Fostering the future of health promotion as seen through the ‘Message from Youth Delegates on Health Promotion and Sustainable Development’

Introduction

‘We are determined to leave no one behind.’ (Shanghai Declaration)(1)

On 21 November 2016, the first day of the World Health Organisation’s (WHO’s) 9th Global Conference on Health Promotion, the brilliantly dramatic backdrop countdown for the signing of the Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development illuminated the stage behind WHO Executive Director Margaret Chan and her colleagues, as they stood in front of an eager crowd to sign into action the newest document meant to guide health promoters as we dive deeper into the age of the United Nations’ (UN’s) Sustainable Development Goals (SDGs). A discussion of why the SDGs are important to global health would not be necessary for an audience which strives daily to address the inequities in today’s global health environment, but we may need to take a deeper look into the systems at play, as well as how the groups affected will be invited to help create change.

The Shanghai Declaration left us with a taste of what is to come for health promotion, on the anniversary of the Ottawa Charter for Health Promotion (2) signed 30 years earlier. The real question now is: how can we nurture the future of health promotion to fulfil the SDGs and truly ensure that no one is left behind? Surely, the answer includes creating an engaging environment for future health promoters and current young leaders in health promotion. After all, the Shanghai Declaration reminds us that health can be achieved by ‘engaging the whole of society.’ If, taking from the Ottawa Charter, we can advocate, enable and mediate when it comes to participation in health promotion as well, we might encourage true support and connection among those of us on the mission to create health for all.

Message from youth delegates on health promotion and sustainable development

As Global Chair of the International Union for Health Promotion and Education (IUHPE) Student and Early Career Network (ISECN), I was invited to the Shanghai conference as moderator and co-planner of the symposium, ‘How can youth become future leaders in delivering on the 2030 Agenda for Sustainable Development?’ Altogether, 10 young leaders from across North America, Africa and Asia developed the format to present their experiences in health promotion leadership and their views on the promises of the SDGs for the future. This 10-member collaboration served to develop the only presentation in which young health promoters were represented at the conference.

We thought to seal the symposium by presenting a united voice for young people: something concrete. For this, we needed to provide a platform for the young voices that may not have had strength within the Shanghai Declaration. Out of this need, the Message from Youth Delegates on Health Promotion and Sustainable Development (3) originated. ‘The Message from Youth Delegates’ is a collection of recognitions, pledges and encouragements on the part of young health promoters globally, as an addition to the Shanghai Declaration. The team strived to highlight that there are diverging views between established and newly emerging professionals that one might not be able to chalk up to pure experience in the field.

A main purpose of the message was to first, as young people, hold ourselves accountable for creating a brighter future for global health, considering youth are typically seen as the ‘acted upon,’ with no regard paid to their potential health-promoting power or influence. Though the term ‘youth’ itself is not a clear age category (my own status as ‘youth’ could itself be called into question as a graduate student), we may think of those represented within the ‘Message from Youth Delegates’ as generally young people who were perhaps born after the instatement of the Ottawa Charter.

Admittedly, the geographic representation found among those who played a part in the message could have been more expansive and a greater number of young people could have played a role in the formation of the message’s ideas. It would have also been valuable for there to have been greater participation in the development of the document from more experienced health promoters who serve as advocates for young people and their contributions to global health. The participants generally agreed on the main components of the message, but an interesting discussion arose regarding the role that culture plays for the youth of today, and the line between the preservation of culture and the transition away from cultural practices that are found to be in contradiction to health. This brings light to the fact that the shifting social environments in which we promote health are calling for change within the field.

The ‘Message from Youth Delegates’ is a genuine call to bring together all generations of health promoters by creating an environment of inclusivity, rather than allowing that health promotion’s future leaders be discouraged by what they may interpret as high levels of elitism and formality. The ‘shared responsibility’ of promoting health mentioned in the Shanghai Declaration clearly supports a call to unite all generations of health promoters. The message was our opportunity as young people to speak out regarding what we see as the future of health promotion. For all of the youthful participants, the most disappointing aspect was the knowledge that our statement may be written off as a mere token of our attempted participation in a conference of that stature, evidenced by the demotion of the document’s title from ‘Shanghai Youth Declaration’ to ‘Message,’ for fear that the contents of the message had not been properly formalized and thus held less weight.

