Health Promotion: The Jakarta Declaration on Leading Health Promotion into the 21st Century

A year ago, the Fourth International Conference on Health Promotion: New Players for a New Era - Leading Health Promotion into the 21st Century, Jakarta, Indonesia, 21-25 July 1997, produced a declaration on health promotion contributing to the international strategies for health.

Its roots can be traced back to some 20 years ago when the World Health Organization´s Member States made an ambitious commitment to a global strategy of 'Health for All' and the principles of primary healthcare through the 'Declaration of Alma-Ata'. The First International Conference on Health Promotion was held in Ottawa, Canada, 11 years ago. That Conference resulted in proclamation of the Ottawa Charter for Health Promotion, which has been a source of guidance and inspiration for health promotion since that time. Subsequent international conferences and meetings have further clarified the relevance and meaning of key strategies in health promotion including healthy public policy (Adelaide, Australia, 1988), and supportive environments for health (Sundsvall, Sweden, 1991).

The Jakarta conference was the first to be held in a developing country, and the first to involve the private sector in supporting health promotion. It provided an opportunity to reflect on what has been learnt about effective health promotion, to re-examine the determinants of health, and to identify the directions and strategies that must be adopted to address the challenges of promoting health in the 21st century.

The declaration on action for health promotion into the next century by the Jakarta conference is presented below in a slightly edited format.

Health promotion is a key investment - Health is a basic human right and essential for social and economic development

Increasingly, health promotion is being recognised as an essential element of health development. It is a process of enabling people to increase control over and to improve their health. Health promotion, through investment and action, has a marked impact on the determinants of health so as to create the greatest health gain for people, to contribute significantly to the reduction of inequities in health, to further human rights, and to build social capital. The ultimate goal is to increase health expectancy, and to narrow the gap in health expectancy between countries and groups.

Determinants of health: New challenges

The prerequisites for health are peace, shelter, education, social security, social relations, food, income, the empowerment of women, a stable eco-system, sustainable resource use, social justice, respect for human rights, and equity. Above all, poverty is the greatest threat to health.

Demographic trends such as urbanisation, an increase in the number of older people and the high prevalence of chronic diseases pose new problems in all countries. Other social, behavioural and biological changes such as increased sedentary behaviour, resistance to antibiotics and other commonly available drugs, increased drug abuse, and civil and domestic violence, threaten the health and well-being of hundreds of millions of people.

New and re-emerging infectious diseases, and greater recognition of mental health problems, require an urgent response. It is vital that approaches to health promotion evolve to meet changes in the determinants of health.

Transnational factors also have a significant impact on health. These include the integration of the global economy, financial markets and trade, wide access to media and communications technology, and environmental degradation as a result of the irresponsible use of resources.

These changes shape people´s values, their lifestyles throughout their lifespan, and living conditions across the world. Some have great potential for health, such as the development of communications technology, while others, such as international trade in tobacco, have a major negative impact.

Health promotion makes a difference

Research and case studies from around the world provide convincing evidence that health promotion is effective. Health promotion strategies can develop and change lifestyles, and have an impact on the social, economic and environmental conditions that determine health. Health promotion is a practical approach to achieving greater equity in health.

The five strategies set out in the Ottawa Charter for Health Promotion are essential for success:

build healthy public policy
create supportive environments
strengthen community action
develop personal skills
reorient health services

There is now clear evidence that:

Comprehensive approaches to health development are the most effective. Those that use combinations of the five strategies are more effective than single-track approaches
Particular settings offer practical opportunities for the implementation of comprehensive strategies. These include mega-cities, islands, cities, municipalities, local communities, markets, schools, the workplace, and health care facilities
Participation is essential to sustain efforts. People have to be at the centre of health promotion action and decision-making processes for them to be effective
Health learning fosters participation. Access to education and information is essential to achieving effective participation and the empowerment of people and communities.

These strategies are core elements of health promotion and are relevant for all countries.

