CONFERENCES AND KEY DOCUMENTS

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1 CONFERENCES AND KEY DOCUMENTS
HABİBE ER YEDİTEPE UNİVERSİTY PUBLİC HEALTH GRADUATE SCHOOL

2 Background of Health Promotion
 The world at the beginning of the 21st century is a world of change. Politically economically, technically, socio-culturally and demographically, countries and communities are in transaction.  The world is significantly different today from some decades ago. New situations pose new problems and at the same time present new opportunities.  New health promotion approaches are required to match them. Health promotion has to be justified against competing claims for the societies resources.  We must strive to find even more effective ways of promoting supporting environments, strengthening communities refocusing services and helping people acquire knowledge and skills for health.  We need to explore the strategies and methods for effectiveness of these activities.

3 Background cont…  The information technology of today and tomorrow can enhance the ability of health promotion to reach people everywhere. This however will require creativity and imitativeness, as well as commitment to policy making. Achieving health for all, with the participation of all, based on the principles of equity and solidarity, requires not only good management but a fresh approach.  It built on the progress made through the Declaration on Primary Health Care at Alma-Ata,1978, Over the past years stretching from Ottawa (1986), the first International Conference on Health Promotion and which gave its name to Ottawa Chatter from Health Promotion, to the second conference in Adelaide (1988) and the third in Sundsvall (1991), Health Promotion has carried its mission of giving health a high position on the political agenda.  Each of these conference has made a significant contribution to public health and to focusing our attention to the necessity for a more holistic & comprehensive approach to addressing the determinants of health. Jakarta conference is the fourth in a series of technical conferences on health promotion, all of which have and continue to make major contributions to health promotion & public health.

4 History  The “first and best known” definition of health promotion, declared by the American Journal of Health Promotion since 1986 is “the science and art of helping people change their lifestyle to move toward a state of optimal health”  Since then and even before there have been plenty of definitions for health promotion 1974 Lalonde Report form Canada 1979 Healthy People report of Surgeon general of united states 1984 WHO 1986 Canadian minister of national health and welfare ☼ Different conferences, important documentations and charters

5 Concept Focal person/s Change behavior Communication Health promotion is directed towards action on the determinants or causes of health promotion, therefore, requires a close co-operation of sectors beyond health services, reflecting the diversity of conditions which influence health. Government at both local and national levels has a unique responsibility to act appropriately and in a timely way to ensure that the ‘total’ environment, which is beyond the control of individuals and groups, is conducive to health.

6 What is Health Promotion?
Today Health Promotion is more than personal and population education. Defined in a number of ways “The process of enabling people to increase control over and improve their health” (World Health Organisation 1986) Health Promotion = health education x healthy public policy. (Tones and Tilford, 1994) Health promotion curative palliative rehabilitative preventive

7 Phylosophy Health promotion is any combination of health, education, economic, political, spiritual or organisational initiative designed to bring about positive attitudinal, behavioural, social or environmental changes conducive to improving the health of populations.  Through the involvement of home, school and community, including: the physical, intellectual, emotional, social and moral development

8 https://www. slideshare

9 Health promotion theories The scope of health promotion activity
 There are many different theories that guide health promotion interventions  Most theories are based in the social sciences including sociology, education, psychology and policy studies  Different approaches to health promotion tap into different theoretical perspectives and academic disciplines  We will examine 4 contrasting models Frameworks and Models are tools that help explain phenomena. Many tools developed to explain the scope of health promotion. 1.Beattie’s (1991) model of health promotion 2.Tones and Tilford’s (1994) empowerment model of health promotion 3.Caplan and Holland’s (1990) Four perspectives on health promotion 4.Naidoo and Wills (2000) typology of health promotion

10 Beattie’s model of Health Promotion
Community Development Empowerment community level Skills Personal Counselling Greater control  Legislative Action Focus Act Resources Policy Health persuasion Needs to focus on why behaviour is happening Authoritative Collective Negotiated Individual

11 Beattie’s model applied
Key features Examines 2 axis i) type of approach used top down (authoritarian) or bottom up (negotiated or owned by clients) ii) size of approach Categorises 4 types of activities a)Personal Counselling eg working with dietician on food and physical individual personal plans and goals b)Health persuasion eg Campaign of eating 5 fruit and vegetables a day on TV c)Legislative action eg laws that subsidise the price of healthy food stuff d)Community development eg communities producing and distributing food themselves

