The boulder in the stream

It was a cold and grey evening and the snows had not yet started when I climbed the stairs to the grand entrance of the Skyline Hotel in Ottawa. As I revolved through the doors a rather charming man opened his arms wide and welcomed me as if I were the prodigal daughter finally come home: Gerry Dafoe was the CEO of the Canadian Public Health Association. If I had known that he had been at the WHO/UNICEF Primary Health Care conference at Alma-Ata 8 years before that ominous Ottawa night (presenting a forceful argument for the role of non-governmental organizations in primary health care) I might have sunk to my knees in admiration. But I was green, and unaware of the historical significance of what was happening.

Somewhere in the bowels of the Skyline Hotel Ron Draper and Ilona Kickbusch, assisted by a band of radical health professionals and social entrepreneurs, were of course already scheming to make history. For this issue of Health Promotion International, some of those ‘tearaways’ we found willing to reflect on the significance of the Ottawa Charter, others would rather reveal its unfulfilled promise. However, as the editors of Health Promotion International approached a motley crew of potential authors some of them quickly resolved one important issue. The editors proposed a series of scholarly, systematic-review type articles, but Michel O'Neill, one of Canada's health promotion founding fathers, swiftly countered: ‘Do we really want to have more words from the dinosaurs and geriatric rockers of health promotion?’.

No. We did not. We wanted to be true to the spirit(s) that brought together the will, resources and inspiration to organize that meeting in Ottawa between 17 and 21 November 1986. We wanted to capture—again—the optimism and hope, and most of all perhaps the combined creativity, of those few hundred people who saw an opportunity to really develop a new public health.

For me, that creativity was best experienced during a well-oiled session in one of the Skyline guest rooms with four hilarious chaps who, by my 26-year-old standards, were already Archaeopteryx in the early 1980s. During my university days I had studied, with great reverence, the proverbs of one Mohan Singh. To us, the sage Singh was the health education equivalent of the Dalai Lama. What transcendent wisdom, what lucid perspicacity, what cogent astuteness spoke from these pearls of profundity! And indeed, that evening in the Canadian capital, I was in the presence of Great Wisdom discovering that cutting-edge thought had nothing to do with physical age, and that Mohan Singh was Hod Ogden. Would this journal ever be able to re-capture all that?

‘An International Conference on Health Promotion’ was organized and sponsored by the European Regional Office of the World Health Organization (facilitated by Ilona Kickbusch), Health and Welfare Canada (facilitated by Ron Draper) and the Canadian Public Health Association (facilitated by Gerry Dafoe). The mere fact that it was pulled off would be one of those things that scholars of the Actor-Network Theory love to describe: the meeting only came about because of a long series of fortuitous and serendipitous synergies between people, agencies and events: (i) a woman who interned at the Alma-Ata Conference and happened to get a temporary position at a UN agency that was led by some Nordic gentlemen who realized that the Zeitgeist required a bit of stirring, conveniently supported by some young doctors in Wales who happened to have maneuvered themselves to the innovative edge of public health interventions, (ii) a man who rode the first wave of green and ecological thinking in health who happened to have a keen eye for futuring and forecasting who happened to be well-connected across the Atlantic, (iii) a bunch of people who grew up with ideals of the 1960s and took their social engagement from the streets into the office, who happened to have reached the age of credibility in the late 1980s. This constellation of stellar bodies just happened to open that one brilliant window of opportunity, and the Ottawa Charter for Health Promotion was born.

To try and re-capture that unique moment of history has demonstrated to be nigh impossible. Following Michel O'Neill's advice, we issued shortlisted authors for this volume with strict marching orders: their pieces needed to be edgy, outside-the-box, inclusive of both the Global North and South, have a perfect author gender and age balance (with a strong emphasis on next generation health promotion thinkers), and unconventional in their arguments. The few dinosaurs that were still included in our line-up at least were edgy and unconventional, and presented cogent and inclusive memoirs of their Ottawa experiences. Some of the ‘next generation’ faithfully represented shifting balances and new tipping points.

We also sought to re-establish the original partnership that forged that unique moment in history. The European Regional Office of the World Health Organization very quickly committed to our endeavour, and used a draft running order of this Supplement to support its own Ottawa Charter celebrations at the 61st Regional Committee meeting held in Baku (Azerbaijan), 12–15 September 2011. Regional Director Dr Zsuzsanna Jakab shows in her editorial that the spirit of the Charter is very much alive in Europe, and has inspired member states to commit to the challenge of its Health 2020 strategy (Jakab and Galea, 2011). The Canadian Public Health Association (CPHA) soon followed suit with a proud commitment to this volume. Trevor Hancock (Hancock, 2011a,b) was asked to reflect on the Canadian health promotion context in an editorial on CPHAs behalf and does so without holding back. Finally some significant Canadian scholarly health promotion development is also illustrated in this volume by Poland, Haluza-DeLay, Labonte and Clavier.

Work, learn and play: Catford (Catford, 2011), Pettersson (Pettersson, 2011) and Kökény (Kökény, 2011) in their pieces describe how they worked, learned and played during and after the Ottawa conference. Their commitments to the value system that the Charter codified are still going strong and, considering the influential positions each of them occupy, bide well for a post-Charter health promotion. Labonte (Labonte, 2011) describes some of those momentous challenges that emerged in the 25 years since 1986 and argues that a strong moral agenda to deal with racism, inequity, and the unwanted aspects of globalization should be part of the health promotion movement.

In the ‘The Charter 25 Years On’ section of this celebration, Saan and Wise (Saan and Wise, 2011), McQueen and De Salazar (McQueen and De Salazar, 2011), Ziglio et al. (Ziglio et al., 2011), Wallerstein et al. (Wallerstein et al., 2011) and De Leeuw and Clavier (De Leeuw and Clavier, 2011) all make the same observation: the development and publication of the Charter was a momentous event that has impacted tremendously on the nature of public health around the world. Every new generation of health promotion and public health professionals can still find profound inspiration in those few pages of what was seen by some as a political pamphlet. Of course, each of the above pieces voices concerns and formulates critical elements where the Charter is yet to fulfil its promise. There needs to be a continuing vigilant commitment to empowerment, community engagement and political action; the need remains to strengthen and validate the role of advocacy, mediation and enabling; and the health promotion community needs to train and maintain a keen eye for windows of opportunity for these strategic parameters. All authors, however, cherish the wisdom and activism that still explodes off the pages of the Charter.

The one exception in this section may be the contribution by Poland et al. (Poland et al., 2011). They claim that the Charter perhaps set the agenda and the Sundsvall declaration sustained the notion of ‘Supportive Environments for Health’, but neither really developed a systematic and systemic, scholarly grounded and socially relevant and responsive transformative direction for health promotion. In their piece, they do set such a developmental agenda for a scholarly robust and socially pertinent health promotion—a truly new public health.

In ‘Looking Ahead’ Dean Whitehead and Fiona Irvine (Whitehead and Irvine, 2011) ask some uncomfortable questions around the ‘developing personal skills’ action area of the Charter. They argue that the remit and message of ‘Ottawa’ have as yet not reached most of the health professions. Particularly at the interface of personal skills and the reorientation of health services substantial change is still required. The significant advances that are made in the area of health literacy still do not align with the training and agendas of clinically located health professionals. Health Promotion International can proudly state that with 23 articles over the years devoted to this issue, Nutbeam (Nutbeam, 2000) started an important development.

Similarly, Baum and Sanders (Baum and Sanders, 2011) convincingly show that much of what has become the mainstream health promotion discourse has developed a blind spot for the health impact of corporate interests that escape public sector governance. In developing an argument around the food industry, health promotion and nutrition, they show that a Health in All Policies approach driven by a strong equity and social justice agenda may in fact counter the fragile food security of many countries.

Laverack and Keshavarz Mohammadi (Laverack and Keshavarz Mohammadi, 2011) seamlessly continue the argument started earlier by Wallerstein et al. (Wallerstein et al., 2011). For the Ottawa Charter and its proponents to maintain relevance in empowerment and community development, they argue, it is important that the health promotion community continues to win and build people's trust and commitment. They provide a series of international case studies that show this is a highly relevant and attainable objective.

In a final manuscript, Krech (Krech, 2011) makes a strong argument for the adaptive power of the Health in All Policies approach—which provides us with a fascinating sneak preview of the next event in the series of ‘Ottawa Charter babies’: the Eight Global Conference on Health Promotion in Helsinki (Finland), in 2013.

Where does this leave us now? As Ludovika Singh, the great Mohan's niece, recently penned:

The Ottawa Charter has had and remains to have a momentous impact on our understanding of health, its determinants, and what can be done to ‘make healthier choices the easier choices’. What the authors in this celebratory supplement observe is that its key messages are as valid as they were 25 years ago. But the world is ever-changing and institutional parameters for a current incarnation of the Charter should be sharpened. We need to continue to advocate, mediate and enable, learn to rely on community practice knowledge, and recognize that the political economy of health dictates a need for astute strategizing. The acknowledgement of the fact that in the 21st century we live in a pervasive ‘health society’ should also drive the further critical review—as authors in this volume have demonstrated—of a better, comprehensive, understanding of governance for health.

Indeed, governance has become the key concept in many of the current health (promotion) policy deliberations around the world. Governance debates were very much part of the WHO/EURO Regional Committee meeting in Baku, continued at the United Nations Heads of State meeting on non-communicable diseases (New York, September 2011), and are at the core of the WHO global conference on social determinants of health (Rio de Janeiro, October 2011). But a strong analytical approach of the governance deficit at many levels of personal and community health action has yet to receive the level of attention it does in the area of environmental politics. There, Biermann et al. (Biermann et al., 2009) argue that ‘governance architectures’ need to be conceptualized. Each of the contributions in this volume points at a similar need for the social and political determinants of health. These arguments strongly echo initial steps in urban health (Burris et al., 2007) and global health (Kickbusch, 2003) governance. The time seems opportune to forge a global agenda for health governance—the Helsinki 2013 Agenda.

REFERENCES