New responses are needed

To address emerging threats to health, new forms of action are needed. The challenge for the coming years will be to unlock the potential for health promotion inherent in many sectors of society, among local communities, and within families. There is a clear need to break through traditional boundaries within government sectors, between governmental and non governmental organisations, and between the public and private sectors. Co-operation is essential; this requires the creation of new partnerships for health, on an equal footing, between the different sectors at all levels of governance in societies.

Priorities for health promotion in the 21st century

1. Promote social responsibility for health

Decision-makers must be firmly committed to social responsibility. Both the public and private sectors should promote health by pursuing policies and practices that:

avoid harming the health of individuals
protect the environment and ensure sustainable use of resources
restrict production and trade in inherently harmful goods and substances such as tobacco and armaments, as well as discourage unhealthy marketing practices
safeguard both the citizen in the marketplace and the individual in the workplace
include equity-focused health impact assessments as an integral part of policy development.

2. Increase investments for health development

In many countries, current investment in health is inadequate and often ineffective. Increasing investment for health development requires a truly multi-sector approach including, for example, additional resources for education and housing as well as for the health sector. Greater investment for health and reorientation of existing investments, both within and among countries, has the potential to achieve significant advances in human development, health and quality of life. Investments for health should reflect the needs of particular groups such as women, children, older people, and indigenous, poor and marginalised populations.

3. Consolidate and expand partnerships for health

Health promotion requires partnerships for health and social development between the different sectors at all levels of governance and society. Existing partnerships need to be strengthened and the potential for new partnerships must be explored. Partnerships offer mutual benefit for health through the sharing of expertise, skills and resources. Each partnership must be transparent and accountable and be based on agreed ethical principles, mutual understanding and respect. WHO guidelines should be adhered to.

4. Increase community capacity and empower the individual

Health promotion is carried out by and with people, not on or to people. It improves both the ability of individuals to take action, and the capacity of groups, organisations or communities to influence the determinants of health. Improving the capacity of communities for health promotion requires practical education, leadership training, and access to resources. Empowering individuals demands more consistent, reliable access to the decision making process and the skills and knowledge essential to effect change. Both traditional communication and the new information media support this process. Social, cultural and spiritual resources need to be harnessed in innovative ways.

5. Secure an infrastructure for health promotion

To secure an infrastructure for health promotion, new mechanisms of funding it locally, nationally and globally must be found. Incentives should be developed to influence the actions of governments, non governmental organisations, educational institutions and the private sector to make sure that resource mobilisation for health promotion is maximised. "Settings for health" represent the organisational base of the infrastructure required for health promotion. New health challenges mean that new and diverse networks need to be created to achieve inter sector collaboration. Such networks should provide mutual assistance within and among countries and facilitate exchange of information on which strategies have proved effective and in which settings.

Training in and practice of local leadership skills should be encouraged in order to support health promotion activities. Documentation of experiences in health promotion through research and project reporting should be enhanced to improve planning, implementation and evaluation. All countries should develop the appropriate political, legal, educational, social and economic environments required to support health promotion.

Call for action

The participants in this Conference are committed to sharing the key messages of the Jakarta Declaration with their governments, institutions and communities, putting the actions proposed into practice, and reporting back to the Fifth International Conference on Health Promotion.

To speed progress towards global health promotion, the participants endorse the formation of a global health promotion alliance. The goal of this alliance is to advance the priorities for action in health promotion set out in this Declaration.

Priorities for the alliance include:

raising awareness about the changing determinants of health
supporting the development of collaboration and networks for health development
mobilisation of resources for health promotion
accumulating knowledge on best practice
enabling shared learning
promoting solidarity in action
fostering transparency and public accountability in health promotion.

National governments are called on to take the initiative in fostering and sponsoring networks for health promotion both within and among their countries.

The participants called on WHO to take the lead in building such a global health promotion alliance and enabling its Member States to implement the outcomes of the Conference. A key part of this role is for WHO to engage governments, non-governmental organisations, development banks, organisations of the United Nations system, interregional bodies, bilateral agencies, the labour movement and co-operatives, as well as the private sector, in advancing the priorities for action in health promotion.