The Ottawa Charter was the First International Conference on Health Promotion (1986). The Charter’s main aim was to continue identifying action to help achieve targets from the World Health Organisation (W.H.O.), "Health for all by the year 2000" (1981). It was a response to rising expectations for a new public health movement around the world. Many involved in health education were critical of the medical model of health and the blaming of people for their individual behaviour. The Ottawa Charter brought together a growing recognition that illness was highly related to health education and promotion, and that promotion required a wide interpretation with the active participation of people and stakeholders.
The Charter has helped influence health promotion in the UK by encouraging the strengthening and improvement of its principles and practice. This includes "building healthy public policy," by identifying obstructions preventing the achievement of healthy public policies. An example of this can be seen in the Department of Health’s "Change4Life" marketing campaign (DOH 2009) where it urged the public to "Eat well, move more and live longer." An obstruction to policy had been the characterisation of today’s generation as more gluttonous and lazy. This was changed to a more supportive and encouraging outlook with a commitment to create an environment in which healthier choices became easier.
Another influence from the Ottawa Charter was "to create supportive environments." An example of this in the UK has been the regeneration of the Lower Lee Valley, one of its most deprived communities, to host the 2012 Olympics and as part of its legacy to promote "Sport and Healthy living." A third priority action area, influenced by the Ottawa Charter, has been "to develop personal skills" and enable people to be educated and learn about their lives and the different stages that take place (Gregory S. et al, 2012). This also enables people to learn how to cope with chronic illness and injury, thereby strengthening community actions. "Reorienting health services" is another example, as it states that the health sector's role is required to move in a health promotion direction, going above the responsibility of providing clinical and curative services (Mcqueen & Salazar, 2011). This has been seen in initiatives such as the Frank Campaign (2003), described in more detail below, which came in to replace the National Drugs Helpline to try and provide a less judgmental and more credible advice service for drug misusers.
The theoretical strategic framework of health promotion found within the Charter also points to the importance of understanding the link between social class (wealth and income) and health. Through advocacy for health, the Charter sees health promotion making economic and environmental conditions favourable to health rather than harmful; it also aims to create equity in health by enabling all people to achieve their full health potential. For health promotion to do this successfully it needs to understand any links between social class and health. In the "Black Report" (Whitehead M., 1992), cultural explanations for health inequalities are referred to as a series of specific behaviours, which have a consequence for health, such as smoking, drinking and bad diet. The Black Report linked these behaviours to those from lower social class backgrounds, providing a diversion from the daily difficulties associated with poverty (Williams G.).
Since the Black Report, there have been arguments about the extent that these behaviours represent cultural explanations or material explanations to health inequality. If these behaviours are a result of stress, rather than a voluntary diversion, it could be argued that they are part of a materialistic/structural explanation to health inequality (West, 1998). In other words, they are behaviours that are not voluntary, and result from the structural existence of poverty.
With the publication of the Marmot Report, which stated clearly "Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health" (Marmot Review, 2010), and the book The Spirit Level (Wilkinson & Pickett, 2010) there seems to be a growing acceptance that inequalities in health are linked to social poverty. There is also a growing acceptance that health promotion and education needs to widen its scope to include the whole lifecycle of a person to provide the right opportunities and support from as earlier an age as possible. For this reason social class, and specifically the underclass, is of interest when formulating health promotion policies.
The social class of ethnic minorities will also be of interest to health promotion policies. For example, wealthy French immigration avoiding tax rises in France is different from an increase in Eritreans and Sudanese fleeing oppressive governments, or from poorer European Romanians. This situation may also affect the accuracy of data used for health promotion, such as segment tool data on causes of death, as these people will have spent much of their lives outside of the UK system and lifestyle. Ethnicity is important because there is clear evidence that some ethnic minority groups in the UK experience higher levels of morbidity and mortality, primarily from chronic diseases that result from smoking, physical inactivity and unhealthy eating. These include diseases such as diabetes, cardiovascular disease, and cancers (Liu J. et al, 2012).
