The Five Action Areas of the Ottawa Charter

BikiCrumbs: The Five Actio… Ottawa Charter

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  • Health is a result of a complex interaction of people’s personal behaviours and the social, economic, political and physical environment in which they live
  • They may be influenced by factors outside their control, and which prevent them making good health decisions
  • The result of this interaction of factors is an inequity in health status among groups of people within the Australian population
  • Health promotion is needed to promote the health of all Australians and to reduce inequities in health status
  • The WHO’s Ottawa Charter for Health Promotion provides a framework for developing and implementing actions to promote health in each of the five priority areas and other areas of health
  • The Ottawa Charter advocates five action areas:
    • Developing Personal Skills
    • Creating Supportive Environments
    • Strengthening Community Action
    • Reorienting Health Services
    • Building Healthy Public Policy
  • The Ottawa Charter encourages health professionals and governments not only to educate people about health matters but also to change the environments in which people live and to involve the community in projects to improve health


Developing Personal Skills

  • Focuses on health promotion that supports personal and social development of the individual
  • The aim is to educate, to provide information on health, and to enhance skills such as decision making and communication
  • It endeavours to empower the individual, increasing the option available to people, and this allows them to exercise more control over their own health and their environments

Modifying Personal Behaviours

  • Often, it requires the development of specific skills to change behaviours
  • These skills include:
    • Decision making
    • Communicating
    • Assertiveness
    • Time management
  • Planning and problem solving
    • Development of personal skills can be best facilitated in the school, at home, at work and in community settings
    • With the development of personal skills, people will be better able to take control of the factors that affect their health, in turn be better able to make positive decisions about their health

Gaining access to information and support

  • There are groups within our population who have little or no opportunity to access information and education about health
  • This my be attributed to:
    • Physical isolation
    • Lack of financial aid to provide health facilities and education programs
    • Poor literacy skills
    • Language barriers
    • Cultural barriers
  • To improve and maintain the health of all Australians, it is important to find ways to provide equitable access to information and support services

Creating supportive environments

  • Focuses on the places people live, work an play and on increasing people’s ability, within these, to make health-promoting choices
  • It is concerned with our lifestyles and our social and physical community
  • Workplaces, support groups, health services, schools, the media and families can all help to provide supportive environments
  • The protection of our natural and built environments and the conservation of natural resources must be addresses in order to maintain a healthy physical environment

Identifying personal support networks and community services

  • Having emotional, social or financial support from people who are close can generally influence the individual’s ability to change
  • Likewise, the community can help promote health through the provision of community support networks e.g. Alcoholics Anonymous
  • Within many communities there exists a range of community services that have been established to support the health need of people
  • Non-profit organisations such as the Cancer Council provide vital information and education to the community. They aim to help reduce cancer respectively through a variety of actions such as providing education to people at risk, fundraising to financially support research and giving personal support to victims and families of these diseases

Identifying sociocultural, physical, political and economic influences on health

  • Often, personal problems have a social cause
  • The social environment in which the individual lives plays a significant role in determining that person’s level of health
  • If health promotion is to be effective, it must address the social, cultural, physical, political and economic factors that affect people’s lives
  • Example: in promoting sexual health within multicultural communities, it is important that health services provide information in a range of languages: pamphlets on Pap Smears and breast checks should be multilingual, a proportion of health-care workers should speak languages other than English, and interpreter services should be available

Strengthening community action

  • The focus is giving communities the chance to identify and implement actions that address their health concerns

Empowering Communities To Take Action

  • Community empowerment to promote health involves:
    • Setting health priorities
    • Making decisions collaboratively
    • Planning health-promoting strategies
    • Identifying and effectively using resources
    • Implementing and evaluating strategies
  • Community resources that can work effectively together to promote individual and community health include schools, workplaces, self-help groups, local governments, community health centers, doctors, the media and interest groups
  • The new public health approach advocates the active involvement of communities, in partnership with health practitioners and government authorities, in the promotion of health
  • It encourages communities to identify health priorities specific to their population and to initiate action to help address these principles

Reorienting health services

  • The focus and delivery of health services has moved away from an emphasis on the clinical and curative aspects of health to one which promotes health, prevents ill health and supports well-being
  • A refocusing on the well-being of the whole person complements traditional roles of diagnosing, treatment and rehabilitation
  • This requires changes in the attitude and 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 centers, as well as through non-government organisations e.g. National Heart Foundation

Identifying the range of services available

  • Primary health-care services are ideal sites for health promotion
  • Health-care services includes hospitals, nursing homes, psychiatric hospitals, doctors’ surgeries, community health centers, women’s health centers, baby health centers, community health nurses who provide home care for the aged, disabled and terminally ill, community midwives who provide support and education for new mothers
  • Primary health care can promote health through a range of strategies:
    • Clinical services
    • Patient education
    • Support and counselling
    • Information source
    • Links with other health services
    • Equitable access
    • Building self-reliance at a personal and community level
    • Establishing supportive environments

Gaining access to services

  • Access to health services depends on the requirements of each service, its physical location, community awareness of its availability and the affordability of the service
  • As a result of the public health insurance scheme, Medicare, the majority of the Australian population can access the services offered by general practitioners
  • The ease which someone can access services depends on that person’s geographical location
  • Many communities have medical centers that provide after-hours services
  • The establishment of non-government, non-profit community health centers provide a large range of clinical and health promotion services

Building healthy public policy

  • Related to the decisions made at all levels of government and by organisations that work towards health improvement
  • Includes legislation, policies, taxation and organisational change in areas such as recreation, welfare, transport, education and housing
  • Examples: taxation subsidies on low-alcohol beer; legislation requiring the wearing of seatbelts; occupational health and safety regulations; school policies related to sun safety; lower speed limits around schools

Identifying the impact of policies on health

  • There have been significant improvements in health as a result of implementing and policing public health policy and legislation
  • The introduction of laws that make it compulsory to wear seatbelts and laws allocating random breath testing greatly reduced the number or road accidents in NSW
  • The implementation of organisational changes can also have a positive impact on health
  • The introduction of ‘no hat, no play’ policies in many NSW schools, particularly primary schools, has increased student understanding of sun-safe behaviours
  • The combination of compulsory health policy and legislation, policing or monitoring of legislation, and increased community awareness through media campaigns will ensure a positive impact on public health

Influencing policy

  • It is important to gain community support and to influence policy through advocacy
  • Advocacy involves lobbying various community sectors about a particular issue e.g. a groups of residents lobbying for the extension of sewage outlets to reduce pollution of local beaches
  • Often it’s the health practitioner who is aware of health problems that are specific to a community
  • Health practitioners have a responsibility to become involved in community advocacy and support community efforts for policy change to improve health

Deciding where to spend the money

  • Health-care expenditure is predominately allocated to health-care services and facilities whose primary function is to treat illness
  • Federal and state governments are under much pressure from the medical profession and the public to channel money into hospitals and other services where the focus is on cure, however, it is the responsibility of governments to acknowledge the cost effectiveness of health promotion strategies and to support them through funding
  • In deciding where to spend money to promote health, the burden of disease and injury must be considered
  • Funding needs to be allocated to health-promotion programs that target the health priority areas, thereby improving health in these areas and reducing expenditure on treatment and rehabilitation
  • Given this, disadvantaged groups must be taken into account

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