12 Tones and Tilford’s (1994) model of health promotion
Key features States interaction between two main sets of processes for health improvement i)development and implementation of healthy public policy ii) health education in which people are empowered to take control of their life. Example attempts of Jamie’s School Diners campaign where school meals was brought into public consciousness and lead to standards for meals and an increase in the budgets for school meals. Only when these two approaches work in parallel can the conditions for living and individuals behavioural aspects of health be addressed

13 Caplan and Holland’s model of health promotion (1990)
Key features More complex and theoretically driven Attempts to unpick what determines health and ill-health and therefore what activities can be used to address health issues. One axis refers to a theory of knowledge and how knowledge is generated in relation to health The other axis refers to how society is constructed and how this impacts on health.

14 Niandoo & Wills 2005 Models of health promotion may help to:
Interrogate and analyze existing practice Plan and chart the possibilities for interventions Conceptualize or map the field of health promotion

15 TANNAHILL’S MODEL OF HEALTH PROMOTION (DOWNIE et al – 1990)
1. Preventive services, e.g.. immunization, cervical screening, hypertension case finding, developmental surveillance, use of nicotine chewing gum to aid smoking cessation 4. Health education for preventive health protection, e.g.. lobbying for seat belt legislation 7. Health education aimed at positive health protection, e.g.. pushing for a ban on tobacco advertising 6. Positive health protection, e.g.. workplace smoking policy. 5. Positive health education, e.g. life skills with young people 3. Preventive health protection, e.g.. fluoridation of water 2. Preventive health education, e.g.. smoking cessation advice and information.

16 TANNAHILL’S MODEL OF HEALTH PROMOTION (DOWNIE et al – 1990) (cont.)
 Shows how these different approaches relate to each other in an all-inclusive process termed health promotion.  Health education- communication to enhance well being and prevent ill health through influencing knowledge and attitudes.  Prevention- reducing or avoiding the risk of diseases and ill health primary through medical interventions.  Health protection safeguarding population health legislative, fiscal or social measures

17 A FRAMEWORK FOR HEALTH PROMOTION ACTIVITIES

18 https://www. slideshare

19 PRINCIPLES OF HEALTH PROMOTION
The five key principles of health promotion as determined by WHO are as follows: 1.Health promotion involves the population as a whole in the context of their everyday life, rather than focusing on people at risk from specific diseases. 2.Health promotion is directed towards action on the determinants or causes of health therefore, requires a close co-operation of sectors beyond health services, reflecting the diversity of conditions which influence health

20 PRINCIPLES OF HEALTH PROMOTION cont.
3. Health promotion combines diverse, but complementary methods or approaches including communication, education, legislation, fiscal measures, organisational change, community change, community development and spontaneous local activities against health hazards. 4. Health promotion aims particularly at effective and concrete public participation. This requires the further development of problem-defining and decision-making life skills, both individually and collectively, and the promotion of effective participation mechanisms. 5. Health promotion is primarily a societal and political venture and not medical service, although health professionals have an important role in advocating and enabling health promotion.

21 The medical or preventative approach Aims  Reduce morbidity and premature mortality  Target: whole populations or high risk groups  Promotion of medical intervention to prevent ill-health Main approaches to health promotion  Medical or preventative  Behavioral change  Educational  Empowerment  Social change

22 The educational approach Aims  To enable people to make an informed choice about their health behavior by  providing knowledge and information  developing the necessary skills  Not similar the behavioral approach, it does NOT try to persuade or motivate change in a particular direction  OUTCOME is client’s voluntary choice which may be different from the one preferred by health promoter Behavior change approach Aims  Encourages individuals to adopt healthy behaviors which improve health  Views health as a property of individuals  People can make real improvements to their health by choosing to change lifestyle  It is people’s responsibility to take action to look after themselves  Involves a change in attitude followed by a change in behavior

23 Empowerment approach Aims
 Helps people identify their own concerns and gain the skills and confidence necessary to act upon them  This is the only approach to use a ‘bottom-up’ (rather than ‘top-down’) approach  Empowerment may involve both self-empowerment and community empowerment  Self-empowerment: *Based on counseling *Uses non-directive ways *Increase person’s control over his/her own live   For people to be empowered they need to: Recognize and understand their powerlessness Feel strongly enough about their situation to want to change it Feel capable of changing the situation by having information, support and life skills WHO defined health promotion as “enabling people to gain control over their lives” (empowerment)

24 Social change approach Aims  Radical approach which aims to change society not individual behavior  Aims to bring changes in the physical, economic and social environment  Healthy choice to become the easier choice in terms of cost, availability and accessibility  Targeted towards groups and populations These approaches have different objectives  To prevent disease  To insure that people are well informed and are able to make health choices  To help people acquire the skills and confidence to take greater control over their health  To change polices and environments in order to facilitate healthy choices

25 https://www. slideshare

26 Alma Ata Declaration, 1978  On Primary Health Care: Essential health care that’s practical, scientifically sound and social acceptable methods and technology made UNIVERSALLY accessible and affordable to individuals and families in the community.  It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world.

