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Ottawa Charter of Health Promotion: Canadian, Global, and Paramedical Implications

  • May 20
  • 7 min read

If you live in Canada, you likely have access to resources like the Canada Food Guide or the Child Tax Benefit. Maybe you've participated in Bike to Work Week or were supported at the hospitals in your efforts to breastfeed after giving birth. Have you ever wondered how these initiatives came to be? Likely not, they were just there. In this post, I explore the Ottawa Charter for Health Promotion, its impact in Canada and globally, and how it has presented itself in my paramedic practice. 

 

The Ottawa Charter for Health Promotion

The Ottawa Charter for Health Promotion ('the Charter') is a seminal document drafted by the World Health Organization (WHO) in 1986 that represents an international agreement for health promotion (HP) and achieving health equity.  Health Promotion is "the process of enabling people to increase control over, and improve their own health. Offering an innovative change in perspective, the Charter views health as a state of complete physical and mental well-being achieved through the activities of daily living rather than as the objective of living. In other words, health is a positive idea that should focus on social and personal resources.

 

The Charter recognizes a shift in responsibility for health from the individual (or those at risk of developing ill health) to organizations, systems, and environments capable of preventing ill health. Governments and organizations can use the Charter as a framework to develop policies and internal practices that promote well-being within communities and workplaces. The Charter advocates a proactive, comprehensive approach to wellness, moving beyond reactive interventions. Health outcomes are determined by daily living patterns. The Charter identifies three core strategies: advocacy (individual and social action in policy and politics), mediation (reconciling sectoral interests), and enabling (empowering individuals in health partnerships).

 

The Charter's Impact in Canada 

The Charter has shaped policy by emphasizing health equity, the creation of supportive environments, and the use of practical tools for Health Promotion. In Canada and globally, its principles are reflected in laws, policies, and programs that promote healthy public policy, community action, skill development, and reorientation of health services. 

 

Policy and Lawmaking

The Charter influences policy and lawmaking, in Canada, by informing the "consolidation and institutionalization of HP (Potvin & Jones, 2011)." Laws and public health policy recognize HP as central to the overall public health. Policy development is structured around social and economic factors and how they influence individual health. In Ontario, the Ministry of Health Promotion (not to be confused with the Ministry of Health) offers expert guidance and resources to individuals and communities to promote healthy behaviour, create supportive environments, and encourage healthy public policy.

 

Health Equity

Next, consider health equity as a crucial concept shaped by the Charter. Healthy equity is when everybody, regardless of race, gender, or sexuality (this is not an exhaustive list of factors affecting inequity), can reach their full potential for health and well-being. The Charter emphasizes health equity and promotes a framework that aims to achieve it. The Pan-Canadian Healthy Living Strategy's Declaration on Prevention and Promotion (created in 2005 and reaffirmed in 2010) seeks to achieve overall health and reduce health disparities 

Health Promotion Tools 

Alongside policy changes and an emphasis on equity, the Charter also encourages development of tools for health promotion. For example, the Health Impact Assessment (HIA) evaluates projects, policies, and programs with respect to their potential to affect health and health equity (from both traditional and social perspectives).  

 

Expanding on these tools, The Population Health Template Working Tool ('The Template') organizes our understanding of health by outlining procedures and processes that examine preparedness for health initiatives. The Template is used by policy makers (to guide and direct policy), educators (to develop HP training), evaluators, grant reviewers, and researchers.

 

Canadian Programs

Shifting focus to specific Canadian programming, the Charter influences provincial health goals through the five action items it outlined. All Canadian provinces have health goals aimed at improving working and living conditions, health behaviours, early childhood development, access to effective health care, and Aboriginal health.

 

Canadian health programs influenced by the Charter include Healthy Schools, which supports redefining educational environments for health development, and the Baby Friendly Initiative, which emphasizes breastfeeding promotion in hospitals. Restrictions on cigarette advertising have led to decreased smoking rates, and legislative measures mandate seatbelt and bicycle helmet usage, as well as bans on drunk driving. Educational initiatives, such as the Canada Food Guide, promote dietary awareness, while community programs like Bike to Work Week encourage increased physical activity. 

 

All provinces (except Ontario) have regional health delivery services that emphasize social determinants of health, enabling them to address community needs more effectively. There are foundational changes from previous funding structures, including increased funding for research in health promotion, child tax benefits, and subsidized daycare. The latter two are attempts to address and recognize the effects of poverty on early childhood development.

 

The Charter's Global Impact 

Globally, it is widely recognized that the Charter has significant influence on policy, as it affirms that healthcare is a human right and an international collaborative effort. The Sustainable Development Goals and reiterations of the Charter are international efforts aimed at ensuring health and well-being for all.

 

Global Programs

There are international programs that mirror Canadian initiatives. "Healthy Cities" is a WHO program that facilitates global intersectoral activities and participation in improving living conditions. "Health Promoting Hospitals" is a joint UNICEF-WHO initiative that identifies hospital standards of care. Additional programs include health-promoting schools, health-promoting workplaces, healthy prisons, and healthy islands.

 

Global Challenges 

Global challenges and changing environments (climate change, technology, growing health inequalities, war) are not addressed in the Charter. Global conferences have convened to enforce the congruity of HP internationally. Globally, it is agreed that there is a need for greater impetus to adapt HP strategies to evolving global challenges. 

 

Early criticisms of the Charter called on global policymakers to develop policies supporting women's health, improving food and nutrition, reducing tobacco and alcohol consumption, and building new relationships with educational institutions. International meetings recognize the need for an evolution in HP practices. Using the Charter as a foundation, international lawmakers agree to improve HP worldwide by making it central to global development, a core government responsibility, a key community focus, and a requirement of good corporate practice. 

