Empowering people for sustainable development: the Ottawa Charter and beyond

I n November 1986, 212 participants from 38 countries convened in Ottawa, Canada, at the first International Conference on Health Promotion organized by the World Health Organization (WHO), Health and Welfare Canada, and the Canadian Public Health Association.Although not representative of the entire globe, these participants adopted the Ottawa Charter on health promotion as "the process of enabling people to increase control over, and to improve, their health".The five action areas identified were to: build healthy public policy; create supportive environments; strengthen community action; develop personal skills; and re-orient health care services, toward prevention of illness and promotion of health [1-3].The Charter laid the foundation for subsequent efforts in advancing global health over the next 30 years, including development of the Millennium Development Goals (MDGs).The MDGs have given way to a more robust and comprehensive agenda, the Sustainable Development Goals (SDGs) [4], underpinned by the principles of reducing inequities and universal health coverage (UHC).Thus the vision of the Charter is foundational to progress in health care over the last 30 years.Here, we review the progress made and discuss the unfinished agenda of the Charter as well as opportunities to accelerate its objectives in the context of UHC and the SDGs, through collaborations of international and local health organizations.The notion of UHC was articulated earlier in September 1978 when the Alma Ata Declaration on primary health care was adopted at a joint conference of the WHO and United Nations Children' s Emergency Fund (UNICEF) [5].This declaration emphasized the importance of 'health for all', a message strengthened through the Charter and in the WHO strategy to ensure 'Health for All by 2000'.In this regard, the Alma Ata Declaration and the Charter were seminal documents that shaped the global health agenda.The Charter urged nations to advocate, enable, and mediate, in order to achieve progress in the five action areas [3].While the ambitious agenda of the Charter and Health for All were not fully realized, this heralded the era of the MDGs that guided the global health agenda from 2000-2015, and yielded substantial but uneven gains.The MDGs have been replaced by the SDGs, which comprise of 169 targets, and were adopted in September 2015 by 193 nations [6].The Ottawa Charter notes that "peace, shelter, education,

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