27 Important Policy Documents
 First ICHP Ottawa, Canada 1986 Resulted in the “Ottawa Charter for Health Promotion”  Second ICHP Adelaide, Australia 1988 Resulted in the “Adelaide Recommendations on Healthy Public Policy”  Third ICHP Sundsvall, Sweden 1991 Resulted in the “Sundsvall Statement on Supportive Environments for Health”  Fourth ICHP Jakarta, Indonesia 1997 Resulted in the “Jakarta Declaration on Leading Health Promotion into the 21st Century”  Fifth GCHP Mexico City, Mexico 2000 Resulted in the “Mexico Ministerial Statement for the promotion of health”  Sixth GCHP Bangkok, Thailand 2005 Resulted in the “Bangkok Charter for Health Promotion in a Globalized World”  7th Global Conference on Health Promotion: Nairobi 2009  8th Global Conference on Health Promotion: Helsinki 2013  9th Global Conference on Health Promotion: Shanghai 2016

28 Ottawa Charter (1986) Health promotion should be a part of public policy, documents and measures. Health promotion should be a part of a community policy and practice. Environment should enable and promote health. People should be able to gain information, knowledge and skills enabling development of health. Health services should more orient on health promotion and support. Pre-requisites for health Ottawa Charter emphasises certain pre-requisites for health which include: 1. Peace, 2. Food and shelter 3. Adequate economic resources 4. Stable eco-system 5. and Sustainable resource use.

29 The Ottawa Charter for Health Promotion The First International Conference on Health Promotion, Ottawa, 1986 It incorporate five key action areas in Health Promotion and three basic health promotion strategies (to enable, mediate and advocate). More specifically: the upper wing that is breaking the circle represents that action is needed to "strengthen community action" and to "develop personal skills". This wing is breaking the circle to symbolise that society and communities as well as individuals are constantly changing and, therefore, the policy sphere has to constantly react and develop to reflect these changes: a "Healthy Public Policy" is needed; the middle wing on the right side represents that action is needed to "create supportive environments for health" the bottom wing represents that action is needed to "reorient health services" towards preventing diseases and promoting health.

30 Commitment to Health Promotion
The participants in this Conference pledge: to move into the arena of healthy public policy, and to advocate a clear political commitment to health and equity in all sectors; to counteract the pressures towards harmful products, resource depletion, unhealthy living conditions and environments, and bad nutrition; and to focus attention on public health issues such as pollution, occupational hazards, housing and settlements; to respond to the health gap within and between societies, and to tackle the inequities in health produced by the rules and practices of these societies;

31 to acknowledge people as the main health resource; to support and enable them to keep themselves, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health, living conditions and well-being; to reorient health services and their resources towards the promotion of health; and to share power with other sectors, other disciplines and, most importantly, with people themselves; to recognize health and its maintenance as a major social investment and challenge; and to address the overall ecological issue of our ways of living.

32 Adelaide Recommendations on Healthy Public Policy The Second International Conference on Health Promotion, Adelaide, 1988 The value of health Equity, access and development Accountability for Health Moving beyond health care Partners in the policy process Action Areas Supporting the health of women Food and nutrition Tobacco and alcohol Creating supportive environments Developing New Health Alliances Commitment to Global Public Health

33 Supporting the health of women
This Conference proposes that countries start developing a national women’s healthy public policy in which women’s own health agendas are central and which includes proposals for: equal sharing of caring work performed in society; birthing practices based on women’s preferences and needs; supportive mechanisms for caring work, such as support for mothers with children, parental leave, and dependent health-care leave.

34 Developing New Health Alliances
The Conference recommends that local, national and international bodies: stablish clearing-houses to promote good practice in developing healthy public policy; develop networks of research workers, training personnel, and programme managers to help analyse and implement healthy public policy.

