The Ottawa Charter of Health Promotion describes health as a resource for everyday living and that “health is created and lived by people within the settings of their everyday life; where they learn, work, play and love” (World Health Organization, 1986). As a multilevel framework of 3 strategies and 5 action areas, the Ottawa Charter of Health Promotion draws upon a social-ecological approach to health promotion (Fry & Zask, 2017).
The 5 action areas tackle health beyond the individual, addressing the broader determinants of health that define the health of the population such as gender, race/ethnicity, socioeconomic status, occupation and housing (Ministry of Health and Long Term Care, 2007). The 3 strategies in the Charter are advocate, enable and mediate: advocacy is essential in establishing conditions that favour good health; enabling is a strategy that supports people to reach their fullest health potential by taking control of their health and mediating consists of coordinated action between different societal groups and health sectors (World Health Organization, 1986).
Advocating, enabling, and mediating are strategies required for the implementation of the 5 key action areas (Fry & Sask, 2017). The five action areas are as follows:
Build Healthy Public Policy
This action area advocates for the government to develop and implement policies that protect the health of individuals and the community (World Health Organization, 1986). This population wide strategy focuses on the economic, social, and environmental factors that affect health such as housing, education, employment, taxation, nutrition, and the environment, resulting in ‘’coordinated action that leads to health, income and social policies that foster greater equity'' (World Health Organization, 1986).
Create Supportive Environments
This action area emphasizes the “inextricable links between people and their environment” (World Health Organizations, 1986). Creating supportive environments is essential to improve living and working conditions. The aim is to improve upon social, economical and cultural environments to facilitate healthy choices, and also to make the places people live, work, and play safe and enjoyable (World Health Organization, 1986).
Strengthen Community Action
In this action area, participation from the community is required to promote healthy living. “At the heart of this process is the empowerment of communities, their ownership and control of their own endeavors and destinies” (Fry & Zask,2017). People may belong to a community defined by geographical location, or through a shared commonality (Fry & Zask,2017). Recognizing that community support has a positive impact on health, communities are empowered to foster relationships through social networks (World Health Organization, 1986).
Develop Personal Skills
The intent of this action area is to support the personal and social development of the individual, to strengthen health literacy, and to help develop skills for coping with illness and stress (World Health Organization, 1986). Improved health literacy ‘’increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health” (World Health Organization, 1986).
Re-Orient Health Care Services.
The goal of this action area is to re-orientate health services by viewing healthcare holistically. Changing the focus from curative medicine to health promotion and illness prevention will ''lead to a change of attitude and organization of health services, which refocuses on the total needs of the individual as a whole person” (World Health Organization, 1986).
COPD is a debilitating, life threatening chronic illness that is the fourth leading cause of death in Canada (Dang-Tan et al.,2015). COPD is an incurable illness, therefore prevention or early diagnosis and management is key in mitigating further progression of the disease and deterioration in lung function (Government of Canada, 2008). Cigarette smoking is the primary cause of COPD in 80-90% of cases (Government of Canada, 2008), and despite increased public awareness of the risks of smoking, COPD continues to carry a high burden of disease in Ontario (CCO & Ontario Agency for Health Protection and Promotion, 2019). Other risk factors for COPD include occupational exposure to dusts, fumes, outdoor pollutants, genetics and childhood respiratory infections (Government of Canada, 2008). In Ontario, the incidence of COPD remains high and the number of ED visits, hospitalizations, and ambulatory visits among persons with COPD has also increased (Gershon et al., 2017). A systematic literature review carried out by Gershon et al., (2012) to examine disparity among persons with COPD led the authors to conclude that COPD is associated with low socioeconomic status. For example, in Ontario, people with COPD were in the lowest income group (23%) as compared to the non-COPD population (17.4%)(Gershon et al., 2017). As a respiratory therapist in Ontario, I am cognizant of the impact the determinants of health can have on health outcomes. Therefore, as the Ottawa Charter of Health Promotion aims to improve health equity by addressing the broader determinants of health, it seems fitting to employ the Ottawa Charter of Health Promotion to inform my understanding of COPD in Ontario.
