Editorial: Four Decades of Citizen Empowerment Since the Ottawa Charter: A Critical Reflection

Dear members of the EUPHA Health Promotion Section,

The Ottawa Charter remains one of the foundational documents of contemporary health promotion. Published in a context of growing criticism of the traditional biomedical model, it introduced a broader vision of health, understanding it not merely as the absence of disease, but as an essential resource for everyday life, placing citizens at the centre of health-related decision-making.

Within this framework, empowerment and active citizen participation emerged as fundamental pillars: individuals and communities were expected to gain greater control over the determinants of their health and to participate in defining priorities, planning policies, and shaping practices that affect them.

Closing on the 40-year milestone of the Charter, it is important to reflect on the extent to which this vision has been effectively achieved

The Ottawa Charter proposed a profound structural change to public health practice and policy. Health would no longer be viewed as the exclusive responsibility of clinical services, but rather as encompassing the social, economic, educational, and political dimensions in which citizens live. Education, housing, working conditions, the environment, and community participation came to be recognised as fundamental determinants of health. This paradigm introduced a clearly democratic dimension into public health, recognising citizens as active agents rather than mere passive recipients of care.

However, many health systems have maintained strongly hierarchical and technocratic structures, where decision-making processes remain concentrated within institutions and among professionals. Public participation by citizens may formally exist, but it is often consultative, episodic, or otherwise limited.

In Portugal, for example, significant progress has been made over recent decades. This was achieved particularly through the strengthening of primary healthcare, the implementation of national health promotion programmes, and the growing emphasis on prevention. The National Health Service (Sistema Nacional de Saúde-SNS) has developed strategies aimed at active ageing, vaccination, mental health, and the promotion of healthy lifestyles. At the same time, patient associations, civic movements, and community initiatives have expanded, seeking to strengthen citizens’ voices in areas such as chronic diseases, rights of access to healthcare, and mental health.

Nevertheless, these advances do not yet sufficiently include effective participation in the development of public policies. Citizen involvement in structural decisions — including healthcare financing, service organisation, and priority setting — remains limited. Furthermore, participation tends to be more accessible to socially advantaged groups with higher levels of literacy and organisational capacity, thereby reproducing existing inequalities affecting more vulnerable populations.

In this context, the concept of empowerment advocated by the Ottawa Charter encounters important structural limitations. Health promotion cannot be analysed in isolation from the social, economic, educational, and political determinants that shape individuals’ real opportunities for choice and intervention.

It is also important to critically reflect on the growing centrality of individual responsibility within contemporary health discourse. In many contexts, health promotion has evolved towards models excessively focused on individual behaviours — including diet, physical activity, emotional management, or treatment adherence — thereby transferring to citizens a disproportionate responsibility for their health condition.

This perspective may obscure structural factors such as poverty, precarious employment, social exclusion, or territorial inequalities. The risk is that genuine empowerment and change may be replaced by subtle mechanisms of individual blame, while ignoring the social contexts that limit each person’s freedom of choice.

While there is now greater access to information and increased opportunities for public expression, phenomena such as misinformation, polarisation, and institutional distrust have also intensified. Therefore, there is currently a stronger formal recognition of the importance of community involvement and citizens’ rights. Nevertheless, social, structural, and political limitations continue to constrain truly democratic participation.

For this reason, the Ottawa Charter retains remarkable contemporary relevance. Its principal challenge remains unresolved: transforming citizen participation from a rhetorical principle into an effective practice of influence, shared responsibility, and collective construction of health.

Thank you for reading.

Dulce Maria do Nascimento do Ó and Manuela Leal

And the members of the Steering Committee: Eric Breton, President of the Health Promotion Section, Elisabeth Nöhammer, Vice President, Dorottya Árva, Geir Arild Espnes, Michelle Baybutt, Sherihane Bensemmane, Kevin Dadaczynski, Suzannah D’Hooghe, John Dierx, Dulce Maria do Nascimento do Ó, Ursula Griebler, Karina Leksy, Monica O’Mullane, Roosa-Maria Savela, and Chrysanthi Tatsi.

About the authors: Dulce works at the Associação Protectora dos Diabéticos de Portugal and Manuela at the Unidade Local de Saúde de Almada-Seixal, USF Amora Saudável. Dulce sits on the steering committee of the Health Promotion Section.

Your section’s Webinars and online workshops

8 June 13.00 CEST

“What would the Ottawa Charter look like if it were written in 2026? An online workshop to gain the perspectives of public health students and early career professionals”. Hosted jointly by the EUPHAnxt and the Health Promotion Section, this will be the place to be to build a better and stronger future for the health promotion field.

Of course, no ageism here. Everyone active in the health promotion world is welcome.
Please spread the word!

Go to the event page and register

EPH Conference Bilbao 2026: Any idea on how we can improve your experience and make the best out of it?

Are you planning to attend the European Public Health Conference in Bilbao? If so, do make the most of your participation by leveraging the network of the Health Promotion Section. Let us know what could contribute to improve your experience of the conference and how we can help. We hope to see you in Bilbao!

A Party needs People! Celebrating the 40^th anniversary of the Ottawa Charter together

As a section, we are celebrating the Ottawa Charter’s 40^th anniversary this year. And a party needs people!

Here is how you can get involved:

• Join our teaching project ‘What would the Ottawa Charter look like if it were written in 2026?’ (more info below)
• Co-organize webinars with us
• Tell us of your events that we can announce and showcase in the Newsletter

Please tell us your interests using this survey so we can get back to you! We are looking forward to receiving your responses!

What would the Ottawa Charter look like if it were written in 2026? Perspectives from young professionals

Borrowing from the title of Donald Nutbeam’s 2008 paper, we are calling on colleagues teaching on bachelor’s, master’s, PhD’s programmes in public health or related domains to get the voices of their students heard on what an updated perspective on health promotion should look like. The results of these discussions will be featured in our newsletters and in the webinars that we will organise throughout the year. There are many ways to proceed. The schools of public health in Rennes (France), Grenada (Spain) and Innsbruck (Austria) have trialled a four-step strategy which goes as follow:

• First, have students read on the history of the Ottawa Charter, and on the context in which it was developed (for a list of suggested readings, write to Breton@ehesp.fr). Have a discussion on the whys and hows and on how the context of public health practice and policy has changed.
• Second, define the destination: What is needed for a population to achieve a high level of health and well-being? Have a conversation on the determinants of health and well-being.
• Third, how to get there? What is the pathway? What strategies are needed?
• Fourth, so then, what is health promotion?

Much care should be taken in keeping our students’ perspectives open (they should not be trapped into the straitjacket of the Ottawa Charter).

This is just one way to do things. Feel free to adapt this strategy or devise a completely different one to give our next generation of public health practitioners, activists and decision makers a voice. Do not hesitate to share your experience of the process and the results with Eric Breton (eric.breton@ehesp.fr). As mentioned, we would be delighted to showcase these efforts in our newsletter, webinars and other events.

Here are some events celebrating the Ottawa Charter

We are planning to build a map of the different events that will take place over the year. We will promote them through our newsletters and help organisers to connect with other colleagues across Europe so their events reach a larger audience.

Fill out the form

Or alternatively write us (eric.breton@ehesp.fr).

EuroHealthNet Annual Seminar 2026: Health promotion and prevention in the digital era, 1 June 2026, Warsaw and online

Marking the 40th anniversary of the WHO Ottawa Charter for Health Promotion, EuroHealthNet’s Annual Seminar 2026 will explore challenges and solutions to strengthening health promotion and disease prevention in the digital era.

Further information on the seminar

Network Meeting of the German Speaking Network on Health Promotion, 11–12 September 2026, Winterthur, Switzerland

The DACH Network Health Promotion is using the 40th anniversary of the Ottawa Charter to draw critical insights and look explicitly towards the future. Under the theme “40 Years of the Ottawa Charter: Review and Future of Health Promotion”, we will examine what health promotion has achieved over the past four decades, which approaches have proven effective, and where untapped potential lies for further development.

How can health promotion respond to current societal challenges? How can identified needs for action be translated into training, evaluation, quality development, and practice? Join us in Winterthur for an inspiring exchange from multiple perspectives and set impulses for a future-oriented health promotion.

Go to the event page and register

Annual Assembly of the French Health Promotion Federation: November 19, 2026, Paris-Aubervilliers

This year annual assembly of the French Health Promotion Federation (Fédération Promotionsanté) will mark the 40^th anniversary of the Ottawa Charter. Health Promotion: Translating Empowerment into Policies for the Commun Good.

In the quest for health equity, solidarity emerges as a driving force and a fundamental value. Consistent with health promotion, solidarity supports approaches based on the recognition of the social role of all people, without discrimination. It fosters social bonds and inclusion as major determinants of health. How can we translate the agency of stakeholders and communities into policies that promote solidarity, by drawing on the principles of health promotion?

Go to more information and registration 

Building population resilience

The Health Promotion Section is planning to intensify work on resilience, e.g. via grants, projects, etc. Please do contact us in case you are working on this topic and interested to collaborate with other colleagues (Elisabeth.Noehammer@umit-tirol.at).

Sixth edition of the Global Community Health Annual Workshop, 9, 10 and 11 June 2026, online

This year’s workshop, ‘Connecting planetary health, climate justice, and community health: from knowledge to impact’, invites participants to explore the links between planetary health and community health and wellbeing. We will look into mobilizing communities, including the involvement of young people, as agents of change, ensuring that climate solutions are just, accessible, and impactful taking into account indigenous perspectives. By bridging knowledge with action, we aim to inspire collaborative strategies that address the root causes of environmental degradation while fostering healthier, more resilient communities.

The Global Community Health Annual Workshop provides a space where community health practitioners, activists, policy makers, and researchers can learn and improve their skills. Registration is free.

Go to information on the UNESCO Chair website

And lastly!

Erratum: In our last two editions of the newsletter, we omitted the name of our newly arrived and most dynamic steering committee member, who is also the section’s link to EUPHAnxt. Our apologies to Dorottya Árva.