35 Future Challenges Ensuring an equitable distribution of resources even in adverse economic circumstances is a challenge for all nations. Health for All will be achieved only if the creation and preservation of healthy living and working conditions become a central concern in all public policy decisions. Work in all its dimensions - caring work, opportunities for employment, quality of working life - dramatically affects people’s health and happiness. The impact of work on health and equity needs to be explored. The most fundamental challenge for individual nations and international agencies in achieving healthy public policy is to encourage collaboration (or developing partnerships) in peace, human rights and social justice, ecology, and sustainable development around the globe. In most countries, health is the responsibility of bodies at different political levels. In the pursuit of better health it is desirable to find new ways for collaboration within and between these levels. Healthy public policy must ensure that advances in health-care technology help, rather than hinder, the process of achieving improvements in equity.

36 Sundsvall Statement on Supportive Environments for Health 3
Sundsvall Statement on Supportive Environments for Health 3. International Conference on Health Promotion, Sundsvall, Sweden, 9-15 June 1991 Supportive Environments : the term supportive environments refers to both the physical and the social aspects of our surroundings. • …… where people live, where they work and play. • ………access to resources for living, and opportunities for empowerment.  • Thus action to create SE has many dimensions: physical, social, spiritual, economic and political. • Each of these dimensions is linked to the others in a dynamic interaction.to the others in a dynamic interaction. Action must be coordinated at local, regional, national and global levels to achieve solutions that are truly sustainable.

37 Four Aspects of Supportive Environments
1.The social dimension, which includes the ways in which norms, customs and social processes affect health.affect health. 2. The political dimension, which requires governments to guarantee participation in decision- making and the decentralization ofmaking and the decentralization of responsibilities and resources. 3. The economic dimension, which requires a re-channelling of resources for the achievement of Health for All and sustainableHealth for All and sustainable development, including the transfer of safe and reliable technology. 4. The need to recognize and use women's skills and knowledge in all sectors, including policy-making, and theincluding policy-making, and the economy - in order to develop a more positive infrastructure for supportive environments

38 The Sundsvall Conference believes that proposals to implement the Health for All strategies must reflect two basic principles: Equity must be a basic priority in creating supportive environments for health, releasing energy and creative power by including all human beings in this unique endeavour. All policies that aim at sustainable development must be subjected to new types of accountability procedures in order to achieve an equitable distribution of responsibilities and resources. All action and resource allocation must be based on a clear priority and commitment to the very poorest, alleviating the extra hardship borne by the marginalized, minority groups, and people with disabilities. The industrialized world needs to pay the environmental and human debt that has accumulated through exploitation of the developing world. Public action for supportive environments for health must recognize the interdependence of all living beings, and must manage all natural resources, taking into account the needs of future generations. Indigenous peoples have a unique spiritual and cultural relationship with the physical environment that can provide valuable lessons for the rest of the world. It is essential, therefore, that indigenous peoples be involved in sustainable development activities, and negotiations be conducted about their rights to land and cultural heritage.

39 Using the examples presented, the Conference identified four key public health action strategies to promote the creation of supportive environments at community level. Strengthening advocacy through community action, particularly through groups organized by women. Enabling communities and individuals to take control over their health and environment through education and empowerment. Building alliances for health and supportive environments in order to strengthen the cooperation between health and environmental campaigns and strategies. Mediating between conflicting interests in society in order to ensure equitable access to supportive environments for health. In summary, empowerment of people and community participation were seen as essential factors in a democratic health promotion approach and the driving force for self-reliance and development.

40 Jakarta Declaration on Leading Health Promotion into the 21st Century The Fourth International Conference on Health Promotion, Jakarta, 1997 Health promotion is a key investment Determinants of health: new challenges Health promotion makes a difference New responses are needed Priorities for health promotion in the 21st Century (

41 Health promotion makes a difference
comprehensive approaches to health development are the most effective. Those that use combinations of the five strategies Milestones in Health Promotion: Statements from Global Conferences 19 are more effective than single- track approaches. particular settings offer practical opportunities for the implementation of comprehensive strategies. These include mega-cities, islands, cities, municipalities, local communities, markets, schools, the workplace, and health care facilities. participation is essential to sustain efforts. People have to be at the centre of health promotion action and decision-making processes for them to be effective. health learning fosters participation. Access to education and information is essential to achieving effective participation and the empowerment of people and communities.

