Editorials

Policy and partnership for health promotion — addressing the determinants of health Kwok-Cho Tang,1 Robert Beaglehole,1 & Desmond O’Byrne1

Health promotion is the process of action, develop personal skills and in Bangkok, Thailand, on 7–11 August enabling people to increase control reorient health services. Along with 2005, spelt out four new commitments over their health and its determinants. the advancement of health-supporting in the Bangkok Charter for Health This is done by strengthening indi- policies and environments, there have Promotion in a Globalized World: to vidual skills and capabilities and the been positive behavioural and lifestyle make the promotion of health central to capacity of groups to change the many changes at the population level which the global development agenda, a core conditions, particularly the social and lead to the reduction of, for example, responsibility for all of government, economic causes, that affect health heart diseases, road injuries, HIV/AIDS a key focus of communities and civil (1–3). The value of health promotion and other infectious diseases (10, 11). society, and a requirement for good has recently been reaffirmed (4, 5). It is The changes are largely confined, how- corporate practices (2). a core function of public health and a ever, to people of a higher level of edu- An expansion of the five Action cornerstone of primary health care. It is cation and socioeconomic background Areas is also required to narrow the both effective and cost effective (6–8), and are much less evident among the equity gap. For example, building and the links between health, health lower socioeconomic groups. Renewed capacity to promote health is a priority promotion and human and economic effort is required to narrow the equity — “capacity” referring not merely to development are increasingly recog- gap. expertise of individual practitioners but nized (5–9). The context of health promotion also to other areas of concern includ- ing policy, partnerships, health promo- In 1986, health promotion came has changed markedly since the Ottawa tion finance and information systems into full force through the Ottawa Charter was adopted. New patterns of (12). It is also necessary to include the Charter for Health Promotion. The consumption and communication, private sector when developing health Ottawa Charter, adopted at the first urbanization and environmental changes promotion policies. WHO Global Conference on Health as well as public health emergencies are In addition to advocacy for health Promotion and reinforced by further critical factors that influence health. based on health rights and solidarity, conferences held in Adelaide, Sundsvall, Rapid and often adverse social, eco- the Bangkok Charter urges all sectors Jakarta and Mexico City, sets out a nomic and demographic changes also and settings to invest in sustainable clear agenda to pursue health for all by affect working conditions, learning policies, actions and infrastructure; to addressing the broad determinants of environments, family patterns and the build capacity to promote health; to health such as shelter, education, food cultural and social fabric of communi- regulate, including through legislation, and income. Through joint efforts with ties. The role of the state has changed for a high level of protection against others, including the International and many states have limited their com- harm; and to build alliances with public Union for Health Promotion and Edu- mitment to the provision of health ser- and other sectors. The Bangkok Charter cation, academic institutes and many vices funded from government revenue. also calls for more conscientious effort professional associations and minis- All these changes have been accelerated to sustain the effectiveness of health tries, health promotion has successfully by globalization, which also opens up promotion by developing benchmarks shifted the focus from behavioural new opportunities for cooperation to for monitoring and plans for imple- change at the individual level (with a improve health and reduce transnational mentation of a worldwide partnership disease orientation) to health-oriented health risks. Greater effort is needed to to fulfil its four commitments. O behaviour and other determinants such bring health closer to the centre of the as a healthy diet, physical activity, per- development agenda. Acknowledgements sonal hygiene, education for women To manage the challenges and Web version only, available at: http://www. and social connectedness, through the opportunities of globalization at global who.int/bulletin use of combinations of the five Ottawa and national levels, collaboration and Charter Action Areas. They apply engagement of all sectors of society are References Web version only, available at: http://www. across different age and population required to ensure that the benefits for who.int/bulletin groups in different settings such as health from globalization are maximized schools, workplaces and communities. and equitable and the negative effects The Action Areas are designed to build are minimized and mitigated. To this healthy public policy, create supportive end, participants in the 6th Global environments, strengthen community Conference on Health Promotion, held

1 Department of Chronic Diseases and Health Promotion, World Health Organization, 1211 Geneva 27, Switzerland. Correspondence should be sent to Dr Tang (email: [email protected]). Ref. No. 05-027201

884 Bulletin of the World Health Organization | December 2005, 83 (12) Editorials

Acknowledgements This manuscript draws on the Bangkok Charter for Health Promotion in a Globalized World, which was devel- oped and finalized by a large number of colleagues in the international health promotion community.

References 1. The Ottawa Charter for Health Promotion. Geneva: World Health Organization; 1986. See: http://www.who.int/healthpromotion/ conferences/previous/ottawa/en/ 2. The Bangkok Charter for Health Promotion in a Globalized World. Geneva: World Health Organization; 2005. See: http://www.who. int/healthpromotion/conferences/6gchp/ bangkok_charter/en/index.html 3. Report of the Fifth Global Conference on Health Promotion. Geneva: World Health Organization; 2000. 4. Wanless D. Securing good heath for the whole population. Final report. London: The Stationery Office; 2004. 5. Commission on Macroeconomics and Health. Macroeconomics and health: investing in health for economic development. Geneva: World Health Organization, 2001. 6. The evidence of health promotion effectiveness: shaping public health in a new Europe. Paris: International Union for Health Promotion and Education; 1999. 7. WHO-CHOICE, Choosing interventions that are cost effective. Geneva: World Health Organization, 2002. See: http://www3.who.int/ whosis/menu.cfm?path=whosis,cea&language =english 8. Applied Economics. Returns on investment in public health. An epidemiological and economic analysis. Canberra: Department of Health and Ageing; 2003. 9. Suhrcke M, McKee M, Sauto Arce R, Tsolova S, Mortensen J. The contribution of health to the economy in the European Union. Brussels: Directorate General for Health and Consumer Protection, European Commission; 2005. 10. The world health report 2002 – Reducing risks, promoting healthy life. Geneva: World Health Organization, 2002. 11. Scaling up the response to infectious diseases. Geneva: World Health Organization; 2002 (WHO/CDS/2002.7). 12. Catford J. The Bangkok Conference: steering countries to build national capacity for health promotion. Health Promot Int 2005;20:1-6.

Bulletin of the World Health Organization | December 2005, 83 (12)