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Health Promotion International, Vol. 16, No. 1, 1,
March 2001
© Oxford University Press 2001
EDITORIAL |
Mexico and beyond
Chair, Editorial Board Change is a defining characteristic of health promotion. Yet many who attended the 5th Global Conference on Health Promotion in Mexico City in June 2000 felt that there was too much change without reason. Even worse, some felt there was disregard for what had been achieved, often in the face of adversity. This issue of Health Promotion International carries an open letter to Dr Brundtland, the Director General of WHO, which expresses such sentiments.
Is there reason for concern? Health promotion for many years has been fostered and advocated by the WHO. It goes back to a challenge set in the early 1980s by the then Director General Dr Halfdan Mahler. I was privileged to be given the task of building this new field of work, and the last 15 years of my professional life have been dedicated to this task at different levels of the WHO. It was an exciting time, a time of professional and personal growth. It saw health promotion permeate a wide range of health activities, it brought new partners on board, it led to new ways of doing things and thinking about things. I remember the 10th anniversary of the Healthy Cities Project in Athens, when one of the mayors stated in his speech that the most important thing about this project has been that it has taught us to view health differently.
It frequently seemed to me that health pro-motion was understood better outside of the WHO than within it, that non-health professionals found it easier to grasp its nature than people who had been trained in a medical perspective. Health promotion is about social processes for health, its essence lies in empowerment. It advocates a power shift in favour of health. It proposes to invest in living and working conditions, and in social capital and social relations. It takes its knowledge base from a broad interdisciplinary enterprise. Many of its arguments have been reinforced in recent years through research on social determinants, on health development and social capital. Most recently, Amartya Sen and Martha Nussbaum have argued for a capabilities and a support-led development process. In reading their work I was astounded how close it came to the principles of the Ottawa Charter.
So must we worry? I don't think so. Health promotion is kept alive by the many advocates out there who are doing it day by day, in cities, schools, work places, universities, ministries of health and NGOs. There are few public health documents that have been so widely disseminated, translated and debated as the Ottawa Charter. Much that was considered new in 1986 is now an accepted way of thinking about health. Lester Breslow, the great epidemiologist, has recently stated that the Ottawa approach is the third great public health revolution. The proof of the health promotion pudding does not lie in conferences—even if they help cement the field and provide social glue—it lies out there in the real world. I would hope that the WHO will continue to support it, indeed I would hope that the WHO wants to use the energy of these many advocates for health. Let us use this period to think hard, argue clearly and get on with the job. Changing a paradigm was never meant to be easy.
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