1. health and fitness

THE OTTAWA
CHARTER
As a response to the emergence of the new public health approach towards health, in
1986 the first International Conference on Health Promotion took place in Ottawa,
Canada. The conference built upon previous progress in health relating to the
Declaration on Primary Health Care at Alma-Ata, the publication WHO Targets for Health
for All, and an intersectoral approach for health. The Ottawa Charter Framework for
Health Promotion underpins all work surrounding health promotion, as it addresses not
only the social and cultural factors that can alter an individuals behaviour to make
positive health choices, but also ensures equity—as achieving good health is attainable
for all individuals. The Ottawa Charter recognises that these factors must work together
to improve the health status of individuals and communities through five areas:
• developing personal skills
• creating supportive environments
• strengthening community action
• reorienting health services
• building healthy public policy
Acronym
Dumb-developing personal skills
Charter-creating supportive environments
Sucks-strengthening community action
Really-reorienting health services
Bad-building healthy public policy.
Developing personal skills
In order for individuals to achieve good health, they must develop the personal skills and
abilities, so they can make the positive behaviour changes to meet the demands of
everyday life. Individuals need to refine and modify poor health behaviours to improve
their health. Providing individuals with information, education and life skills enables them
to exert control over their actions and increases the options available to them. Enabling or
empowering people to develop skills that will assist them in preventing or treating disease
or illness, is a positive step towards individuals achieving good health.
Developing personal skills such as decision making, problem solving, self-awareness,
critiquing information, planning for change, developing time-management skills, and
refining communication and assertiveness skills will assist individuals to make positive
health decisions.
Examples of Developing Personal Skills
Enabling people to make positive behaviour changes can be achieved
through:
• compulsory PDHPE lessons in schools from kindergarten to Year 10 where
skills on coping with change, resilience and lifestyle diseases are taught
television and radio commercials that encourage individuals to make
positive health choices
• making sure brochures on accessing health services are provided in a
variety of languages to cater for the diversity of communities
• time-management seminars to develop skills around organising time to
look after your health
• development of communication skills, such as assertiveness skills
developing health literacy skills to enable individuals to understand
different health products and services
• English-speaking courses for new migrants to Australia.
Creating supportive environments
This action area focuses on the places where people live, work and play. It also focuses on
increasing people's ability within these settings to make health-promoting choices. It is
concerned with our social and physical environments. We need to take care of, protect
and support each other, our community and our natural and built environments from
threats to health. The organisation of work and leisure and the use of technology should
enhance health and provide a safe, stimulating, satisfying and enjoyable environment.
Workplaces, support groups, health services, schools, the media and families can all help
to provide supportive environments.
Examples of Creating Supportive environments
Creating supportive environments can be
achieved through:
• childcare centres in workplaces
• needle exchange programs
• safety electrical switches in the home
• speed humps, roundabouts and speed
limits
• sun protection for outdoor areas
• modifying sports for young children e.g.
kanga cricket, netta netball
• providing counsellors where needed e.g.
in schools.
Strengthening community action
When communities join to take action for their health, we can see positive
improvements. Communities who make decisions, plan strategies and
implement them to improve health for their population generally see
improved health benefits. When communities take ownership of the health
issues they face and advocate for change, they are more likely to embrace
these changes. Empowering communities to take control of their needs and
decide how they can best work towards meeting these needs is essential for
positive health behaviour change. In order for communities to take action,
forming partnerships with health agencies or government or non-government
agencies can assist them to implement strategies, access and gain information,
and create opportunities to improve their community’s health.
Examples of Strengthening
Community Action
Strengthening community action can be achieved through:
family planning and HIV/AIDS clinics in communities
• community events such as the City2Surf
• events such as ‘Clean up Australia Day’
• communities lobbying for improvements to their environment, for
example, overhead bridges for students to cross busy roads near
schools
• encouraging traditional cultural activities within various ethnic
groups for
• the community, such as Chinese New Year and Greek Easter
celebrations
• single-parent support groups
• YMCA or drop-in centres for young people
• Health Promoting schools
• text messages to young people to remind them to eat healthy and
to exercise.