It’s a tremendous step forward that the conference organizers approved the inclusion of a symposium led by young people, and its success may be able to serve as a wedge in the door to greater levels of youth participation in future WHO matters. All the same, when taking into account the broader activities pursued in the global health domain, a consensus quickly reached by the planners of the youth symposium was that we desired to emphasize a lack of youth participation in policy, largely due to the fact that we feel it is where youth have been failed the most.

Policies are created that impact the health of young people without their input, though they are more than capable of undertaking authentic conversations to express their needs and wants in relation to their health. This is of particular importance because the matters taken on by the SDGs all directly involve youth, their communities, and their future. As we see time and again in health promotion literature, we must work with communities in order to provide them what they need, not merely attempt to deliver on the action by means of supposition. The ‘Message from Youth Delegates’ also serves as a reminder that youth are on the front lines of health promotion work in their communities, often even directing their own organizations, and they are making undeniable progressive change in the health of those around them. This type of direct work proves that young people have the capacity to participate in health promotion, even if it means forging their own path when interactions with more prominent institutions seem out of reach.

For us, as young global health workers, the field of health promotion represents our propensity for positive transformation and absolute hope for the future. It’s a distinct way of connecting with the world: health promotion allows us to take control of our own health and environment, where we have previously felt none. For all health promoters, our work offers us the opportunity to give more to our children and to future generations. This is what the ‘Message from Youth Delegates’ was meant to convey.

The future of health promotion

While it is perhaps easy to write off young people’s desire to be involved more meaningfully in health promotion action due to lack of experience or education, we may need to take a giant step back to gain a more complete understanding of how the field of health promotion (and global health in general) has evolved and will evolve. Globalization and the ever-increasing impact of technology continue to mutate the environments from which the next generations of health promoters are emerging. This is necessary to take into account when speaking in terms of quantifiable ‘experience’ and ‘education’ that will perhaps never be successfully compared between newer and more seasoned health promoters. Will the young people of today be able to phase into the WHO and other such institutions successfully? Will these organisations need to transform?

The Shanghai Declaration states that it will ‘remove barriers to empowerment’ when it comes to health. It is likely that the best way to empower young people as a group is to make sure that they have an equal opportunity to contribute to the world of health promotion, by being recognized as current leaders with relevant views regarding health in their communities. The future of health promotion may include an emphasis on recognizing work done at the grassroots level, which would increase collaboration between the many young people involved in this work, policy makers, and others with a great amount of influence in the sphere of global health. By focusing more energy on breaking down the barriers between generations of health promoters in order to increase participation, we can create more supportive environments from which the ensuing leaders of global health organizations and institutions will come forth.

In an ideal future:

Conclusions

Unexpectedly, as a result of the enormous support from conference participants, a speaker of the youth symposium, Judith Oketch (from Kenya), was chosen to speak on behalf of young health promoters during the closing ceremony of the conference, which included the reading of a summarized version of the ‘Message from Youth Delegates.’ While this may count as a small win for young global health workers, the real win was proving that when people come together to advocate for the participation of younger generations, we can create an alliance powerful enough to ensure that the field of global health remains tolerant, dynamic and connected.

Communities may be able to support young people and recognize that most of the ‘big issues’ affect them on a different level, but it is unknown whether a more thoughtful approach will be taken to fuel their interest in carrying health promotion through the epoch of the SDGs to a more innovative level. It is a delicate balance between experience and education, but youth health promoters, as expressed in the ‘Message from Youth Delegates,’ recognize the value they have added to health promotion with ‘front lines’ work and leadership. By taking purposeful action, we can ensure that this category of irreplaceable health workers should not have to let others make decisions for them that will affect their health and communities.