42 Priorities for health promotion in the 21st Century
2. Increase investments for health development 1.Promote social responsibility for health • avoid harming the health of individuals • protect the environment and ensure sustainable use of resources • restrict production of and trade in inherently harmful goods and substances such as tobacco and armaments, as well as discourage unhealthy marketing practices • safeguard both the citizen in the marketplace and the individual in the workplace • include equity-focused health impact assessments as an integral part of policy development. Greater investment for health and reorientation of existing investments, both within and among countries, has the potential to achieve significant advances in human development, health and quality of life. Investments for health should reflect the needs of particular groups such as women, children, older people, and indigenous, poor and marginalized populations.

43 4. Increase community capacity and empower the individual
3. Consolidate and expand partnerships for health Improving the capacity of communities for health promotion requires practical education, leadership training, and access to resources. Empowering individuals demands more consistent, reliable access to the decision-making process and the skills and knowledge essential to effect change.( media support) Partnerships offer mutual benefit for health through the sharing of expertise, skills and resources. Each partnership must be transparent and accountable and be based on agreed ethical principles, mutual understanding and respect. WHO guidelines should be adhered to.

44 5. Secure an infrastructure for health promotion
Priorities for the alliance include: “Settings for health” represent the organizational base of the infrastructure required for health promotion. Training in and practice of local leadership skills should be encouraged in order to support health promotion activities. Documentation of experiences in health promotion through research and project reporting should be enhanced to improve planning, implementation and evaluation. All countries should develop the appropriate political, legal, educational, social and economic environments required to support health promotion. • raising awareness of the changing determinants of health • supporting the development of collaboration and networks for health development • mobilizing resources for health promotion • accumulating knowledge on best practice • enabling shared learning • promoting solidarity in action • fostering transparency and public accountability in health promotion

45 The Fifth International Conference on Health Promotion:
The conference objectives were: To show how health promotion makes a difference to health and quality of life, especially for people living in adverse circumstances; To place health high on the development agenda of international, national and local agencies; To stimulate partnerships for health between different sectors and at all levels of society.

46 1. Recognize that the attainment of the highest possible standard of health is a positive asset for the enjoyment of life and necessary for social and economic development and equity. 2. Acknowledge that the promotion of health and social development is a central duty and responsibility of governments, that all sectors of society share. 3. Are mindful that, in recent years, through the sustained efforts of governments and societies working together, there have been significant health improvements and progress in the provision of health services in many countries of the world. 4. Realize that, despite this progress, many health problems still persist which hinder social and economic development and must therefore be urgently addressed to further equity in the attainment of health and well being.

47 5. Are mindful that, at the same time, new and re-emerging diseases threaten the progress made in health. 6. Realize that it is urgent to address the social, economic and environmental determinants of health and that this requires strengthened mechanisms of collaboration for the promotion of health across al sectors and at all levels of society. 7. Conclude that health promotion must be a fundamental component of public policies and programmes in all countries in the pursuit of equity and better health for all. 8. Realize that there is ample evidence that good health promotion strategies of promoting health are effective.

48 Actions Considering the above, we subscribe to the following:
A. To position the promotion of health as a fundamental priority in local, regional, national and international policies and programmes. B. To take the leading role in ensuring the active participation of all sectors and civil society, in the implementation of health promoting actions which strengthen and expand partnerships for health. C. To support the preparation of country-wide plans of action for promoting health, if necessary drawing on the expertise in this area of WHO and its partners. These plans will vary according to the national context, but will follow a basic framework agreed upon during the Fifth Global Conference on Health Promotion, and may include among others: The identification of health priorities and the establishment of healthy public policies and programmes to address these. The support of research which advances knowledge on selected priorities. The mobilization of financial and operational resources to build human and institutional capacity for the development, implementation, monitoring and evaluation of country-wide plans of action.

49 D. To establish or strengthen national and international networks which promote health.
E. To advocate that UN agencies be accountable for the health impact of their development agenda. F. To inform the Director General of the World Health Organization, for the purpose of her report to the 107th session of the Executive Board, of the progress made in the performance of the above actions.

