PHA-Exchange> Bangkok Charter - PHM Input Needed

[Kumanan Rasanathan]

Vannakkam and Kia Ora Koutou

Please find below the text of the latest draft of the Bangkok Charter.
We have copied the text from the pdf available on the WHO website. You
may like to refer to the fully formatted pdf at:

http://www.who.int/healthpromotion/conferences/6gchp/bangkok_charter_comments/en/


As you may be aware, the Bangkok Charter is to be launched
at the Bangkok conference on health promotion in August, as a
significant update of the Ottawa Charter. The Bangkok Charter is an
attempt to address the significant global developments that have
occurred in the last twenty years. Significant work has been undertaken
to produce a document with the aim of meaningfully influencing the
practice of health promotion to engage with these issues to improve
health. As such, the rationale behind this document should be supported
by all those who advocate "health for all".

However, many of us in New Zealand are concerned about the latest draft
of the document. In particular we are concerned about its neutral
treatment of globalisation (as shown by the proposed commitment to
ensure that "globalisation becomes more health friendly"!), its lack of
consideration of indigenous health, and its failure to clearly endorse
the MDGs and recent international human rights and environmental
treaties. We are concerned that this document will thus be cynically
used as a roll-back position, which is possible given the international
endorsement it will receive. Comparing the draft Charter to the
People's Health Charter, there are obvious problems. Furthermore, the
latest draft is more tepid than previous versions, removing references
to the need for equity and the consideration of the impact of war on
health. 

We have not seen anything on the PHM list about this document. We
believe that the PHM could make a material difference to improve this
document. The consultation process for the document has been unclear up
to now, but essentially it is being driven by WHO. WHO is now seeking
comment by the 14th of July via a form availabe at the above site
(http://www.who.int/healthpromotion/conferences/6gchp/bangkok_charter_comments/en/).

We understand that the PHM is fully occupied at the moment preparing
for the PHA-2. However, the Ottawa Charter is widely used in New
Zealand and elsewhere, and we believe that a well framed Bangkok
Charter could be a valuable tool in the fight for "health for all".
Moreover, as currently framed, we are concerned it could have a
negative effect. As such, we would appreciate your suggestions on how
the PHM can advocate to improve this document. One of us (Kumanan) will
be at the IPHU and PHA-2 in Cuenca, and it would great if we could make
time there to discuss this. However, it may be important to submit
something by the deadline of July 14. We are hoping that among the PHM
ranks, some of you may have a better idea about the best way to proceed
with this.

We look forward to hearing from you.

Nandri

Kumanan Rasanathan and Alison Blaiklock

-------------------------

D R A F T V.5.0 24/6/05

THE BANGKOK CHARTER FOR HEALTH PROMOTION

OVERVIEW

Health is a human right

One of the fundamental rights of every human being, without distinction
of race, gender, age, religion, political belief, culture, economic or
social condition, is the enjoyment of the highest attainable standard
of health. 

Health is the "state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity".

Principles

Health promotion is based on the following principles:
• Social justice and health equity
• Respect for diversity, dignity and human rights

Aims

The Bangkok Charter aims to:
• Engage and provide guidance to the many stakeholders in all countries
• Reaffirm health promotion as the process of enabling people to
increase control over their health and its determinants and thereby
improve their physical and mental health

Determinants of health

Health promotion is a core component of public health and targets the
full range of modifiable determinants of health.

Background 

The Bangkok Charter for Health Promotion in a globalized world
highlights the new challenges that need to be met and the commitments
that need to be made by a broad range of stakeholders. 

The Bangkok Charter endorses the Ottawa Charter of 1986 which laid out
the values, principles and purposes of health promotion. The Bangkok
Charter builds on the five action areas of the Ottawa Charter to:
• Build healthy public policy
• Create supportive environments
• Develop community action
• Develop personal skills
• Reorient health services

It also builds on the recommendations of the subsequent international
health promotion conferences: Adelaide, Australia (1988); Sundsvall,
Sweden (1991); Jakarta, Indonesia (1997); and Mexico City, Mexico
(2000).

CHALLENGES

Global challenges

Globalization, environmental change, urbanization, political and
demographic transitions, the disease burden, advances in science and
information technology, and the role of the state have all evolved
since the Ottawa Charter. Health inequalities remain a grave concern,
as does the limited health promotion capacity in many
countries.

Active participation required

To address these issues effectively, health promotion requires active
participation from a wide range of partners including:
• The health sector
• All governments
• International organizations
• The private sector
• Nongovernmental organizations and civil society
• The wider community

Health promotion in a globalizing world

Globalization opens up new avenues for cooperation. However, it can
also:
• weaken governmental control over a growing number of health
determinants
• subject individuals and communities, in all countries, to rapid
social change

Globalization also demonstrates the central importance of health for
poverty reduction and the economic and social development of nations as
emphasized by the importance given to health in the Millennium
Development Goals.

Globalization offers new opportunities for the promotion of health in
diverse sectors, with a widening variety of stakeholders whose
commitment and action are critical for health promotion in an
increasingly interdependent world.

