Dietitians carrot a lot about health promotion

In a perfect world, the implementation of the Ottawa Charter would reap health benefits for all and be seamlessly implemented. However, upon reviewing Canadian and international accounts of use of the charter in the real world, it appears that it is not a simple task (Frankish et al., 2006; Lee, 2006; Thompson et al., 2017). The Ottawa Charter set the stage for improved health promotion efforts with a focus on reducing social imbalances that may limit a person’s potential to achieve optimal health (Thompson et al., 2017; Watson, 2008). Upon its concept, health promotion was put on the map of leaders around the world to promote what was needed for health and the measures needed to support the WHO Health for All policy (Thompson et al., 2017).

Perhaps one of the most powerful health promotion strategies that has been implemented in Canada was that of tobacco. As part of this legislation Ontario (Canada) took cues from the Ottawa charter to build healthy public policy with increased taxes and prices for tobacco, restrictions on smoking in public spaces and even programs to eliminate farm operations to grow tobacco at the policy level (SMDH Exec summary). The federal government used graphic warnings on packaging to deter people from smoking (Christie, 2016). Likewise, through community engagement by utilizing social marketing campaigns, school-based programs for children and adolescents to never smoke, and workplace education and elimination of smoking on any workplace property occurred (Executive Steering Committee, 2017).

Globally, the Ottawa Charter has endorsed an upstream approach toward systems and environments to promote good health with the goal of avoiding illness and tackling the causes of negative health (Thompson et al., 2017; Wilberg et al., 2021). When the charter was established, the objective was for the five key action areas to be utilized together for the most impact and benefit to the population (Thompson et al., 2017). Wilberg et al. reviewed how action areas of the charter have been used throughout Europe from the perspective of health professionals recently (2019). Their review identified that development of personal skills was the most frequently and consistently used (Wilberg et al., 2019). The likely explanation appears to be that this method of health promotion can be the most easily implemented for a variety of different approaches and has possibility of reaching many people (Wilberg et al., 2019). It is supported by a strong history in Europe of engaging the school system in health programming and the use of established channels to reach the public (Wilberg et al., 2019).

Primary care is often used as another way to support building personal skills in various countries and can extend into the community since people go home and tell their family and friends what they learned through their work (Thompson et al., 2017). Reorienting of health services has been perceived to have had the lowest uptake in use as a health promotion strategy throughout the world and likely related to changing government’s philosophy over the years and what is on the agenda at the time (Frankish et al., 2006; Kirk et al., 2014; Thompson et al., 2017; Wilberg et al., 2019). This can lead to limited access to funding that is needed to make the investment for health professionals to have dedicated time to support the programs (Wilberg et al., 2019). Without a strong commitment to funding it is difficult to see impact despite the potential to reach a great number of people through this method

Dietitians can play a unique role in health promotion given our capacity to assess, diagnose and treat nutrition related problems because of our ability to translate science into easy to understand, reliable and knowledge about (EFAD, 2012). This makes us perfect supporters of using the health promotion action areas of the Ottawa Charter. Nutrition can play a pivotal position in health promotion and disease prevention given the number of risk factors that are related to poor health (EFAD, 2012). The charter notion of developing personal skills is paramount to the work of dietitians and is often used in strategies to improve health (Wilberg et al., 2019).

Yearly dietitians work collaboratively on initiatives to promote other aspects of the charter through Nutrition Month across Canada. This initiative began many years before the Ottawa Charter and truly embodies the action areas of developing personal skills, supporting community action, creating supportive environments, and building healthy public policy. Given the reach of the promotion throughout the country in workplaces, hospitals, community centres, libraries, media and schools there is a significant amount to be learned by this approach (Dietitians of Canada, 2022; Wilberg et al., 2019). Finding ways to uphold the interconnection among the charter strategies is much needed throughout the world to see success within health promotion practice (Wilberg et al., 2019).

Hancock (2011) draws attention to the limitations of the use of health promotion strategies in Canada and offers insight into his thoughts on the various strategies and how the governments have failed to uphold the virtue of the charter. It is difficult to disagree with his review given the situation of healthcare in Canada at this moment and he suggests that the inability to recognize the benefits of health promotion in positive health change in his article which is now 11 years old is a significant barrier (Hancock, 2011). However, today I am feeling optimistic and going to remain firm in my belief of the powerful impact that dietitians have had over the years on modifying health behaviours of others which may help reduce health imbalances.

Christie, G. (2016). The Ottawa Charter after 30 years: New Drivers for Impact. http://thevitalityinstitute.org/canadian-leadership-ottaw-charter-health-promotion-30-years

Dietitians of Canada. (2022). History of Nutrition Month. https://www.dietitians.ca/Advocacy/Nutrition-Month/The-History-of-Nutrition-Month

European Federation of the Associations of Dietitians, EFAD. (2012). Report on the role of the dietitian in effective health promotion to reduce health inequities. http://www.euprimarycare.org/sites/default/files/Report%20on%20the%20Role%20of%20the%20Dietitian%20in%20effective%20health%20promotion%20to%20reduce%20health%20inequalities.pdf

Executive Steering Committee. (2017, Aug 23). Smoke-free Ontario Modernization Report. https://www.simcoemuskokahealth.org/docs/defaultsource/hulibrary/reports/sfo_modernization_esc_report.pdf?sfvrsn=0

Frankish, C., Moulton, G., Rootman, I., Cole, C., & Gray, D. (2006). Setting a foundation: Underlying values and structures of health promotion in primary health care settings. Primary Health Care Research & Development, 7(2), 172-182. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/4741CE33F63CC1D21E9D66A4CC1570E5/S1463423606000223a.pdf/setting-a-foundation-underlying-values-and-structures-of-health-promotion-in-primary-health-care-settings.pdf

Hancock, T. (2011). Health promotion in Canada: 25 years of unfulfilled promise. Health promotion international, 26(S2). https://academic.oup.com/heapro/article/26/suppl_2/ii263/579220

Kirk, M., Tomm-Bonde, L., & Schreiber, R. (2014). Public health reform and health promotion in Canada. Global Health Promotion, 21(2), 15-22. https://pubmed.ncbi.nlm.nih.gov/24534261/

Lee, K. (2006). Global health promotion: how can we strengthen governance and build effective strategies? Health Promotion International, Vol 21, S1, 42-50. https://doi.org/10.1093/heapro/dal050

Thompson, S. R., Watson, M. C., & Tilford, S. (2018). 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://0-www-tandfonline- c com.aupac.lib.athabascau.ca/doi/full/10.1080/14635240.2017.1415765? =top&needAccess=true

Wilberg, A., Saboga-Nunes, L. & Stock, C. (2021). Are we there yet? Use of the Ottawa Charter action areas in the perspective of European health promotion professionals. Journal of Public Health, 29, 1–7 https://doi.org/10.1007/s10389-019-01108-x