The 5th Global Conference on Health Promotion, Mexico, 2000

The Fifth Global Conference on Health Promotion (5GCHP) – Health Promotion: Bridging the Equity Gap – was held 5-9 June 2000 in Mexico City. This conference built on the advances of the previous four International Health Promotion Conferences, particularly taking forward the priorities of the last International Conference on Health Promotion held in Jakarta, Indonesia in 1997.

The First International Conference on Health Promotion held in Ottawa, Canada, in 1986 created the vision by clarifying the concept of health promotion, highlighting the conditions and resources required for health and identifying key actions and basic strategies to pursue the WHO policy of Health for All. The Ottawa Charter for Health Promotion identified prerequisites for health including peace, a stable ecosystem, social justice and equity, and resources such as education, food and income. Key actions to promote health included building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills, and reorienting health services. The Ottawa Charter thus highlighted the role of organizations, systems and communities, as well as individual behaviours and capacities, in creating choices and opportunities for the pursuit of health and development.

Building healthy public policy was explored in greater depth at the Second International Conference on Health Promotion in Adelaide in 1988. Public policies in all sectors influence the determinants of health and are a major vehicle for actions to reduce social and economic inequities, for example by ensuring equitable access to goods and services as well as health care. The Adelaide Recommendations on Healthy Public Policy called for a political commitment to health by all sectors. Policy-makers in diverse agencies working at various levels (international, national regional and local) were urged to increase investments in health and to consider the impact of their decisions on health. Four priority areas for action were identified: supporting the health of women; improving food security, safety and nutrition; reducing tobacco and alcohol use; and creating supportive environments for health.

This latter priority became the focus of the Third International Conference on Health Promotion in Sundsvall, Sweden, in 1991. Armed conflict, rapid population growth, inadequate food, lack of means of self determination and degradation of natural resources are among the environmental influences identified at the conference as being damaging to health. The Sundsvall Statement on Supportive Environments for Health stressed the importance of sustainable development and urged social action at the community level, with people as the driving force of development. This statement and the report from the meeting were presented at the Rio Earth Summit in 1992 and contributed to the development of Agenda 21.

The Fourth International Conference on Health Promotion held in Jakarta, Indonesia, in 1997 reviewed the impact of the Ottawa Charter and engaged new players to meet global challenges. It was the first of the four International Conferences on Health Promotion to be held in a developing country and the first to involve the private sector in an active way. The evidence presented at the conference and experiences of the previous decade showed that health promotion strategies contribute to the improvement of health and the prevention of diseases in developing and developed countries alike. These findings helped to shape renewed commitment to the key strategies and led to further refinement of the approaches in order to ensure their continuing relevance. Five priorities were identified in the Jakarta Declaration on Leading Health Promotion into the 21st Century.

These were confirmed in the following year in the Resolution on Health Promotion adopted by the World Health Assembly in May 1998:

• Promoting Social Responsibility for Health
• Increasing Community Capacity and Empowering the Individual
• Expanding and Consolidating Partnerships for Health
• Increasing Investment for Health Development
• Securing an Infrastructure for Health Promotion

At the start of the new century, two challenges remain: to better demonstrate and communicate that health promotion policies and practices can make a difference to health and quality of life; and to achieve greater equity in health. Concern for equity is at the core of the health promotion concept and a thread that runs through the previous conferences and their declarations. Our understanding of the root determinants of inequities in health has improved significantly. Yet inequalities in social and economic circumstances continue to increase and erode the conditions for health. For these reasons, the Fifth Global Conference on Health Promotion focused on bridging the equity gap both within and between countries.