 

Expenditure dedicated to HP is notably lower in countries with a lower Gross Domestic Product (GDP); for example, in 2016, the UK spent 9.77% of its GDP on health compared with the United States, which spent 17.2%. Joint European ventures highlight this disparity, suggesting political leadership and ideologies are hugely influential in funding allocation. 

 

International Differences 

As there is an identifiable difference between nations' health, there is a strong impetus on developing countries to have HP practices that positively impact developing nations, in an effort to address international health gaps. There are also differences among nations in their interpretations, focus, and success with HP. 

  • Korea focuses on population equity, community participation, empowerment, and socio-ecological difference. 

  • England (depending on political leadership) shifts from a focus on the individual to the underlying determinants of health. Building supportive communities and reorienting health services are the Charter's strongest areas of influence. Furthermore, though there are shifts in focus, there remains a strong emphasis on health equity.

  • India has a strong emphasis on national health programs, focusing on equitable distribution of health care, community participation, intersectoral coordination, and technology. 

  • To address health equity, Sweden developed a program called "Health on Equal Terms" that aims to improve social conditions (housing, communities) unrelated to disease. 

 

The Charter and Paramedicine

As a paramedic, there are two areas of interest in my practice that draw on the central tenets of The Charter and HP: community paramedicine (CP) and peer support programs (PSP). 

 

Community Paramedicine

Paramedics are uniquely positioned to address gaps in healthcare and health inequities. Central to closing this gap is CP, a program that offers care outside traditional out-of-hospital emergency medical practice. It includes community education, preventive services, treatment of minor illness and injury, promotion of healthy lifestyles, and management of chronic disease. This program is built on advocacy (for a holistic health approach), mediation (between governments, services, and communities), and enabling (putting the program into action). 

 

Peer Support Programs

Paramedics' individual well-being often takes a back seat. There is value in workplace health promotion (WHP) to prevent work-related disease, reduce hazards, and improve employees' personal health.  Improvements in WHP could improve worker physical and mental health, reduce sick leave, and enhance productivity.  Paramedics have the highest rate of post-traumatic stress disorder among emergency service workers. The PSP is beneficial for improving paramedic wellbeing by providing skills and coping strategies, access to resources and referrals, and a sense of belonging (Price et al., YEAR). Our PSP demonstrates changes to policy, strengthens our (already) supportive environment, reorients services, develops a greater sense of community, and improves personal skills. 

 

The next time you notice a wellness initiative in a public space, at work, or in your communities, think of The Charter and its influence on our overall health and wellness. 

 

RESOURCES

 

Agarwal, G., McDonough, B., Angeles, R., Pirrie, M., Marzanek, F., McLeod, B., & Dolovich, L. (2015). Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a community health assessment programme with Emergency Medical Services (CHAP-ems) implemented on residents aged 55 years and older in subsidised seniors’ housing buildings in Ontario, Canada. BMJ Open, 5(6).  https://doi.org/10.1136/bmjopen-2015-008110  

 

Chen, T.-H., Huang, J.-J., Chang, F.-C., Chang, Y.-T., & Chuang, H.-Y. (2016a). Effect of workplace counseling interventions launched by workplace health promotion and Tobacco Control Centers in Taiwan: An evaluation based on the Ottawa charter. PLOS ONE, 11(3). https://doi.org/10.1371/journal.pone.0150710 

 

 

Chen, T.-H., Huang, J.-J., Chang, F.-C., Chang, Y.-T., & Chuang, H.-Y. (2016b). Effect of workplace counseling interventions launched by workplace health promotion and Tobacco Control Centers in Taiwan: An evaluation based on the Ottawa charter. PLOS ONE, 11(3). https://doi.org/10.1371/journal.pone.0150710 

 

Drewitz-Chesney, C. (2012). Posttraumatic stress disorder among paramedics. Workplace Health & Safety, 60(6), 257–263. https://doi.org/10.1177/216507991206000605 

 

First international conference on health promotion. World Health Organization. (2026). https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference 

Glouberman, S., & Millar, J. (2003). Evolution of the determinants of Health, health policy, and Health Information Systems in Canada. American Journal of Public Health, 93(3), 388–392. https://doi.org/10.2105/ajph.93.3.388 

 

Health promotion. Public Health Ontario. (2026). https://www.publichealthontario.ca/en/health-topics/health-promotion 

 

 

Kumar, S., & Preetha, G. S. (2012). Health promotion: an effective tool for global health.Indian Journal of Community Medicine,37(1), 5-12.

 

Lee, A., Fu, H., & Chenyi, J. (2007). Health promotion activities in China from the Ottawa Charter to the Bangkok Charter: revolution to evolution.Promotion & education,14(4), 219-223

 

Let’s Learn Public Health. (2017). Introduction to Health Promotion and the Ottawa Charter [Video]. YouTube.  https://youtu.be/G2quVLcJVBk 

 

Potvin, L., & Jones, C. (2011). Twenty-five years after the Ottawa Charter: The Critical role of health promotion for public health. Canadian Journal of Public Health, 102(4), 244–248. https://doi.org/10.1007/bf03404041 

 

 

Thompson, S., Watson, M., & Tilford, S. (2017). The ottawa charter 30 years on: Still an important standard for health promotion. International Journal of Health Promotion and Education, 56(2), 73–84. https://doi.org/10.1080/14635240.2017.1415765 

 

WHO Press, Milestones in health promotion statements from global conferences (2009). Switzerland. Retrieved May 18, 2026, from https://iris.who.int/server/api/core/bitstreams/7823208e-639a-43ea-b213-5d1bde86c15f/content. 

 

 

 

 

 
 
 

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