Twenty-five years after the Ottawa charter: The critical role of health promotion for public health

After a quarter of a century, the Ottawa Charter for Health Promotion, often recognized as a foundational document of health promotion, continues to be relevant for public health. Inspired by the WHO Constitution, the Alma Ata Declaration, and the Lalonde Report, the Ottawa Charter endorses a positive definition of health, situates health as a product of daily life, proposes core values and principles for public health action, and outlines three strategies and five action areas reaching beyond the boundaries of the health care sector. The Charter established a radical agenda for public health, specifically to expressly convey the values public health pursues, thereby increasing the potential for the reflexivity of the field and opportunities to consider complementary values in actions that promote population health. In this paper, we examine how public health has integrated health promotion by exploring examples of changes in public health systems and practice at international and national levels of governance. Nevertheless, an important challenge remains for health promotion: better use of research to understand how the values, principles and processes of health promotion can help to achieve public health mandates. A three-pronged action plan is proposed.