50 The 6th Global Conference on Health Promotion Bangkok Charter for Health Promotion, on 7-11 August 2005 Five key principles have guided health promotion strategies: 1.Health promotion is context driven: Focuses on health and its underlying social and economic determinants for analyzing socioeconomic, gender and ethnic gaps in health and disease patterns in populations. 2. Health promotion integrates the three dimensions of the WHO health definition: Promoting health means addressing the multi-dimensional nature of health: its physical, social, and mental dimensions (and often, spiritual health) 3. Health promotion underpins the overall responsibility of the state in promoting health All levels of government have a responsibility and accountability for protecting, maintaining and improving the health of its citizens, and need to include health as a major component. 4. Health promotion champions good health as a public good Good health is beneficial to the society as a whole, its social and its economic development. 5. Participation is a core principle in promoting health. The participation of people and their communities in improving and controlling the conditions for health is a core principle in promoting health.

51 Specific challenges for action
The role of the state and governments Participatory public policy processes Partnerships Health promotion is building on different alliances, sharing common goals, values and approaches. Basically and simplified, partnerships can be categorized into four groups: 1. Between public agencies in multisectoral action 2. Between public sector and NGOs 3. Between health promotion and academia 4. Between public sector and private enterprises. Leadership and sustainable health promotion infrastructures A global approach. Ensuring sustainable funding on investment and the contribution of other sectors by reorientation Continuity and follow-up mechanisms

52 7th The Nairobi Global Conference on Health Promotion, Kenya, October 2009
Health promotion will be seen in this conference to be an essential, effective approach in line with the renewal of Primary Health Care as endorsed by the Executive Board of WHO: To achieve the agreed international health development goals: in the health arena, the development goals associated with the eradication of poverty include targets on addressing specific diseases like malaria, tuberculosis, HIV/AIDS and broader issues like undernutrition, reproductive, maternal and child health. The urgent need is for these goals to be met, and here health promotion has specific expertise that can accelerate the progress to attainment. To address the emergence of noncommunicable diseases, injury, and mental disorders, a group of conditions that are growing at epidemic rates in low and middle income countries. They cause over 60% of the world’s mortality and lead the rankings in terms of preventable disability. Furthermore, health systems often lack the mechanisms for sustainable funding of health promotion, even as they buckle under the increasing costs of the growing burden of noncommunicable conditions. To tackle the issue of inequities in the distribution of health by gender, social class, income level, ethnicity, education, occupation, and other categories. Development goals should explicitly promote an approach that fosters equity, or fairness of distribution across the divides of social structure as part of the renaissance in the Primary Health Care movement.

53 The implementation gap
There are three major gaps in the health and development effort that have to be effectively addressed: The gap in health programmes where the evidence about good health promotion practice could be more effectively incorporated The gap in policy-making and intersectoral partnerships where the social determinants of health, or the inequitable health impacts, have not been considered and The gap in health systems, making the capacity of a health system to promote health itself an indicator of performance.

54 Mobilizing global champions
They will include health promotion practitioners and academics, together with: high level representatives from bilateral and multilateral development agencies national and local level policy-makers and multisectoral teams from developing countries representatives of civil society representatives from global health programs with an interest in health promotion.

55 The process The participants will examine the gaps and the role of health promotion in closing them. The discussions, workshops, case studies and plenary sessions will be organized in five main tracks and an Africa Day: Community empowerment Health literacy and health behavior Strengthening health systems Partnerships and intersectoral action Building capacity for health promotion Africa Day.

56 The immediate outcomes
Technical product Call to action A consultation is under way with global health programs, developing a practical package of evidence on health promotion interventions that addresses the top health risks and the conditions with the highest disease burden. This product will be presented to the tracks of the conference and examined in the light of experience from countries, emerging as consolidated, practical guidance for countries. A political statement that calls for the inclusion of health promotion outcomes within the design of development programs will be drafted through an expert- and Web-based consultation in the months leading up to the conference and will be adopted on the last day of the conference. Advocacy for extending the international development goals to include noncommunicable conditions will also proceed in parallel. The possibility of a launch of a Partnership Council on Noncommunicable Diseases is being considered.

57 We, the participants of this conference:
Health for All is a major societal goal of governments, and the cornerstone of sustainable We, the participants of this conference: Prioritize health and equity as a core responsibility of governments to its peoples. Affirm the compelling and urgent need for effective policy coherence for health and well-being. Recognize that this will require political will, courage and strategic foresight.

