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The author traces the development of the concept of health promotion from 1980s policies of the World Health Organization. Two approaches that signify the modernization of public health are outlined in detail: the European Health for All targets and the settings approach. Both aim to reorient health policy priorities from a risk factor approach to strategies that address the determinants of health and empower people to participate in improving the health of their communities.
These approaches combine classic public health dictums with "new" strategies, some setting explicit goals to integrate public health with general welfare policy. Health for All, health promotion, and population health have contributed to this reorientation in thinking and strategy, but the focus of health policy remains expenditure rather than investment. (Am J Public Health. 2003;93: 383-388)
IN 1986, AT AN INTERNATIONAL conference held in Ottawa, Ontario, Canada, under the leadership of the World Health Organization (WHO) (and with a strong personal commitment from then Director General Halfdan Mahler), a broad new understanding of health promotion was adopted. The Ottawa Charter for Health Promotion has since exerted significant influence-both directly and indirectly-on the public health debate, on health policy formulation, and on health promotion practices in many countries.1,2 The work on this document was spearheaded by the WHO European Regional Office and was developed over a period of 5 years of intensive research and debate. It was based on the "Health for All" philosophy,3 the Alma Ata Declaration,4 and the Lalonde health field concept.5
The Ottawa charter initiated a redefinition and repositioning of institutions, epistemic communities, and actors at the "health" end of the disease-health continuum, a perspective that had been labeled the "salutogenic approach" by Aaron Antonovsky.6 In overcoming an individualistic understanding of lifestyles and in highlighting social environments and policy, the orientation of health promotion began to shift from focusing on the modification of individual risk factors or risk behaviors to addressing the "context and meaning" of health actions and the determinants that keep people healthy. The Canadian Lalonde report is often cited as having been the starting point of this new development Recently the director of the Pan American Health Organization, Sir George Alleyne, reflected on this issue, stating that "it is perhaps not accidental that the impetus...