tion strategies can develop and change life- ditional boundaries within government sec- styles, and the social, economic and envi- tors, between government and non-gov- ronmental conditions which determine ernment organisations, and between the health. Health promotion is a practical public and private sector. Co-operation is approach to achieving greater equity in essential. Specifically, this requires the crea- health. tion of new partnerships for health on equal ground between the different sec- The five Ottawa Charter strategies are es- tors at all levels of governance in societies. sential for success: • build healthy public policy PRIORITIES FOR HEALTH PROMOTION IN THE 21ST • create supportive environments CENTURY • strengthen community action 1. Promote social responsibility for • develop personal skills health • re-orient health services. Decision makers must be firmly commit- There is now clear evidence that: ted to social responsibility. Both the pub- lic and private sectors should promote • comprehensive approaches to health health by pursuing policies and practices development are the most effective. that: Those which use combinations of the five strategies are more effective than • avoid harming the health of other in- single track approaches dividuals • settings offer practical opportunities for • protect the environment and ensure the implementation of comprehensive sustainable use of resources strategies. These include mega-cities, is- • restrict production and trade in inher- lands, cities, municipalities, and local ently harmful goods and substances communities, their markets, schools, such as tobacco and armaments, as well workplace, and health care facilities as unhealthy marketing practices • participation is essential to sustain ef- • safeguard both the citizen in the mar- forts. People have to be at the centre ketplace and the individual in the of health promotion action and deci- workplace sion-making processes for it to be ef- fective • include equity-focussed health impact assessments as an integral part of policy • health learning fosters participation. development Access to education and information is

64 Healthy Documents • World Alliance for Breastfeeding Action • People’s Health Assembly 2. Increase investments for health Both traditional communication and the development new information media support this proc- ess. Social, cultural and spiritual resources In many countries, current investment in need to be harnessed in innovative ways. health is inadequate and often ineffective. Increasing investment for health develop- 5. Secure an infrastructure for health ment requires a truly multi-sectoral ap- promotion proach, including additional resources to education, housing as well as the health To secure an infrastructure for health pro- sector. Greater investment for health, and motion, new mechanisms of funding it lo- re-orientation of existing investments - cally, nationally and globally must be both within and between countries - has found. Incentives should be developed to the potential to significantly advance hu- influence the actions of governments, man development, health and quality of nongovernmental organizations, educa- life. tional institutions and the private sector to make sure that resource mobilization for Investments in health should reflect the health promotion is maximised. needs of certain groups such as women, children, older people, indigenous, poor “Settings for health” represent the organi- and marginalised populations. sational base of the infrastructure required for health promotion. New health chal- 3. Consolidate and expand lenges mean that new and diverse net- partnerships for health works need to be created to achieve intersectoral collaboration. Such networks Health promotion requires partnerships for should provide mutual assistance within health and social development between and between countries and facilitate ex- the different sectors at all levels of gov- change of information on which strategies ernance and society. Existing partnerships are effective in which settings. need to be strengthened and the poten- tial for new partnerships must be explored. Training and practice of local leadership skills should be encouraged to support Partnerships offer mutual benefit for health health promotion activities. Documenta- through the sharing of expertise, skills, and tion of experiences in health promotion resources. Each partnership must be trans- through research and project reporting parent and accountable and be based on should be enhanced to improve planning, agreed ethical principles, mutual under- implementation and evaluation. standing and respect. WHO guidelines should be adhered to. All countries should develop the appro- priate political, legal, educational, social 4. Increase community capacity and and economic environments required to empower the individual support health promotion. Health promotion is carried out by and CALL FOR ACTION with people, not on or to people. It im- proves both the ability of individuals to Participants are committed to sharing the take action, and the capacity of groups, key messages of the Declaration with their organisations or communities to influence governments, institutions and communi- the determinants of health. ties, to put into practice the actions pro- posed, and report back to the 5th Inter- Improving the capacity of communities for national Conference on Health Promotion. health promotion requires practical edu- cation, leadership training, and access to In order to speed progress towards global resources. Empowering individuals de- health promotion, participants endorse the mands more consistent, reliable access to formation of a global health promotion the decision making process and the skills alliance. The goal of this alliance is to ad- and knowledge essential to effect change. vance the action priorities for health pro- motion expressed in this declaration.

65 Healthy Documents • World Alliance for Breastfeeding Action • People’s Health Assembly Priorities for the alliance include: works for health promotion both within and between their countries. • raising awareness about the changing determinants of health Participants in Jakarta ’97 called on WHO • supporting the development of collabo- to take the lead in building a global health ration and networks for health devel- promotion alliance and enabling its mem- opment ber states to implement the results of the Jakarta Conference. A key part of this role • mobilisation of resources for health is for WHO to engage governments, promotion nongovernmental organisations, develop- • accumulating knowledge on best ment banks, UN agencies, interregional practice bodies, bilateral agencies, the labour movement and co-operatives, as well as • enabling shared learning the private sector in advancing the action • promoting solidarity in action priorities for health promotion. • fostering transparency and public Copyright © by World Health Organization, accoutability in health promotion Division of Health Promotion, Education and National governments are called to take Communication, CH-1211 Geneva 27, Swit- zerland initiative in fostering and sponsoring net-

66 Healthy Documents • World Alliance for Breastfeeding Action • People’s Health Assembly