Health Promotion International, 2021;36(S1):i1–i3

doi: 10.1093/heapro/daab150
Supplement Article

The continuing evolution of health promotion

1, 2
Don Nutbeam *, J. Hope Corbin , and Vivian Lin3

Downloaded from https://academic.oup.com/heapro/article/36/Supplement_1/i1/6460421 by guest on 22 February 2022

1
Professor of Public Health in the School of Public Health, University of Sydney, Sydney, NSW 2006,
Australia, 2Department of Health and Community Studies, Woodring College of Education, Western
Washington University, Bellingham, WA 98225, USA and 3Professor of Practice (Public Health), Faculty of
Medicine, University of Hong Kong, Hong Kong SAR, China
*Corresponding author. E-mail: [email protected]

The Ottawa Charter for Health Promotion provided a the fundamental social and economic changes indicated
template that has fundamentally re-shaped public health above and have advocated practical public health
practice in the past 35 years (WHO, 1986). The compel- responses that have their roots in the strategies of the
ling logic of its key strategies—build healthy public pol- Ottawa Charter. The most recent of these conferences
icy, create supportive environments for health, was in 2016 and produced the Shanghai Declaration on
strengthen community actions, develop personal skills promoting health in the 2030 Agenda for Sustainable
and reorient health services—now routinely provide a Development (WHO, 2016). The conference positioned
comprehensive and inclusive framework for addressing health promotion methods and strategies at the heart of
any major public health challenge. actions required to achieve the UN Sustainable
Profound social and economic changes have occurred Development Goals (SDGs) (United Nations, 2015). At
and continue to occur since the Charter was written. the core of the Shanghai Declaration are key strategies
The globalization of trade has had a major impact on advocating improved governance for health, the devel-
economies and systems of governance that have an effect opment of healthy cities and improvements in health lit-
on the lives of everyone. The internet, mobile communi- eracy in populations around the world.
cations and digital technologies have opened access to A commentary on the Shanghai Declaration reports
information and services that were unimaginable at that that health promotion offers ‘practical solutions to the
time. Our understanding of the interconnections be- complex and interconnected challenges represented by
tween environmental change, human health and the the SDGs’, noting that promoting health should become
health of our planet has undergone a fundamental trans- ‘a cornerstone of all national or local SDG strategies and
formation. More than 50% of the world’s population implementation plans’ (Kickbusch and Nutbeam, 2017).
now live in urban settings. New threats to health have The authors note that these challenges can take us to un-
emerged. These include previously unknown infectious comfortable and messy places where health is a politi-
diseases—from HIV to the current COVID-19 pan- cized concept and not always given the priority that we
demic—as well as more insidious, progressive changes may wish it to have; and where health promotion is be-
associated with the emergence of non-communicable ing interpreted in different ways for different purposes.
diseases in all countries. The authors remind us that our role is to demonstrate
Such profound changes have required continuous how health promotion can be delivered most effectively
adaptations to the health promotion strategies estab- in variable circumstances, and how health promotion
lished through the Ottawa Charter. Since 1986 WHO ethics can be upheld.
has organized a series of global conferences that have This special supplement to Health Promotion
helped to refine and develop the concept and strategies International has been supported by the World Health
of health promotion. These conferences have addressed Organization to build on the progress and challenges

C The Author(s) 2021. Published by Oxford University Press.

V
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
i2 D. Nutbeam et al.

emerging from the Shanghai Conference and provide a leadership and mobilization of community members.
platform for discussion at the 10th Global Conference Drawing on the experience from the case studies, these
on Health Promotion. The conference reflects WHO’s strategies enable communities to achieve shared goals,
triple billion agenda, specifically highlighting the role of assess and adapt to changing context and prepare for fu-
health promotion in the pursuit of health and wellbeing ture emergencies. The paper on the commercial determi-
for all through WHO’s Healthier Populations frame- nants showcases the WHO Framework Convention for
work and measurable impacts (WHO, 2019, 2020). Tobacco Control (FCTC) (WHO, 2003) as a working
The purpose of the supplement is to provide a collec- model for preventing harmful industries ‘from wielding

Downloaded from https://academic.oup.com/heapro/article/36/Supplement_1/i1/6460421 by guest on 22 February 2022

