Ottawa 1986: back to the future.

When Ottawa’s starting pistol was fired in the snow blizzards of November 1986, who would have thought that the health promotion race would have sped so long and so hard without roads? Across the world, there are government health promotion strategies and reviews, statutory authorities and foundations, consumer interest groups, professional associations and journals. University departments and professors proudly bear the name, Masters and Bachelor degrees are in abundance and a new book seems to appear every few months. Millions of dollars are increasingly being invested in health promotion programmes by governments and international organizations, like the World Bank, as well as through voluntary contributions from people themselves. Outcomes are now obvious globally from a health-promoting school in Africa to a healthpromoting market in Asia, to a health-promoting hospital in Europe and to a health-promoting city in South America. Smoking has fallen in many countries, HIV has been curbed, road injuries prevented and mental health promotion centre-staged. It is quite remarkable that this has all happened in just a quarter of a century. Perhaps there are times when stars align, forces unite, nature speaks and people have their day. This was true for the year 1986 when the Internet Mail Access Protocol was defined—opening the way for e-mail—and IBM unveiled the PC Convertible, the first laptop computer. That same year the Human Genome Project was launched laying down the foundations for a new era in health and medical research. In the USA, smoking was banned on all public transport and the nicotine patch was invented. In the UK, bovine spongiform encephalopathy, commonly known as mad cow disease, was first identified and caused many deaths over the next few years and a major reform in farming practices. Sadly, the worst ever nuclear disaster occurred as the Chernobyl Nuclear Power Station causing the release of radioactive material across much of Europe. Following a number of trouble-free years in space exploration, the Space Shuttle Challenger exploded shortly after takeoff watched by people live on TV around the world. The Soviet Union launched the Mir space station and President Gorbachev introduced Perestroika (restructuring) and Glasnost (openness). There was also an important ‘breakthrough’ in US– USSR Arms Talks leading to a commitment to disarm which ended the long period of instability of the Cold War. And to cap the year off, there was the Ottawa Charter. Looking back, the origins of health promotion are complex and no single driver is responsible. However, most commentators would agree that the shift in thinking began to occur around an important global meeting of WHO at Alma Ata, Kazak, in the former Soviet Union in 1978 (WHO, 1978). The Declaration of Alma Ata formally adopted Primary Health Care as the principle mechanism for health-care delivery. It crucially recognized that health improvements would not occur just by developing more health services or by imposing public health solutions from the centre. Alma Ata heralded a shift in power from the providers of health services to the consumers of those health services and the wider community. This led WHO, in 1981, to prepare a global strategy Health for All by the Year 2000 with a series of measurable targets and goals (WHO, 1981). This initiative became the driving force for comprehensive health development over the following two decades and Health Promotion International, Vol. 26 No. S2 doi:10.1093/heapro/dar081 # The Author (2011). Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected]