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.