58 Critical points The mandate for healthy cities :
Meanwhile, only 12 percent of cities globally reach pollution control targets. With such trends in mind, the World Health Organization (WHO) has identified urbanization as one of the key challenges for public health in the 21st century The 2030 Agenda for Sustainable Development places renewed emphasis on just how interconnected our social, economic and environmental ambitions are. Health promotion efforts grounded in a healthy cities approach can contribute to achieving The Sustainable Development Goals (SDGs), including SDG 11: Make cities and human settlements inclusive, safe, resilient and sustainable. A healthy cities approach which catalyzes political leadership and participatory governance can be transformational for health and health equity, as well as help mitigate the impacts of environmental degradation, climate change, ageing, migration, growing inequalities and social isolation. Major health inequities persist across the world, with rates of illness and premature death significantly higher amongst the poorest and most excluded groups.

59 The mandate for health literacy
Defining health literacy : Health literacy refers, broadly, to the ability of individuals to “gain access to, understand and use information in ways which promote and maintain good health” for themselves, their families and their communities. While different definitions are used and health literacy is an evolving concept, there is agreement that health literacy means more than simply being able to "read pamphlets", "make appointments", "understand food labels" or "comply with prescribed actions" from a doctor. An important factor in improving health outcomes :We stress that health literacy is an important factor in ensuring significant health outcomes and in this regard, call for the development of appropriate action plans to promote health literacy (The United Nations ECOSOC Ministerial Declaration of 2009 )

60 Reducing health inequities :
Empowering citizens : Meeting the health literacy needs of the most disadvantaged and marginalized societies will particularly accelerate progress in reducing inequities in health and beyond. Health literacy gained through health education and various forms of communication, as well as actions taken through health systems and other policies, have the potential to support achievement of targets related to SDG 3 on health while advancing a wide range of other SDGs. Reducing health inequities : This injustice is not mere coincidence – the poor are more likely to live, work, study and play in environments that are harmful to health.

61 We call on governments to fulfil their obligations to their peoples’ health and well-being by taking the following actions: Commit to health and health equity as a political priority by adopting the principles of Health in All Policies and taking action on the social determinants of health. Ensure effective structures, processes and resources that enable implementation of the Health in All Policies approach across governments at all levels and between governments. Strengthen the capacity of Ministries of Health to engage other sectors of government through leadership, partnership, advocacy and mediation to achieve improved health outcomes. Build institutional capacity and skills that enable the implementation of Health in All Policies and provide evidence on the determinants of health and inequity and on effective responses. Adopt transparent audit and accountability mechanisms for health and equity impacts that build trust across government and between governments and their people. Establish conflict of interest measures that include effective safeguards to protect policies from distortion by commercial and vested interests and influence. Include communities, social movements and civil society in the development, implementation and monitoring of Health in All Policies, building health literacy in the population.

62 We call on WHO to Support Member States to put Health in All Policies into practice. Strengthen its own capacity in Health in All Policies. Use the Health in All Policies approach in working with United Nations agencies and other partners on the unfinished Millennium Development Goals agenda and the post-2015 Development Agenda. Urge the United Nations family, other international organizations, multilateral development banks and development agencies to achieve coherence and synergy in their work with Member States to enable implementation of Health in All Policies

63 "Health for all and all for health,” and is being hosted by the Government and China and the Municipal Government of Shanghai. “Health promotion is about enabling and empowering people, communities and societies to take charge of their own health and quality of life.” Goals To highlight the critical links between promoting health and the 2030 Agenda for Sustainable Development.

64 Objectives To provide guidance to Member States on how to reflect promoting health into national Sustainable Development Goal (SDG) responses, and how to accelerate progress on SDG targets. Exchange national experiences in: strengthening good governance for health through action across government sectors; broadening and strengthening social mobilization; and promoting health literacy. To highlight the health sector’s changing role as the key advocate for promoting health. To highlight the crucial role that cities – and municipal leaders, especially Mayors – play in promoting health (creating Healthy Cities), in the context of an increasingly urbanized global population.

65 From Ottawa to Shanghai & the sustainable development agenda
Thirty years ago, the Ottawa Charter for Health Promotion recognized the need to enable people to increase control over and to improve their health and well-being by ensuring healthier, sustainable environments where people live, work, study and play. Social justice and equity were highlighted as core foundations for health, and there was agreement that health promotion is not simply the responsibility of the health sector. The 2030 Agenda for Sustainable Development, the world’s ambitious and universal “plan of action for people, planet and prosperity”, includes 17 Goals, 169 targets and 231 initial indicators. The Agenda offers a new opportunity to involve multiple stakeholders to ensure that all people can fulfil their potential – to live in health and with dignity and equality.

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67 Many