Health Promotion International, Vol. 16, No. 1, 3-4,
March 2001
© Oxford University Press 2001
EDITORIAL |
Mexico conference on health promotion: open letter to WHO Director General, Dr Gro Harlem Brundtland
Research Centre for Health Promotion, University of Bergen, Bergen, Norway (initiating author) ABC Region School of Medicine, Santo André—São Paulo, Brazil Department of Human Nutrition, St Francis Xavier University, Nova Scotia, Canada School of Public Health, University of Debrecen, Debrecen, Hungary Public Health and Medical Sociology, Université Laval, Québec, Canada Health Promotion and Education Unit, School of Public Health, Free University of Brussels, Belgium Promotion and Public Health, Colombia Centre for Health Promotion, University of Toronto, Toronto, Canada Netherlands Institute for Health Promotion and Disease Prevention, Woerden, The Netherlands School of Health, Liverpool John Moores University, Liverpool, England School of Medicine, University of New Mexico, New Mexico, USA School of Public Health of the University of São Paulo, São Paulo, Brazil Australian Centre for Health Promotion, The University of Sydney, Sydney, Australia We want to thank you for attending the Global Conference on Health Promotion, held in Mexico City, 5–9 June 2000. We welcomed much of what you said in your opening speech.
However, we are seriously concerned about some of your comments. Your speech characterized health promotion as being narrow, and implied that under your leadership health promotion at WHO was being given a new and enlightened role in the organization's work. Among other themes you emphasized the importance of chronic and infectious disease control, and especially the need to fight tobacco. You have linked these themes to health promotion, both in your remarks and in practice, having organized them together in a new cluster at the WHO headquarters.
In our view it is this linkage of health promotion with specific diseases and risk factors that is narrow and does not reflect the essence of health promotion. That is not health promotion as we teach it, as our students and public health workers practice it, and as it has developed as a core function of public health. Over the past 25 years, health promotion activists (like us, but including people from every walk of life) have developed, tested, refined and disseminated strategies to improve the effectiveness of health promotion action. The heart of this work is captured in the Ottawa Charter, launched by the WHO, which is a document so well conceived that it remains a vital guide to this day. Due to the impact of the Charter, there remain today few areas of the world where health promotion is equated with a focus on the individual, where lifestyle change and risk factor reduction is the order of the day.
As academicians, we love a good argument over definitions better than most. But we are unanimous in our understanding that, first and foremost, health promotion can be practised by doctors, mayors, educators, presidents, advocates, researchers, social and public health workers, prison guards, priests, administrators, governors, everyday citizens and politicians alike. When these people are working on matters relevant to health, following a health promotion approach obligates them to encourage openness and participation, strive for the empowerment and autonomy of others, and hold equity and justice as the highest of principles.
This way of thinking about and doing health promotion has been adopted around the globe, with great commitment and success as was presented and documented at the technical sessions of the Global Health Promotion Conference in Mexico City. Health promotion's track record of success is documented in a wealth of academic publications reporting on basic research, community-based projects, policy initiatives and new health promotion infrastructures around the globe. There is no lack of evidence.
Especially in the Southern Hemisphere, but elsewhere as well, health promotion is a main tool for human development, and in some countries, health promotion has developed as a profession. One size does not fit all. In certain regions, targeted health promotion may be fitting and desirable. In other regions, a professional health promotion infrastructure aimed at community development may be what is needed and welcomed. Yet other regions enjoy other combinations of approaches as the active work of the WHO Regional Offices in health promotion has shown. Their joint reference point has been the Ottawa Charter and WHO's leadership.
This leads us to our main point. It is very discouraging, and it can be harmful, for the Director General of the WHO to imply that this wealth of experience in health promotion is narrow, without value and needs focusing on specific issues such as tobacco control. This discredits a growing professional community that has committed itself to innovation in public health.
We think the merging of disease prevention and health promotion at the WHO headquarters in Geneva is unfortunate, because it will reinforce the mistaken notion, held by a few, that ‘health promotion’ is just another term for ‘disease prevention’. It is true, of course, that the strategies of health promotion are essential in successful disease prevention efforts but the organizational format you have chosen downplays health promotion's role in empowering people to take positive health action and it negates totally what has already been achieved.
WHO should be proud of having helped develop a vibrant field of public health action rather than discredit it. WHO's leadership was vital to the growth of health promotion, and we want WHO to be a key partner in its continued maturation. We are convinced that there are mutual benefits in working together—health promotion professionals and the WHO—in partnership. As a first step in that direction we urge that you appoint a senior advisor who is planted firmly in the health promotion community and is highly respected by professionals and member states. Such a person could advise you on how to capitalize on the strong global health promotion resources that could help you meet your most important goals at this crucial period of global health development.
Sincerely yours,
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