Is the Ottawa Charter still relevant to health promotion today?

The Ottawa Charter for Health Promotion, introduced in 1986, was groundbreaking for its time and laid a foundation for modern health promotion strategies. It changed how we thought about health, moving away from a purely biomedical model and toward a socio-ecological approach to health that emphasized empowerment, intersectoral action, and community involvement (Raphael & Bryant, 2022). However, I would argue that while the Charter was historically significant, it is no longer fully relevant in today's public health context.

The Charter doesn't address today's health issues like climate change, digital health inequality, systemic racism, and rising chronic illness in aging populations, and these are complex issues. The Charter doesn't fully reflect these challenges or offer clear guidance for how to address them. Although the Charter emphasized empowerment, it often placed responsibility for health outcomes on individuals, rather than addressing the deeper social, economic, and political structures that limit health choices. With today's complex health challenges, approaches that focus more on systems and barriers than individual-level change are needed.  

A good example of this is health behaviourism, which focuses on changing personal behaviours through education, for example, teaching people to stop smoking or eat healthier. These efforts often assume that giving people the right information will lead to better choices. But this overlooks the fact that behaviour is usually shaped by a person's circumstances. For example, smoking rates are higher in communities dealing with poverty and stress (CCSA, 2020), not because people don't know the risks, but because they face other barriers that may make it harder to quit. The Charter focuses too much on behaviour-based approaches and doesn't address the systems that drive those behaviours.

Public Health Ontario (2023) pointed out that there's a disconnect between the Ottawa Charter's ideals and how they play out in practice. They describe a kind of "push and pull" between what the Charter set out to do and what's actually needed now. Health promotion today needs to do more than encourage individual change—it needs to focus on changing the systems that make it hard for people to stay healthy in the first place. We're seeing this shift in newer public health frameworks like Ontario's Public Health Standards, which put a stronger focus on social determinants of health and supporting community-led action (Public Health Ontario, 2023).

The Ottawa Charter laid the groundwork for health promotion, but today's health promotion requires more than the Charter of 1986. To support health equity, we need a modern framework that addresses the root causes of poor health, including poverty, discrimination, and digital exclusion, not just the behaviours that result from them.

References:

Canadian Centre on Substance Use and Addiction. (2020). Substance use and the social determinants of health. https://www.ccsa.ca/sites/default/files/2020-07/CCSA-Substance-Use-Social-Determinants-of-Health-Report-2020-en.pdf

Public Health Ontario. (2023). Focus on foundations: Revisiting the health promotion foundations of the Ontario Public Health Standards. Retrieved from https://www.publichealthontario.ca/-/media/Documents/F/2023/focus-on-foundations-health-promotion.pdf

Raphael, D., & Bryant, T. (2022). The health of populations: Beyond medicine. In D. Raphael (Ed.), Social determinants of health: Canadian perspectives (4th ed., pp. 4–30). Toronto, ON: Canadian Scholars.