tion of papers summarizing the current state of knowl- influence over the institutions and actors of global and
edge and to advance thinking on the future of health national governance’. The paper examines different
promotion. The papers were commissioned in the con- strategies for addressing the commercial determinants of
text of WHO’s current priorities, and its contributions health. It recognizes that formal conventions such as the
to the achievement of the Sustainable Development FCTC are one path for impacting commercial determi-
Goals (SDGs). WHO’s priorities include achieving nants, but that we need to deploy a wider range of strat-
Universal Health Coverage (UHC): responding success- egies to respond and adapt to rapidly changing
fully to global health emergencies (including COVID- circumstances.
19); and creating healthier populations (WHO, 2020). The paper by Hancock and colleagues examines a
The papers cover a wide terrain, reflecting the core further key challenge emerging from the task of posi-
elements of the Shanghai Declaration by exploring law tioning health promotion methods and strategies at the
and urban governance through the paper by Burris and
heart of actions required to achieve the UN SDGs by ad-
Lin; and the future evolution of health literacy by
vancing planetary health promotion through local-level
Sørensen and colleagues (Burris and Lin, 2021;
actions (Hancock et al., 2021). The paper provides
Sørensen, 2021). The paper on governance suggests
strong advocacy for health promotion actors to become
that regardless of their powers, organizational struc-
part of the emerging network of community organiza-
tures and boundaries, cities have legal levers they can
tions and individuals working to create sustainable, just
manipulate for health promotion. They can use their le-
and healthy communities.
gal powers to address the effects of policies that they
Finally, we have two papers that explore emerging
themselves can control, and they may also have the au-
issues in health promotion examining evolving con-
thority to use the law to address deeper determinants
cepts in health and wellbeing by Corbin and col-
of health to directly and indirectly reduce economic
leagues; and Digital Health Promotion by Lim and
and social inequality. The paper on health literacy
colleagues (Corbin et al., 2021b; Koh et al., 2021). The
builds on the challenge set out in the Shanghai
paper on wellbeing situates the concept within the
Declaration of delivering large-scale societal improve-
ment in health literacy through a systematic approach founding documents of WHO and health promotion,
to capacity development. The paper presents an over- explores alternative measurement strategies, briefly
arching framework for sustainable change with a range presents promising cases of wellbeing policy initiatives
of action areas to stimulate the structural transforma- and explores points of controversy and tension. The
tion needed at different levels. These include training a paper concludes by describing how health promotion
health literate workforce and supporting health literate might contribute to wellbeing policy frameworks that
organizations, as well as enabling health literacy- promote the sources of human and planetary thriving
informed technology and innovation. through sustainable development.
Other papers examine the application of health pro- The paper by Lim et al. examines the potential bene-
motion strategies in response to public health emergen- fits and challenges of digital technology for current and
cies through the paper by Corbin and colleagues; and in future health promotion strategies. The benefits include
addressing the commercial determinants of health expanding access to health information and health-pro-
through a paper by Bettcher and colleagues (Corbin moting services, as well as lowering the cost of scaling
et al., 2021a; McHardy 2021). The paper on public up activities to reach larger populations. It also high-
health emergencies, presents five cases studies from the lights key challenges including the growth of misinfor-
USA, Singapore, Sierra Leone, Kenya and South Africa mation and disinformation through digital media; and
and highlights several critical success factors. These in- ensuring widespread accessibility and affordability to
clude co-development of relevant education and com- digital technology in ways that minimize social
munication strategies, amplification of community inequities.
The continuing evolution of health promotion i3

Taken together this set of papers provides an over- Hancock, T. et al. (2021) Towards healthy One Planet cities and
view of several key transformations facing the global communities: planetary health promotion at the local level.
community and suggests pathways for the application Health Promotion International, 36(Suppl 1), i53–i63.
Kickbusch, I. and Nutbeam, D. (2017) A watershed for health
of health promotion methods and strategies to meet
promotion: the Shanghai Conference. Health Promotion
these challenges. This collection of papers reflects the
International, 32, 2–6.
evolving local and global contexts and emerging prior- Koh, A. et al. (2021) Digital health promotion: promise and
ities for health promotion. Insofar as promoting health peril. Health Promotion International, 36(Suppl 1), i70–i80.
is one of the three strategic priorities for the WHO’s

Downloaded from https://academic.oup.com/heapro/article/36/Supplement_1/i1/6460421 by guest on 22 February 2022

McHardy, J. (2021) The WHO FCTC’s lessons for addressing
13th General Programme of Work, the papers point to the commercial determinants of health. Health Promotion
the evolution of our paradigm about health—i.e., shift- International, 36(Suppl 1), i39–i52.
ing from disease to risk factors to determinants, and Sørensen, K. (2021) Building health literacy system capacity: a
from individual, through social to planetary health framework for health literate systems. Health Promotion
International, 36(Suppl 1), i13–i23.
and wellbeing. Research, policy and practice in health
United Nations. (2015) Transforming Our World: The 2030
promotion will need to similarly evolve to keep up
Agenda for Sustainable Development. United Nations, New
with these emerging health challenges and changing York. https://sustainabledevelopment.un.org/post2015/trans
contexts. formingourworld/publication (last accessed September 2021).
World Health Organisation. (1986) Ottawa Charter for Health
Promotion. World Health Organisation, Geneva. https://
DISCLAIMER www.who.int/teams/health-promotion/enhanced-wellbeing/
The authors alone are responsible for the views first-global-conference (last accessed September 2021).
expressed in this article and they do not necessarily rep- World Health Organisation. (2003) Framework Convention on
Tobacco Control. World Health Organisation, Geneva.
resent the views, decisions or policies of the institutions
https://www.who.int/fctc/text_download/en/ (last accessed
with which they are affiliated.
September 2021).
World Health Organisation. (2016) Shanghai Declaration on
Promoting Health in the 2030 Agenda for Sustainable
REFERENCES
Development. World Health Organisation, Geneva. https://
Burris, S. and Lin, V. (2021) Law and urban governance for www.who.int/publications/i/item/WHO-NMH-PND-17.5
health in times of rapid change. Health Promotion (last accessed September 2021).
International, 36(Suppl 1), i4–i12. World Health Organisation. (2019) Thirteenth General
Corbin, J. H., Oyene, U. E., Manoncourt, E., Onya, H., Programme of Work 2019-2023. World Health
Kwamboka, M., Amuyunzu-Nyamongo, M. et al. (2021a) Organisation, Geneva. https://www.who.int/about/what-
A health promotion approach to emergency management: we-do/thirteenth-general-programme-of-work-2019–-2023
effective community engagement strategies from five cases. (last accessed September 2021).
Health Promotion International, 36(Suppl 1), i24–i38. World Health Organisation. (2020) The Triple Billion Targets:
Corbin, J. H., Abdelaziz, F. B., Sørensen, K., Kökény, M. and A Visual Summary of Methods to Deliver Impact. World
Krech, R. (2021b) Wellbeing as a policy framework for Health Organisation, Geneva. https://www.who.int/data/sto
health promotion and sustainable development. Health ries/the-triple-billion-targets-a-visual-summary-of-methods-
Promotion International, 36(Suppl 1), i64–i69. to-deliver-impact (last accessed September 2021).