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The end of Ottawa.

Published in:
In-Touch, December 1998
Newsletter of the Public Health Association of Australia

It is with deep regret that I announce the end of Ottawa, read: the end of health promotion as we have known it for some times. We had knowledge of its lingering disease for quite a while. The exposure to Jakarta in 1997 did only speed up the process of deterioration. Now, the Australian Foreign Aid Organization AusAID hammered final nails into the coffin of health promotion.

After a three-year period of comprehensive health promotion programs in some of the Pacific Islands (supported by the World Health Organization and other UN agencies and non-governmental organizations), AusAID authoritatively and without consultation with international organizations involved in those programs declared: they have all failed. I wonder who the genius behind this assessment is. Have I missed someone really important during the past 20 years?

AusAID decided that the Pacific Islands need something better than health promotion. Thank God, that AusAID knows what the people and communities of the Pacific Islands need. The arrogance of this policy approach is incomprehensible these days, well, at least that's what I thought. Community needs assessment? Never heard of. Community involvement? Beware. Cooperation? We don't need it because we know better.

AusAID looks way back and finds that prevention is the cure for international health. Non-communicable diseases, professionally known as NCDs, are the new flavor of the month. Let's prevent them, AusAID exclaims and invites the professional community of Australia to submit proposals for a six years research program, valued at 1.5 million Australian Dollars each year ("Feasibility and design study for a Pacific non-communicable disease program"). Given the budget cuts of Australia's tertiary sector, nobody will be surprised if everyone who is affiliated with public health will submit her/his or their proposal.

This offer is simply too good to be true. Nothing new to learn, no development of new strategies, methods, research protocols, and training modules, because everything has been developed in the past and is easily accessible for those who want to access it. In case you don't believe it, consult the respective pages of the WWW Virtual Library: Public Health and you have access to these materials.

$1.5 million for prevention of NCDs - doesn't that sound familiar? Stanford, North Karelia, Minnesota, Germany and what were the results then? Not much which is why health promotion was launched in Ottawa (Canada) in the year 1986.

The development of the Ottawa Charter started in the early 1980s in the WHO Regional Office for Europe. Its main reason: develop an alternative to bio-medical prevention, which focuses on the development of living and working conditions conducive to health and which integrates people into the process of this development. Social action for health instead of preventive programs against diseases.

Health stands for substantially more than physiological parameters can display. And it encompasses more than a prevention program for non-communicable diseases is able to deal with. Get to where people, live, work, love, play you name it, but get to them, listen to them, work with them - that's what health promotion is supposed to stand for.

Way back in the early 1980s we had learnt the lesson that medical expertise may be useful with regard to the treatment of diseases, but it falls much too short when it comes to the promotion of health. Health relates to life, and life relates to land, and land relates to spirituality, and spirituality relates to health.

Now that sounds pretty strange in the era of economic rationalism and global policy projects aiming at the global shopping mall and TV station. We don't need no empowerment of people, is the message sent out by the powerful ones. We do need some thought control, they don't tell us but that's what they're after. Health promotion is considered to be bad medicine in this power game. It is considered the problem.

The times they are a-changing quickly, Mr Zimmerman.

And why do we cut down health promotion after 3 years and give prevention another 6 years to prove its incapability to come up with solutions for problems, which are not rooted in the preventive, i.e. medical system? Well, that's an interesting question and I wonder what the answers will be.

AusAID? Does it mean Aid from Aus or simply Aid for Aus? An employment program for medical specialists of NCDs and for experts in repetitive research? Just wait and see.

Postscript May 2000:
In the meantime, AusAID has established the program valued 3,750 000 Australian Dollars for 3 years and 9 months. It aims at 4 Pacific Islands and it focusses on: prevention of smoking and drug abuse, physical exercise, and nutrition.

See also the changes currently under way with the World Health Organization. They are documented on the web-site of the International Public HealthWatch. Check the "What's new" button and the archives.

Copyright © by Eberhard Wenzel, 1997-2001