Reorienting health
services
The focus and delivery of health services has moved away
from an emphasis on the more traditional aspects of health:
diagnosis, treatment and rehabilitation. The reorientation of
health services has focused on the well-being of the whole
person: promoting health, preventing ill health and
supporting well-being. This requires a change in attitude and
the organisation of health services, and changes to
professional education, training and research.
Health promotion can take place in a number of settings,
such as schools, workplaces and community health centres,
as well as through NGOs, such as the National Heart
Foundation of Australia and the Cancer Council.
Examples of Reorienting
health services
An example of this reorientation includes:
• health professionals working with and supporting schools in
health promotion initiatives such as MindMatters, Jump Rope
for Heart and the New South Wales Healthy School Canteen
Strategy.
• Police working in schools to support road safety education
• Cardio Vascular surgeons giving presentations on the risks of
smoking
• companies such as Banana Boat handing out free sunscreen at
the beach during summer
• Educating nurses in health care promotion practices
• Doctors promoting healthy eating
Building healthy public policy
In order to assist individuals and communities to improve their health,
governments, organisations, workplaces and schools need to implement
policies, guidelines and rules that work towards achieving good health.
These policies are aimed at providing supportive environments in which
individuals and communities can lead healthy lives. Policies enable
governments and organisations to be accountable. Policies can assist or
hinder an individual’s or community’s health and, therefore, governments
and organisations are accountable in ensuring policies are aimed at
improving health outcomes.
Policies need to encompass every aspect of an individual’s life, if they are to
be effective in improving the health status of a population.
Some healthy public policies are:
• anti-discrimination laws
• guidelines on the use of solariums
• school anti-bullying policies
• age restrictions for drinking alcohol
• age restrictions for different levels of driving,
• e.g. learner’s permit 16 years, P-plate drivers 17 years
• compulsory third-party car insurance, to cover someone
• if they are injured
Case study: alcohol
abuse in society
Alcohol-related issues are prevalent in society and increasing at
an alarming rate. Issues such as binge drinking, underage
drinking, alcohol-related violence and
drink driving have a significant impact not only on the
individual consuming the alcohol, but also on society in
general. In order to address this health issue, various
government and non-government organisations and
communities have put strategies in place. As this issue is
not in isolation, the use of the Ottawa Charter
Framework for Health Promotion has been the backbone in
assisting different sectors to work collaboratively with
individuals to bring about positive changes in
health behaviour. To see how the Ottawa Charter can be used to
combat alcohol abuse in Australia, a variety of strategies that
have been used across a number of health promotion programs,
are applied here to the five action areas of the Ottawa Charter.
Developing personal skills- Alcohol Abuse
• Compulsory PDHPE lessons that focus on the short and long-term effects of alcohol on
the body.
• Healthy Harold vans which visit primary schools to educate young children about the
effects of alcohol.
• Education through schools’ pastoral care programs on how to party safely if alcohol is
available or how to enjoy yourself at a party without alcohol.
• Information in magazines such as Woman’s Day and Men’s Health about the impact
alcohol can have on the body.
• Information in newsletters and university magazines on safe drinking levels for
alcohol.
• Having students practise role-play scenarios similar to those young people might face
around alcohol, so they can practise their problem solving, communication and
assertiveness skills.
• Knowing how and where to access reputable information relating to alcohol. For
example, internet sites such as the Australian Drug Foundation or local community
health centres.
• Undertaking a first-aid course to develop skills to assist people with alcohol-related
injuries.
• Creating posters, postcards, coasters, stickers and wallet cards to educate people on
the dangers of excessive alcohol consumption.
Creating supportive environments- Alcohol Abuse
• Workplaces providing non-alcoholic drinks for after-work drinks.
• Creating alcohol-free workplaces.
• Companies providing counselling services for employees who are directly or
indirectly affected by alcohol-related issues.
• Parents supervising teenage parties if there is alcohol.
• Parents modelling responsible drinking in front of their children.
• Cooperation between police and festival organisers to screen and check people’s
bags for alcohol at youth festivals such as V Festival or Good Vibrations.
• Fundraising for charities linked with alcohol issues, such as domestic violence
charities.
• Pubs and clubs changing cups made of glass to plastic cups and enforcing the
responsible service of alcohol.
• Bouncers at pubs, clubs and parties making sure people behave responsibly around
alcohol.
Strengthening community action- Alcohol Abuse
• Supporting Alcoholics Anonymous groups.
• Providing support groups for families who have lost loved ones to alcohol-related
issues such as domestic violence and road accidents.
• Police offering and supervising Blue Light events, such as hosting alcohol-free
dances for young people.
• Pubs and clubs having a ‘2 am lock out’ policy to prevent drunken people from
entering the premises.
• Pubs and clubs offering free bus services to take patrons home.
• Offering support groups for victims of sexual assault, which may be fuelled by
alcohol abuse.
• Church communities offering food and shelter to victims of alcohol-related crimes.
• Local community activities to engage young people to be active citizens and prevent
boredom issues leading to the consumption of alcohol.
• Communities providing statistics to support the submission for alcohol reforms to
the local government in their area.
Reorienting health services-alcohol
abuse
• Increased funding for health promotion initiatives to target underage and
binge drinking.
• Registering parties with police to prevent gate crashers.
• Wheelchair basketball guest speakers to talk about injury prevention relating to
alcohol.
• NRMA Road Trauma Forums for young people to prevent drink driving.
• Increased funding for health promotion programs relating to alcohol, particularly
for young people.
• The Police Citizens Youth Clubs (PCYC) offering activities at night to remove
boredom for young people.
• Seminars run by Rotary on harm minimisation for adolescents and parents.
• Free water handed out at youth festivals such as the V Festival and Good
Vibrations.
Principles of social justice
Access to good health should be available to all individuals. While most
people generally have good health, the gap is widening in many areas of the
Australian population. Health inequalities that exist have significant negative
health impacts. Marginalised groups such as those with low socioeconomic
status, Indigenous Australians, people living in rural and remote areas,
people from non-English speaking backgrounds and older people, generally
face poorer levels of health. Health inequalities are usually the result of an
individual being in a disadvantaged social position; of inability to access
information, services and resources; overexposure to various risk factors
such as fast-food outlets and poor living conditions; lack of control over
their own circumstances and a health care system that may be unaffordable
Equity
In order for all individuals to achieve good health, access to health care
services and information must be fairly distributed. Ensuring communities
have the necessary infrastructure to provide quality health care for a free
or low cost and have the ability to seek out health services regardless
of age, gender or ethnicity is essential for individuals to achieve good
health. Individuals have the right to good health, and governments need
to ensure that all individuals have access to the same health care services
and treatments. For example, people living in rural communities should
have access to a dietician just as people living in the city do. As certain
communities have higher health inequities than others, additional resources
may be provided to reduce these health inequities. This could be through
an increase of health services such as counsellors or through building more
infrastructure such as nursing homes or hospitals. This would ensure greater
equity of resources to those communities in greatest need. In order to reduce
inequities, individuals should be able participate in the decision-making
process within their community in relation to health needs. Individuals
should be active participants in their own lives, planning for and making
decisions about their own health.
Diversity
Australia continues to grow into a diverse nation. From the physical diversity of
the land to the social diversity of its cultures, Australia needs to consider many
factors when addressing various health issues. Ensuring population groups
within society are not discriminated against in terms of age, gender, sexuality or
location is important in achieving good health for individuals. Providing health
information in various languages, placing health services in places easy to
access by public transport, celebrating various cultures and understanding the
different health issues for the various population groups is essential in ensuring
all individuals have the opportunity to achieve good health.
Supportive environments
Providing environments where people are supported is essential
to achieving good health. Homes, workplaces, schools and
communities play a vital role in ensuring all people, regardless of
their background, have the opportunity to be valued and make
positive contributions to society. When the environment around
a person supports positive health habits, it is easier for an
individual to make positive choices. Ensuring environments in
which people live are conducive and supportive for positive
health is crucial for improving the health status of individuals.
Celebrating the diversity of a community, empowering
individuals and communities to take action on a health issue
close to their heart and enabling people to improve
environments is essential in achieving good health.