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The Ottawa Charter for Health Promotion, sub-titled “The Move Towards a New Public Health,” has been identified as an influential and guiding document and tool (IUHPE and CCHPR 2008; Baum and Sanders 2011) responsible for laying a foundation for health promotion theory and practice (IUHPE and CCHPR 2008; Nutbeam 2008) and broadening its outcomes beyond the absence of disease (Laverack and Mohammadi 2011). Since its inception at the First International WHO Conference on Health promotion in Ottawa, Canada, in November 1986, it has sparked the conceptualization, development, discourse, and integration of health promotion while inspiring professionals, politicians, and citizens worldwide (Dooris 2013), giving health promoters a sense of identity (Pettersson 2011) and taking on a ‘Holy Grail’ status (McPhail-Bell, Fredericks and Brough 2013). The Charter provided a strong, holistic vision highlighting interdependency (Porter 2007) while describing health as a resource for everyday living and health promotion as “the process of enabling people to increase control over, and to improve, their health” (Ottawa Charter for Health Promotion 1986). The Charter also paved the way for the settings approach to health promotion (Dooris 2013) and an “active and interactive” comprehension of health (Kickbusch 2007). Health promoters were presented with various roles and functions which were delineated in the Charter (advocating, enabling, and mediating) and recommended five action areas, which at the time of publication were awaited but also considered quite radical (Scriven and Speller 2007). Areas considered essential for public health action (Kickbusch 2007) included: healthy public policies, supportive environments, personal skills, community action, and reorientation of health services. Building healthy public policy involves advocating for and establishing health as political priorities at all levels and sectors, embracing accountability for health and decision-making impacts on health (WHO 2009; Ottawa Conference Report 1986). The action area "Creating supportive environments" acknowledges the interconnectedness between people and their environment and that people, communities, and the environment need to be cared for and protected with unified, mutual action (WHO 2009; Ottawa Conference Report 1986b). Strengthening community action puts a focus on engaging community resources and strengthening competencies, collaboration, and participation (WHO 2009; Ottawa Conference Report 1986c; Fry and Zask 2016). Developing personal skills is often referred to as health education and health literacy (Fry and Zask 2016). The supplementations of health information and skill development are ways health promoters can care for the personal and social growth of individuals and provide options to foster greater choice and control within environments and towards maintenance of health and wellbeing (WHO 2009; Ottawa Conference Report 1986d; Fry and Zask, 2016). Reorienting health services advocates for a health care system which prioritizes health and requires the shared responsibility and contributions of people, communities, health professionals, organizations, and government (WHO 2009; Ottawa Conference Report 1986e). The purpose of health promotion was to combine the old public health with a commitment to the new public health, thus creating a synergy between a social determinants approach and individual and community empowerment * Christiane Stock christiane.stock@charite.de

Are we there yet? Use of the Ottawa Charter action areas in the perspective of European health promotion professionals