The concept of health promotion is closely linked to the Ottawa Charter which was published in 1986 by the World Health Organization. The document was developed in response to growing expectations for a new public health movement around the world and it defined health promotion as:
the process of enabling people to increase control over the determinants of health, and thereby improve health.
To reach a state of complete physical, mental and social well-being, an individual or group should be able to identify and to realize their aspirations and to satisfy their needs as well as be able to cope with environmental demands and – in turn - to change their environments. Health is therefore seen, not as an objective of living but as a resource for daily life. Health is a positive concept emphasizing social and personal resources, as well as physical capabilities. Therefore, health promotion is not just the responsibility of the health sector, but needs to actively involve individuals and populations themselves. Successfully and actively taking charge of health, however, requires support on different levels.
In the Bangkok Charter, published in 2005, the above mentioned concept of health promotion was lifted to a higher global level with the purpose of addressing the different determinants of health in a globalized world through health promotion:
Health promotion action is typically oriented towards structures of the society, the environment, and policies.
All three elements, society, environment and policies, are necessary for influencing and supporting individual lifestyle and health behaviors. Examples could be the creation of bicycle lanes to encourage physical activity or the provision of healthy school meals in order to change individual nutrition status but also in doing so decrease the effects of social inequity due to children’s different socio-economic and cultural backgrounds. Similarly, smoking bans in public places or tax policies targeting harmful substances such as alcohol, tobacco or fatty foods are aimed at creating social-environmental contexts which favor healthy change.
The examples above make it clear that a health promotion approach extends far beyond individual health risk behaviors but is centered on creating the conditions which enable positive health behaviors in whole communities. Seen from this perspective, health impact considerations and health targets need to be integrated in all areas of decision-making, from traffic planning, to food regulations and social benefit policies (‘Health in All Policies’).
In pursuing and sustaining health promoting environments close collaboration is required between a) researchers providing scientific evidence for health determinants and best available evidence for effective interventions, and b) local stakeholders such as policy makers and practitioners, who are experts in their own communities. This collaboration enables actions based on local needs, values and priorities, thus empowering local communities to increase control over and improve their health.