MHST 631: Exploring the Impact of Cultural Bias in the Ottawa Charter for Health Promotion in Canada

In 1986, the World Health Organization (WHO) hosted the first International Conference on Health Promotion in Ottawa, Canada, to kickstart a global public health movement (WHO, 1986). The gathering produced an innovative health promotion framework and global agreement, which is commonly referred to as the Ottawa Charter for Health promotion (the Charter). The document  was endorsed by leaders, organizations, governments, and community agencies worldwide (WHO, 1986). This blog post will explore criticisms of the Ottawa Charter in relation to cultural bias with a focus on Canadian Indigenous health.

The Charter consists of five fundamental health promotion principles for promoting health: building health public policy, creating supportive environments, strengthening community action, reorienting health services, and developing personal skills (WHO, 1986).  This pioneering framework has provided a multi-faceted understanding of health and health promotion and is often considered the “gold standard” by international health educators  (Thompson et al., 2018). 

Criticisms of the Charter

Sendall et al. (2023) contend that the Charter is rooted in “Western-centric” philosophies that fail to capture Canada’s intricate history. This disconnect leads to challenges in applying the Charter to diverse populations that are not Eurocentric, as their unique characteristics are not factored into the foundational principles of the Ottawa Charter. It also does not acknowledge the unique cultural dynamics, power structures and systemic racism that fuel health inequities, especially amongst vulnerable populations across the globe (McPhail et al., 2013). In the Canadian context, the Charter’s disregard for colonialism’s historical impacts on health, undermines its cultural relevance for Indigenous populations (Sendall et al, 2023).

Cultural Relevance for Indigenous People in Canada

Lee et al. (2020) report that Indigenous perspectives are often overlooked in Western health promotion frameworks, including the Ottawa Charter. This misalignment with Indigenous views on health and healing, can undermine the intent and effectiveness of modern health promotion strategies, and contribute to poor health outcomes. Therefore, it is important for health practitioners to embed Indigenous worldviews when developing programs for Indigenous communities as this approach would lead to more inclusive practices and health promotion strategies for vulnerable groups (Anderson & Brown, 2022)

Figure 1 is an adaptable tool that was developed by British Columbia’s First Nations Health Authority (FNHA) to depict wellness through an Indigenous lens.

Figure 1: FNHA Indigenous Health and Wellness model

Source:  First Nations Perspective on Health and Wellness (2012). First Nations Health Authority. (2012). First Nations perspective on health and wellness.

The model illustrates that Indigenous people traditionally adopt a holistic, human-centred approach that acknowledges land, community and family, in conjunction with wisdom, responsibility, and respect. Recognition and synchronicity of these domains in modern health promotion practice, may lead to more balanced, interconnected strategies that meet the unique needs of Indigenous people in Canada (First Nations Perspective on Health and Wellness, 2012).

Truth and Reconciliation (TRC) of Canada Calls to Action

The 2015 TRC Calls to Action of Canada, provides 94 recommendations that are aimed at addressing health and social disparity among Indigenous peoples, on a national level (Sanzone et al., 2019). Unlike the Charter, the report acknowledges the impacts of colonization on Indigenous health and calls for the integration of Indigenous philosophies into public health policy (Sanzone et al., 2019). Addressing “historical injustices” may lead to better health outcomes for the Indigenous population over time (Richmond and Cook, 2016) so adaptations of the Charter that factor in these complexities, may improve its relevance in contemporary Canada.

Indigenous Health in the future

There are ongoing efforts taking place in Canada that aim to improve health promotion programming for Indigenous people which include adaptations of the Charter that include an Indigenous world view (Johnson et al., 2023). Although there have been struggles, many of these approaches are gleaning promising results for Indigenous health and wellbeing (Green and Turner, 2022). It is hoped that Canada will continue to recognize the significance of colonialism and embed Indigenous knowledge within modern health promotion frameworks (Green and Turner, 2022).

Conclusion

Despite being groundbreaking , significant gaps have emerged when the Ottawa Charter is applied to Indigenous populations and other disadvantaged groups Canada and worldwide. Its Western-centric framework often overlooks the holistic approaches and cultural perspectives that may help reduce health inequities (Lee et al., 2020) .In Canada, it is essential that health practitioners integrate Indigenous worldviews into their practices, as this will cultivate more inclusive approaches that resonate with the diverse communities they serve. By doing so, we can develop health promotion strategies that honor Canada’s rich history and effectively address everyone's unique needs (Green and Turner, 2022).

References

Anderson, C. J., & Brown, L. M. (2022). Health promotion and Indigenous communities: Addressing gaps in the Ottawa Charter framework. Journal of Indigenous Wellbeing, 7(1), 50-62. https://doi.org/10.26053/ijw.2022.007.01.0050

First Nations Health Authority. (2012). First Nations perspective on health and wellness. https://www.fnha.ca/PublishingImages/wellness/wellness-and-the-first-nations-health-authority/first-nations-perspective-on-wellness/FNPOW.png\

Green, A. M., & Turner, J. C. (2022). Integrating Indigenous knowledge into health promotion frameworks: An analysis of the Ottawa Charter and its application. Health Promotion Practice, 23(4), 545-555. https://doi.org/10.1177/15248399221102723

Johnson, S. P., Williams, T. A., & Martinez, N. D. (2023). Cultural adaptations of health promotion frameworks: Lessons from Indigenous health programs in Canada. Global Health Action, 16(1), 1-12. https://doi.org/10.1080/16549716.2023.2175598

Lee, M. J., Smith, J. H., & Davis, A. L. (2020). Indigenous perspectives on health promotion: A critical review of the Ottawa Charter and its relevance to Indigenous health. International Journal of Environmental Research and Public Health, 17(18), 6904. https://doi.org/10.3390/ijerph17186904

McPhail-Bell, K., Fredericks, B., & Brough, M. (2013). Beyond the accolades: A postcolonial critique of the foundations of the Ottawa Charter. Global Health Promotion, 20(2), 22–29. https://doi.org/10.1177/1757975913490427

Richmond, C. A. M., & Cook, C. (2016). Creating conditions for Canadian aboriginal health equity: the promise of healthy public policy. Public Health Reviews (2107-6952), 37(1), 1–16. https://0-doi-org.aupac.lib.athabascau.ca/10.1186/s40985-016-0016-5

Sanzone, L., Doucette, E., Fansia, N., Fu, C., Kim, E., Lo, K. P., Malhi, P., & Sawatsky, T. (2019). Indigenous approaches to healing in critical care settings: Addressing the Truth and Reconciliation Report’s calls to action. Canadian Journal of Critical Care Nursing, 30(3), 14–21. 

Sendall, M. C., Neely, E., Pederson, A., & Early, J. (2023). Health promotion paradigms. In P. Liamputtong (Ed.), Handbook of social sciences and global public health (pp. 445–466). Springer International Publishing. https://doi.org/10.1007/978-3-031-25110-8_23

Thompson, E. B., & Williams, R. K. (2021). Revisiting the Ottawa Charter: A review of its application to Indigenous health promotion in Canada. Canadian Journal of Public Health, 112(2), 274-284. https://doi.org/10.17269/s41997-021-00425-4

World Health Organization. (1986). Ottawa charter for health promotion (No. WHO/EURO: 1986-4044-43803-61677). World Health Organization. Regional Office for Europe. https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf