Health promotion. What is it? What will it become?

This article was written in the wake of the first International Conference on Health Promotion, held in Ottawa in 1986, to resist a potential polarization of ideological views in health promotion between a social or system model and a more traditional individual view sometimes associated with the terms health education and lifestyle. An integration of these viewpoints appears to be emerging in policies and in practice, although some advocates continue to debate the terms and to defend the polar models. Some of the historical and conceptual roots of health promotion are discussed. Some concepts seem to be more divisive than others. The diverse interests and constituencies involved need concepts that transcend and integrate the wide variety of viewpoints. We suggest that the concept expressed in the Ottawa Charter for Health Promotion of enabling be the central integrative concept, capturing as it does the essence of the shift in power base entailed in the new public health, from a dominance by bureaucracies to more control by the community. In terms of action, we suggest community as the optimal integrating focus, sitting as it does conceptually at a point of balance between the system and the individual. With enabling and community accepted as pivotal concepts for an integrated approach to health promotion, all other action and policy can flow with less rancour and more of the cooperation essential to the intersectoral needs of health promotion.