Another reason why ethnicity is becoming more and more relevant is the increasing growth of the ethnic minority population in the UK: Londoners that were born in the UK have decreased from 73% in 2001 to 63% in 2011. The UK white ethnic group reduced from 94.1 % in 1991 to 91.3% in 2001 to 86% in 2011. By 2051, it is estimated that 20% of the population will identify themselves with an ethnic minority group (ONS, 2011). For this reason, if health promotion can help it, it is important to take into account Ethnic minorities and how they respond best to these promotions.
The Frank campaign (2003), started as a government funded initiative, providing drug advice to young people and their families. It became a support of the government’s drug specific Public Service Agreements that included: reducing the use of Class A drugs by young people under the age of 25; increasing the participation of drug users in drug treatment programmes; and reduce the harm of illegal drugs. One of its key messages being "Drugs are illegal, talking about them isn’t." They used eight TV adverts, the radio and campaign posters, presenting an approachable nature. It also launched a chat website, accessible 24 hours a day. By 2006, it had achieved 12 of its 19 performance targets including: 68% awareness amongst young people; 29% of young people "very likely" to call the helpline (Frank review, 2006).
However, in 2006, after a series of a more hard-lined approach TV and radio adverts that were aimed at attracting parents to the service, there was a 7% decrease in the percentage of people believing that FRANK advisers "knew what they were talking about" (Frank review, 2006). One of the issues FRANK has is trying to appeal simultaneously to the different target audiences of parents, youth and the broad range of drug misusers. Linnel from Lifeline, the harm reduction charity states: "The ads certainly haven’t got any credibility among serious drug users but I don’t think they are aiming for that" (Wheeler B., 2013). In a 10-year review in 2013 it was admitted that, although during that time drug use in the UK reduced by 9%, there is no real evidence that media driven anti-drugs campaigns have stopped people from taking drugs. Most of this drop in drug use is thought to have been due to a decline in cannabis use, connected to attitudes towards smoking tobacco.
The UK Drug Policy Commission (2010), revealed that widespread stigma still exists in society and is a barrier to substance user recovery. In this report, Blakemore states: "If the government’s drug strategy is to succeed, it must first address this very real barrier of stigma" (UKDPC, 2010). By having to keep FRANK anonymous and maintaining the criminal nature of drug taking, it is not able to use all the means available to fully educate and encourage drug takers to seek early help.
The initiative "Moving More, Living More" (2014) was started by the Coalition government and the Mayor of London. Its purpose was to promote physical activity across the UK, by building on the success of the London Olympics in 2012 and using this success to encourage people to a healthier lifestyle of exercising more often.
Grant H. (Minister for Sport) believes that there are many positive benefits to taking part in consistent physical activity, that can lead to a healthier body and an improved well-being (Department of Health et al, 2014). Over 30% of people are able to reduce the risk of dying by exercising; due to physical activity around 20-35% are able to lower the risk of suffering from coronary heart disease and stroke.
By the end of February (2014), P.H.E (Public Health England) ran a consultation, aimed at looking for ideas on more ways to encourage and support physical activities at national and local levels (Moving More, Living More, 2014). An example of its influence within schools was the setting of recommendations to promote physical activity and education during school hours, as well as during school break periods, and to encourage active transport to and from school. It was recommended that all schools provide a playground that would allow for varied physical activities.
Another example of one the initiatives that have resulted from "Moving More, Living More" is the "Cycling Workplaces" initiative (September 2014), which offered free cycling products and services to businesses. This was to encourage staff to cycle to and from work, as well as aiming to reduce cycling barriers, such as lack of parking for bikes and perceived safety fears. Now, over 200 businesses have registered, representing around 56,000 employees (Mayor of London Office, 2015). Also, more than 50 cycle safety sessions have taken place, with over 500 cycle parking spaces being installed.
Another result of "Moving More, Living More" is the "Walking Workplaces" initiative piloted in 2014 to test ways to encourage people to walk more as part of their commuting to and from work. The "Moving More, Living More" initiative has shown some success, but where it and the FRANK initiatives are still not working are in the socially deprived areas or ethnic populations where more needs to be done in health promotion.