Building Healthy Public Policy
As stated above, cigarette smoking is the biggest risk factor for COPD, attributing to 80-90% of cases in Canada (Government of Canada, 2008). The most effective way to prevent or slow down the progression of COPD and mitigate its clinical course is by cessation of smoking, or reduced exposure to the other risk factors (Government of Canada, 2008). Current policies in Ontario, such as Ontario’s Smoke Free Ontario Modernization Act (2017), Canada’s Tobacco and Vaping Products Act (2018) and the Canada’s Clean Air Act (2006) all advocate for this strategy.
Furthermore, the Lung Health Act (2017) is another initiative at the policy level that supports Ontarians with COPD. Established by the Lung Health Act, the Lung Health Advisory Council has a mandate to develop provincial action plans with respect to lung disease, and has recommended ''fair and equitable patient access to proven and effective'' treatments (Bill 71, 2017).
Creating Supportive Environments
Increasing the ability of people to make healthy choices is key in preventing COPD, or slow down its progression. The Smoke Free Ontario Modernization Act (2017) advocates for a safer environment through the prohibition of smoking in enclosed workplaces and enclosed public places, thereby reducing exposures to second hand smoke.
The Lung Health Foundation also creates a supportive environment as it advocates to raise awareness through various public health campaigns, and through the programs it delivers. Through its Helping the Missing Million campaign, the Lung Health Foundation is empowering Ontarians by creating an environment of awareness, and removing the stigma of lung disease. This initiative supports early diagnosis and treatment for those afflicted with COPD (The Lung Health Foundation, n.d.).
Strengthen Community Action
For the COPD patient, social networks and a sense of community are paramount in maintaining good health (World Health Organization, 1986). Online social networks such as My COPD Team, COPD 360, and The Lung Association virtual support group offer emotional and community support to those afflicted with COPD. Caregiver online support groups for those taking care of family members with COPD are also available. Additionally, Ministry of Health and Long Term Care has partnered with public health units, schools, businesses, and volunteers across the province to develop community-led programs aimed at curbing tobacco use, a key risk factor for COPD. Community participation and local resources were key in the implementation and support of these programs targeting strategies such as the prevention of tobacco use, protection from exposure to environmental smoke and support for smoking cessation (Ministry of Health and Long Term Care, 2012).
Develop Personal Skillls
Empowering people with COPD to take control and seek autonomy over their health through access to education and information is key in developing personal skills. For instance, patients can arm themselves with information as they refer to this patient reference guide Chronic Obstructive Pulmonary Disease: Care in the Community for Adults. This guide empowers individuals with COPD or their caregiver to work with health care professional, ask informed question and create a care plan that works for them. This particular reference guide also advocates for culturally appropriate care (Health Quality Ontario,2018).
Re-Orient Health Care Services
Pulmonary rehabilitation programs throughout Ontario offer more holistic care to address the total needs of the COPD patient. Through an education and exercise/nutrition program, patients are followed by a multidisciplinary team and are taught how to lead an active and balanced life. The multidisciplinary care team is composed of a respirologist, a dietitian, an occupational therapist, a pharmacist, a physiotherapist, a physiotherapy assistant, a clinical and health psychologist, a therapeutic recreation therapist, a respiratory therapist, a social worker and a nurse (St-Joseph's Health Care London, n.d.-a).
In summary, the inherent strength of the Charter’s framework lies in its capacity to use the five action areas to translate recommendations into actionable strategies, and these action areas are interactive and mutually contributing (Fry & Zask, 2017). It became apparent in my research that the 5 action areas could feature simultaneous strategies and also benefit from each other. For instance, the Re-Orient Health Services action area features the pulmonary rehabilitation program as an example of addressing health in a more holistic way. The rehabilitation program also fulfills the goals within the action area of Strengthen Community Action as evidenced by the comments made by the participants of the rehabilitation program. One participant ''found being among others with COPD powerful'' (St. Joseph's Health Care London, n.d.-b) and stated ''when you interact with people, you feel better. And when you feel better, you stop thinking about your own health problems'' (St. Joseph's Health Care London, n.d.-b). Another participant stated that the group format increased his motivation and gave him incentive to continue (St-Joseph's Health Care London, n.d.-b).In light of the information gathered in this blog, I believe the Ottawa Charter of Health Promotion is still relevant today and proves to have far reaching potential in its applicability.
