In 1986 the World Health Organisation held the first global conference on health promotion at which the Ottawa Charter for Health Promotion was drafted and adopted. It has become the bible for health promoters with its five strategies of building healthy public policy, creating a supportive environment, strengthening community action, promoting individual skills and re-orienting health services. Today health promoters from around the world are gathering in Helsinki for the 8th conference on the theme of health in all policies. The deliberations this week in Helsinki will hopefully deepen the work of the commission on the social determinants of health (2008), and the political declarations issued from the Rio meeting on social determinants of health (2011), and the UN high level meeting on the prevention and control of non communicable diseases by determining how health can become a concern of all sectors.
The first event has been a seminar to mark the launch of, Health in All Policies: Seizing opportunities, implementing policies (HiAP), a book prepared as background to the conference. One of the key tensions that this conference will have to grapple with was pointed out in the introduction to the HiAP book by Margaret Chan, director general of the WHO, who noted “effort to prevent non-communicable disease pit public health objectives against the interests of powerful and highly profitable corporations.” The seminar continually asked the question of whether HiAP is relevant to all settings and especially low and middle income settings. This seems like a strange question and I pondered on whether they’d be any setting where “health in no policies” would be relevant! The question is more about whether there is capacity to implement the sophisticated policy approaches that HiAP demands. Ravi Ram (African Medical and Research Foundation) argued HiAP should be part of the post 2015 MDGs goal as it would be consistent with development assistance beyond the traditional vertical funding models. There was debate, led by Ron Labonte (University of Ottawa), about whether HiAP is essentially a reformist strategy. He argued that the problems currently posed by global capitalism require something far more profound. Yet any form of post capitalist society would certainly need to ensure that health and wellbeing were central aims of social, economic, and political organisation, and ensure ways of financing, planning, and managing policy to achieve these health aims. The threat to health from corporate interests was reinforced by Vera da Costa e Silva (FIOCRUZ, Brazil) discussing the tactics of big tobacco. She noted that the tobacco companies are deploying 120 lawyers to fight Australia’s plain packaging legislation in the World Trade Organisation. The seminar concluded with a consideration of the tactics that can be used to open the policy space for health and Eeva Ollila (Ministry of Social Affairs and Health, Finland) spoke of the ways in which political windows of opportunity can best be used to advance health agenda.
Looking through the conference programme, perhaps the most striking thing is the absence of behaviour change paradigms, which assume that promoting health should primarily rely on increasing individuals’ knowledge and so their behaviour. Instead the global health promotion community accepts that while knowledge matters, and at the end of the day behaviours must change, the way to bring about this change is primarily through the social and economic environments of everyday life and the underlying structural factors that shape these environments. The big question that will be explored over the coming five days is: what makes this change happen effectively.
Declaration of interest: I hold a Federation Fellowship from the Australian Research Council. In the past three years I have received research grants from the Australian Research Council and the Australian National Health and Medical Research Council. I am a member of the Global Steering Council of the People’s Health Movement, and from 2005-2013 served as co-Chair of this Council.
Fran Baum is a professor of public health. She is the director of the Southgate Institute of Health Society and Equity, Flinders University, Adelaide, Australia, and is a member of the Global Steering Committee, People’s Health Movement. She is an Australian Research Council Federation fellow.