Health promotion works

There is a wide body of evidence to show that health promotion works
and in particular:
• Interventions that use the five Ottawa Action Areas are the most
effective
• Settings such as schools, workplaces, communities and cities offer
practical opportunities for the implementation of comprehensive
strategies
• Participation, especially by the community, is essential for the
sustainability of health promotion efforts
• Access to education and information is critical to achieving a high
level of health literacy, effective participation and the empowerment
of individuals and communities
• Health education and life skills training, when properly planned and
implemented, encourage positive behavioural changes
• Political leadership, good governance and supportive policies are key
ingredients of success

NEW COMMITMENTS

Four commitments

To meet the wide range of existing, emerging and potential future
opportunities and challenges, commitment is required by the full range
of stakeholders to ensure that:
• Globalization becomes more health friendly
• Health promotion is a core responsibility of all governments
• Health is a key to good corporate practices
• Environments empower individuals and communities to improve their
health

Make globalization health friendly

The task of ensuring that health becomes central to the global agenda
requires actions by all concerned stakeholders to:
• Promote dialogue and cooperation among civil society, the private
sector, government and intergovernmental bodies to coordinate action on
public health
• Balance the benefits of globalization with the benefits of local
action so that the assets of culture are preserved and cultural
diversity is enhanced
• Make public health an integral part of foreign and domestic policy
and international relations including in times of conflict
• Support national government actions and intergovernmental alliances
that protect people from the potentially harmful effects of products,
services and marketing strategies
• Address the brain drain from developing countries

Make health promotion a core responsibility of all governments

To ensure that health promotion is an integral part of socioeconomic
and political development, governments should use the whole of
government approach to:
• Tackle the social and economic causes of poverty, poor health and
inequalities
• Ensure that the health implications of all government policies and
legislation are taken into consideration
• Ensure that investments outside the health sector contribute to the
achievement of health outcomes
• Strengthen health promotion in all sectors, including the adoption of
the whole-ofgovernment approach
• Develop appropriate legal and regulatory frameworks to promote
public-private and inter-sectoral collaboration
• Improve surveillance and tracking of emerging global health threats
• Invest in health promotion research and its application to practice

Make health a key to good corporate practices

The business sector is a key stakeholder in the achievement of
population health. This sector needs to:
• Invest in health and safety in the workplace
• Ensure that production processes, products and marketing strategies
do not undermine health
• Foster public–private partnerships and multinational alliances to
enhance health through greater corporate social responsibilities
• Undertake collaborative efforts with public sector health care
providers to enhance access to basic, good quality health care services

Make environments to empower individuals and communities

This commitment will include actions that:
• Provide policy environments which enable communities to engage in
selfdetermined health promotion action
• Establish networks and partnerships, particularly with
nongovernmental organizations that strengthen community actions for
tackling local, national and global health issues
• Support evidence-based traditional and complementary approaches to
health.
• Make health-promoting information available to every individual and
engage in efforts to ensure high levels of health literacy
• Assist communities to engage in activities that promote mental health
especially when they are undergoing rapid transition

MAKING IT HAPPEN

Making it happen

The Bangkok Charter is an important step in strengthening
action-oriented health promotion. Making it happen will require:
• Adopting integrated strategies in different settings across different
age groups.
• Acknowledging the importance of partnerships for health
• Recognizing the urgent need to strengthen health promotion capacity
at all levels in all countries
• Affirming the adoption of the evidence-based approach to policy
development and practice

Implementation strategies

To ensure continuing progress on health promotion, the following five
implementation are required:
(# Action 
Requirement)
1 Invest 
Achieve adequate and sustainable financing for investment in
actions that tackle the determinants of health and in health
systems that are appropriate, affordable and accessible
2 Advocate 
Advocate for evidence-based policies, resources and practices that
support and protect health by engaging the political system at all
levels, and by working with nongovernmental and community
organizations
3 Build Capacity
Build capacity to promote health, particularly in the areas of policy
development and practice, health literacy, community
actions, leadership, workforce and research
4 Enable and mobilize
Enable and mobilize individuals and communities to overcome
structural barriers to health, to enhance social support, and to
reinforce social norms conducive to health, in particular through
information and communication technology
5 Form partnerships
Form partnerships with public, private and nongovernmental
organizations to create sustainable actions across sectors to
address the determinants of health

BENCHMARKS FOR MEASURING PROGRESS

Health promotion is result oriented

To measure progress on implementation of the Bangkok Charter, the World
Health Organization, in collaboration with other partners, will
encourage, and work with, Member States to develop appropriate
indicators, processes and mechanisms.

Benchmarks for measuring progress

The following benchmarks, against which progress can be measured,
will enable countries and communities to report on progress in 2009 and
at regular intervals:
• Capacity and structure for health promotion
• Investment in health promotion
• Health concerns in international trade agreements
• Policies focusing on health determinants in all sectors
• Stakeholder participation in policy formulation, planning and
implementation in health promotion

A GLOBAL PLEDGE

A global pledge 

This Bangkok Charter urges all stakeholders to work together in a
worldwide health promotion partnership to undertake the commitments and
strategies outlined above for the health and well-being of all. 

We, the participants of the 6th Global Conference on Health Promotion
in Bangkok, Thailand, have discussed the draft Charter prepared and
developed through a process in which a wide range of organizations,
networks, groups and individuals from many countries have contributed,
and strongly support the principles, commitments, actions and
implementation strategies outlined in this Charter.