References
Bill 71: An Act to establish the Lung Health Advisory Council and develop a provincial action plan respecting lung disease. (2017). 1st Reading November 22, 2016, 41st Legislature, 2nd session. Retrieved from the Legislative Assembly of Ontario website: https://www.ola.org/en/legislative-business/bills/parliament-41/session-2/bill-71
CCO & Ontario Agency for Health Protection and Promotion (Public Health Ontario). (2019, July). The burden of chronic diseases in Ontario: key estimates to support efforts in prevention. Queen’s Printer for Ontario. https://www.publichealthontario.ca/-/media/Documents/C/2019/cdburden-report.pdf?sc_lang=en
Dang-Tan, T., Ismaila, A., Zhang, S., Zarotsky, V., & Bernauer, M. (2015). Clinical, humanistic, and economic burden of chronic obstructive pulmonary disease (COPD) in Canada: a systematic review. BMC research notes, 8, 464. https://doi.org/10.1186/s13104-015-1427-y
Fry, D., & Zask, A. (2017). Applying the Ottawa Charter to inform health promotion programme design. Health Promotion International, 32(5), 901–912. https://doi.org/10.1093/heapro/daw022
Gershon, A. S., Dolmage, T. E., Stephenson, A., & Jackson, B. (2012). Chronic obstructive pulmonary disease and socioeconomic status: a systematic review. COPD, 9(3), 216–226. https://doi.org/10.3109/15412555.2011.648030
Gershon A. S., Mecredy G., & Ratnasingham S. (2017). Chronic Obstructive Pulmonary Disease in Ontario, 1996/97 to 2014/15. Institute for Clinical Evaluative Sciences. https://www.ices.on.ca/Publications/%20Atlases-and-Reports/2017/COPD
Government of Canada. (2008, July 10). Chronic Obstructive Pulmonary Disease. https://www.canada.ca/en/public-health/services/chronic-diseases/chronic-respiratory-diseases/what-copd-prevented.html
Health Quality Ontario. (2018). Patient Reference Guide Chronic Obstructive Pulmonary Disease Care in the Community for Adults. Queen's Printer for Ontario. https://www.hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-chronic-obstructive-pulmonary-disease-patient-guide-en.pdf
The Lung Health Foundation. (n.d.). The Missing Million COPD. https://lunghealth.ca/advocacy/national-studies/the-missing-million-copd/#:~:text=The%20Missing%20Million%20COPD%20More%20than%20one%20million,as%20many%20have%20COPD%20and%20don%E2%80%99t%20know%20it.
Ministry of Health and Long-Term Care. (2007, May). Preventing and Managing Chronic Disease: Ontario’s Framework. https://www.health.gov.on.ca/en/pro/programs/cdpm/pdf/framework_full.pdf
Ministry of Health and Long-Term Care. (2012). Publications: Ontario Programs for Health Promotion and Disease Prevention. https://www.health.gov.on.ca/en/public/publications/hpromo/hpromo.aspx#:~:text=Tobacco%20Use%20Reduction%20The%20Province%20of%20Ontario%20takes,provinces%2C%20including%20Quebec%2C%20Nova%20Scotia%20and%20New%20Brunswick.
St. Joseph's Health Care London. (n.d.-a). Lung Diseases Program - Services. https://www.sjhc.london.on.ca/areas-of-care/lung-diseases-program/services
St. Joseph's Health Care London. (n.d.-b). COPD patients breathe in benefits of fitness. https://www.sjhc.london.on.ca/news-and-media/our-stories/copd-patients-breathe-benefits-of-fitness#:~:text=%20COPD%20patients%20breathe%20in%20benefits%20of%20fitness,for%20the%20first%20graduates%20of%20the...%20More%20
World Health Organization. (1986, November 21). Ottawa Charter for Health Promotion: First International Conference on Health Promotion. https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf
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