Health Promotion in an Age of Normative Equity and Rampant Inequality

Document Type : Editorial


Canada Research Chair, Globalization and Health Equity, Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada


The world was different when the Ottawa Charter for Health Promotion was released 30 years ago. Concerns over the environment and what we now call the ‘social determinants of health’ were prominent in 1986. But the acceleration of ecological crises and economic inequalities since then, in a more complex and multi-polar world, pose dramatically new challenges for those committed to the original vision of the Charter. Can the 2015 Sustainable Development Goals (SDGs), agreed to by all the world’s governments, offer a new advocacy and programmatic platform for a renewal of health promotion’s founding ethos? Critiqued from both the right and the left for, respectively, their aspirational idealism and lack of political analysis, the SDGs are an imperfect but still compelling normative statement of how much of the world thinks the world should look like. Many of the goals and targets provide signals for what we need to achieve, even if there remains a critical lacuna in articulating how this is to be done. The fundamental flaw in the SDGs is the implicit assumption that the same economic system, and its still-present neoliberal governing rules, that have created or accelerated our present era of rampaging inequality and environmental peril can somehow be harnessed to engineer the reverse. This flaw is not irrevocable, however, if health promoters – practitioners, researchers, advocates – focus their efforts on a few key SDGs that, with some additional critique, form a basic blueprint for a system of national and global regulation of capitalism (or even its transformation) that is desperately needed for social and ecological survival into the 22nd century. Whether or not these efforts succeed is a future unknown; but that the efforts are made is a present urgency.


Commentaries Published on this Paper

  • Labonté Identifies Key Issues for Health Promoters in the New World Order; Comment on “Health Promotion in an Age of Normative Equity and Rampant Inequality”

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  • Global Health in the Anthropocene: Moving Beyond Resilience and Capitalism; Comment on “Health Promotion in an Age of Normative Equity and Rampant Inequality”

          Abstract | PDF


Main Subjects

  1. World Health Organization (WHO). Ottawa charter for health promotion. Charter presented at: International Conference on Health Promotion; November 17-21, 1986; Ottawa, ON. Accessed June 29, 2016.
  2. Labonté R. Death of program, birth of metaphor: the development of health promotion in Canada. In: Pederson A, O'Neill M, Rootman I, eds. Health promotion in Canada. Toronto: WH Saunders; 1994:72-90.
  3. Labonté R, Penfold S. Canadian perspectives in health promotion: a critique. Health Education. 1981;19:4-9.
  4. Labonté R, Stuckler D. The rise of neoliberalism: how bad economics imperils health and what to do about it. J Epidemiol Community Health. 2016;70(3):312-318. Doi:10.1136/jech-2015-206295.
  5. 62 people own the same as half the world, reveals Oxfam Davos report. Oxfam International. January 18, 2016. Accessed June 29, 2016.
  6. Extreme carbon inequality: why the Paris climate deal must put the poorest, lowest emitting and most vulnerable people first. Oxfam Media Briefing. December 2, 2015. Accessed June 29, 2016.
  7. Bauman Z. Liquid Modernity. Cambridge: Polity Press; 2000.
  8. United Nations Framework Convention on Climate Change (UNFCCC). Paris Agreement. December 12, 2015. Accessed on June 29, 2016.
  9. Nelson A. Renewable energy smashes global records in 2015, report shows. The Guardian. June 1, 2016. Accessed June 29, 2016.
  10. Van der Zee B. The missing development trillions: welcome to the debate. The Guardian. May 9, 2016. Accessed June 11, 2016.
  11. The 169 commandments. The Economist. May 28, 2015. Accessed June 11, 2016.
  12. Bond P. UN Millennium Development Goals replaced by new “distraction gimmicks.” Telesur. September 25, 2015. Accessed June 11, 2016.
  13. Milanovic B. Global Inequality: A New Approach for the Age of Globalization. Boston: Harvard University Press; 2016.
  14. Hickel J. The true extent of global poverty and hunger: questioning the good news narrative of the Millennium Development Goals. Third World Q. 2016;37(5):749-767. doi:10.1080/01436597.2015.1109439
  15. Woodward D. Incrementum ad Absurdum: Global growth, inequality and poverty eradication in a carbon-constrained world. World Economic Review. 2015;4. Accessed June 29, 2016.
  16. United Nations Development Group. A million voices: the world we want. Accessed June 29, 2016. Published September 10, 2013.
  17. Chapman A. Globalization, human rights and the social determinants of health. