Abstract
In penning this editorial in late 2016 I have been prompted to reflect on the year gone by and what it might mean for the world of health promotion going forward. The year 2016 was a significant one. There was the 22nd International Union for Health Promotion and Education (IUHPE) World Conference on Health Promotion in Curitiba in May; the World Health Organization’s (WHO) Ninth Global Conference on Health Promotion in Shanghai in November; the 30th anniversary of the publication of the Ottawa Charter for Health Promotion (1); and the Oxford Dictionary declared ‘post-truth’ as its international word of the year (2).
Both conferences produced accompanying statements. The Brazilian-hosted event gave birth to the Curitiba Statement on Health Promotion and Equity (3), while the WHO event co-organised and hosted by the People’s Republic of China was marked by the adoption of two documents: the Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development (4), and the Shanghai Consensus on Healthy Cities (5). An important question is the extent to which there is a degree of consistency between these documents produced within months of one another.
The Curitiba Statement was produced through a process that involved conference delegates contributing their ideas. It cannot claim to represent the views of all attendees but nevertheless it seems consistent with both the themes and mood of the event. It calls for action at all levels of society to address the social determinants of health, equity and participation; to treat health as a human rights issue; to recognise that the practice of health promotion ‘is influenced directly and indirectly by politics and ideologies.’ In this context I would highlight the impact of one of the keynote presentations. Prof. David Stuckler made a strong empirical case for challenging the accepted (by some) orthodoxy that economic austerity measures are the only way to remedy the financial crisis. What is important here is the extent to which the field of health promotion gets involved in debates about political economy and uses research and evidence to review the ways and extent to which wider social policies impact upon the health of whole populations, and in particular on health equity.
Given the political priority attached to the Sustainable Development Goals (SDGs), it is clearly a strategic and professionally sensible move to make the link between the health promotion world and the SDGs agenda. The Shanghai Declaration does so by highlighting the importance of effective governance to promoting health through the use of legislative and fiscal policies, including those that operate at a global level. Importantly it asserts the necessity of ‘transparency and social accountability.’
The involvement of over 100 mayors from cities around the world lent weight to the emphasis on the need for political engagement and reflected a recognition of the trend towards urbanisation and city-bound migration. The Mayors’ commitment extended to ‘10 Healthy City action areas which we will integrate fully into our implementation of the 2030 sustainable development agenda.’
A significant contribution to the Shanghai conference was through a Message from Youth Delegates on Health Promotion and Sustainable Development presented at the closing ceremony (6). It was clear from its enthusiastic reception that the message of the need to bridge the gap between the generations and to involve and engage with young people in future health agendas, was well received. A more detailed piece on the Youth Message appears later in this issue (7).
There appears to be some sense of a shared agenda across the two conferences and their related outputs. People will argue about the relative weight given to some themes and to specific wording but what is encouraging is the evident commitment to engaging with the SDGs, to equity and to the role that health promotion can and must play if these goals are to be realised.
The Shanghai Declaration is the latest position statement emerging from global conferences and other events. In addition to Ottawa itself there have been many others on health promotion, and still more on particular topics. Many would argue that the Ottawa Charter is the one that has truly stood the test of time as a conceptual foundation. It is still referred to today as being of enduring relevance. The observation made in Shanghai was that health promotion must transition from a theory/technically-based discipline to one that is more politically focused.
But perhaps the real question relates to the extent to which the rhetoric of this latest declaration will be matched by action. Over the years many action points have been listed in successive statements, but how many have been prioritised, funded or implemented? Despite policy commitments to reduce health inequity, have we seen real reductions in health inequalities?
The Shanghai Declaration concludes with the comment that ‘We recognize that health is a political choice and we will counteract interests detrimental to health and remove barriers to empowerment….’ (4). It further asserts that the ‘participants pledge to accelerate the implementation of the SDGs through increased political commitment and financial investment in health promotion’ (4).
And this brings me back to the Oxford Dictionary’s word of the year. We apparently now live in an era of ‘post-truth politics,’ with an emphasis on opinion and emotion, and with scant regard for policy detail. In this context, how will we ensure that policy commitments are met?
Without resources, commitment and accountability, declarations endorsed in the excitement of the moment will remain no more than the products of wishful thinking. This is not a counsel of despair, more a call to be realistic, fervent in our desire to implement these pledges and to hold our governments to account in implementing declarations they have signed up to.
My own pledge is that the IUHPE, as the international voice of and for health promotion, will play its part in supporting this endeavour and I would encourage would-be authors to explore these themes of accountability and commitment in future journal papers.