40 years of the Ottawa Charter for Health Promotion—Reaffirming Health for All

The health of its people is one of the most positive and productive resources society can have. (Mahler 1986, p. 410) On the 21st November 1986, the first International Conference on Health Promotion in Ottawa, Canada presented a Charter that would change the way we think about and act on health. The Ottawa Charter for Health Promotion (World Health Organization 1986) reframed our approach to health and wellbeing, including how we understood, approached, and advocated for ‘Health for All’. The key prerequisites, actions, and commitments that were enshrined in the Charter challenged the dominant medicalized and curative focus of health, positioning health as a positive resource for everyday life. The Charter recognized that health is shaped by a complex web of interconnected determinants. It reaffirmed that health is not influenced solely by individual behaviours, but is: …created and lived by people within the settings of their everyday life; where they learn, work, play and love. (World Health Organization 1986) The Charter’s vision—that health is for everyone, and that health must be integrated into as many policy arenas as possible—continues to drive health promotion advocacy efforts at all levels across the globe. This includes an emphasis on human rights, social justice, equity, and inclusive collective action, as well as the central role of ‘Health in All Policies’ (World Health Organization and Government of Finland 2013). Health promotion is one of the pillars in the World Health Organization's (WHO) Fourteenth General Programme of Work (2025 - 2028) adopted by member states, and there are also new areas of focus that were unforeseen at the time of the Ottawa Conference (Kökény 2011; Kickbusch and Holly 2023). In 2013, then WHO Director General Dr Margaret Chan warned about the ‘formidable opposition’ that harmful corporate interests posed in undermining efforts to build healthier societies through tactics designed to protect profits and prevent regulatory reform—noting that ‘market power readily translates into corporate power’ (Chan 2013). In 2024, current WHO Director General Dr Tedros Adhanom Ghebreyesus highlighted the challenges posed by the infodemic, arguing that while new digital spaces had given people unprecedented access to information, they had also ‘… turbo charged the spread of mis- and disinformation’ (Ghebreyesus 2024). In the same year the WHO adopted an important resolution recognizing the climate crisis as one of the ‘major threats to global public health’ (World Health Organization 2024). Action on the commercial determinants of health (Kickbusch et al. 2016; Thomas et al. 2024), the digital determinants of health (Holly et al. 2025), critical health literacy (Okan et al. 2023; Nutbeam 2025), infodemics (including the rapid spread of mis- and disinformation) (Purnat et al. 2023), and planetary health (Redvers et al. 2025; Sallaway-Costello et al. 2025) has become central to health promotion efforts at a time when a range of powerful vested interests pose substantial threats to the health of communities and our planet. As with any global movement, the 40-year history of health promotion since the Ottawa Charter has been punctuated by peaks and troughs. There are, of course, many successes to celebrate across each of the Charter’s action areas—including the important leadership and support for health promotion initiatives at the WHO. Areas of policy change and action which once seemed impossible under biomedical models of health, have flourished. Health promotion has become a priority in many areas of global health governance and agenda setting—including but not limited to the WHO Framework Convention on Tobacco Control (World Health Organization 2003), and its integration into the Sustainable Development Goals (World Health Organization 2017). National policy innovations have exemplified how substantial investment and intersectoral collaboration can operationalize health promotion in everyday environments. Settings approaches have focused on transforming the social contexts where individuals engage in their daily activities such as cities (Giles-Corti et al. 2022), and schools (World Health Organization 2021). For example, the WHO Healthy Cities project led to the creation of sustained networks for action within and across countries, which helped to diffuse knowledge and share information, while engaging citizens and communities in partnerships for health (Kickbusch 2003). Despite significant structural and political challenges, the powerful youth climate movement embodies the Charter’s vision of strengthening community action and participation, as young people around the globe mobilize in their communities, on the global stage, and through social media platforms to demand climate justice (Arnot et al. 2024; Tafon and Saunders 2025). And the Charter’s socio-ecological lens underpins the One Health approach which links human, animal, and environmental health (Winkler et al. 2025). However, with new times come new challenges for health promotion (Thomas and Daube 2023). Many countries face challenges with budget allocations for prevention activities. These include resourcing for the implementation of policies relating to NCDs in countries where there continues to be a primary focus on infectious disease (Owusu et al. 2023). Health advocates also struggle to compete with short-term political agendas, and with powerful industries that have significant access to politicians and policy makers behind closed doors (Chung et al. 2024; Thomas et al. 2025). Entrenched interests, including from the pharmaceutical sector, continue to resist systemic change to health systems. Action on the commercial determinants of health requires governments to address the broad range of tactics that harmful industries use to influence policies—including political donations and lobbying. Most recently, the development of the Geneva Charter for Wellbeing (World Health Organization 2021) provided a holistic way forward for framing countries’ health policies, and reminded us that a ‘wellbeing society’ can only be achieved through meaningful engagement of ‘people, communities, sectors and government at all levels’ (Lin et al. 2022, p. 2). As Ratima et al. (2019) argue, this must include centring: Indigenous voices and Indigenous knowledge systems in health promotion to promote planetary health, health equity, and sustainable development now and for future generations (pg 5). Given the above, we must continue to acknowledge that the barriers to health equity are deeply political (Baum et al. 2022). The interconnected public health, financial, energy, humanitarian, and political crises of the last 5 years have at times shaken the position of health promotion. However, while the global risks we face are enormous and interconnected, the opportunities to accelerate change are extraordinary as well (Kickbusch 2021). Armed conflicts, the climate crisis, food insecurity, and widening economic inequalities highlight that the Charter’s priorities for health, such as peace, shelter, education, and social justice, are just as vital now as they were 40 years ago. The Charter’s values must continue to provide a compass for the bold and courageous action needed from the global health community to continue to demand public accountability for health from those in power (Kickbusch 1986, p. 3). We must confront new threats to health, learn from the lessons of the past, and organize the cooperation of international, national, and civil actors in the interests of health and wellbeing. The 40th anniversary of the Ottawa Charter coincides with the 40th anniversary of Health Promotion International. Since the journal was established it has provided a platform to advance and critically engage with the values enshrined in the Charter. To celebrate the 40th anniversaries of both the Charter and the journal, Health Promotion International will curate a special collection featuring 40 editorials, case studies, and interviews, which will critically reflect on the Charter’s legacy while exploring the new pathways for health promotion in today’s world. The ‘Ottawa Charter at 40’ series will feature perspectives from leaders in academia, policy, advocacy, and those working to implement health promotion programmes at the local level. Importantly, we are committed to engaging the next generation of health promotion leaders and practitioners, whose insights will help shape our responses to complex contemporary health challenges. We invite our readers to contribute to this dialogue by responding through commentaries to published editorials, and by joining the global conversations on social media sites using the hashtag #Ottawa40. Our aim is to create a vibrant, open-access resource that not only celebrates past achievements but also inspires future directions for health promotion. In 1986 then Director General of the WHO Dr Halfdan Mahler asked the health promotion community if we were willing to commit to being advocates for health (Mahler 1986). Health Promotion International looks forward to joining the global health promotion community in promoting approaches that elevate community voices, foster innovation, and shape the next chapter of health promotion. We urge the health promotion community to continue to be bold, brave, and outspoken in Ottawa Charter at 40 debates, events, and social media activities in their own countries and to continue to advocate for a fairer and healthier world that respects the limits of our planet and the potential of all people. S.T. is Editor in Chief, I.K. is Chair Emerita, O.O. is an Associate Editor, and M.K. is a Board Member for Health Promotion International. All authors contributed to the writing and critical revision of the manuscript. None declared.

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