Crafting health promotion: from Ottawa to beyond Shanghai

This year there are celebrations, around the world, of the 30th anniversary of the Ottawa Charter. We have seen similar celebrations five years (e.g., De Leeuw 2011, REFIPS 2012) and ten years ago (e.g., Baum 2007, Ridde, Guichard & Houeto 2007). The Charter remains visionary and inspirational, with a lasting legacy. But it has not delivered on its vision comprehensively. Two of its action areas stand out as having failed to show real evidence of success: the call to build healthy public policy, and the need to reorient health services for health promotion.‘Healthy Public Policy’ has now been replaced by ‘Health in All Policies’ (De Leeuw, Ståhl & Tang (2014). ‘Reorientation of Health Services’ still struggles. Both of these, in our assessment (de Leeuw 2017), suffer from the relative marginalisation of health promotion advocacy on the fringe of the mainstream medical-industrial complex. Clinical care and the pharma and biomedical technology sector continue to grow, while public health and health promotion remain on the resource and policy periphery. A partial solution to this challenge is for the global health promotion community to embrace a health political science (Bernier & Clavier 2011, Clavier & de Leeuw 2013). This would explain the political process for making choices in the public domain, and explicitly recognise issues of power, perception and trade-offs. The world of 2016 is very different from the world of 1986. Socialist states and Marxism-Leninism have all but disappeared from the face of the earth. Globalisation and its neoliberal market dictatorship is now the dominant and virtually unchallenged ideology (Labonté 2016). Progress has been made but it has not been shared by all. Humanity as a whole is doing better, but differences between populations and groups persist and grow, in terms of health, well-being, wealth and life opportunities. Knowledge, information and entertainment are available everywhere and anytime, at mind-numbing speeds, qualities and quantities. The gap in the ozone layer may have closed, and acid rain disappeared, but they have been replaced by the seemingly unstoppable advent of the slow disaster of climate change. Rampant population growth and (often disaster-driven) mobility have led to an urban planet with hundreds of millions living in camps, slums and on the fringe. The ecosystem services that buffer hardships for these people – fresh air, clean water, food, fuel, building materials, and protection from flooding – are collapsing. Against this backdrop, the government of the People’s Republic of China with the World Health Organization is organising the Ninth Global Conference on Health Promotion in Shanghai in November 2016.In this world - is the Ottawa Charter still relevant? Is the Shanghai Declaration on Health Promotion going to have the visionary and lasting impact the Charter had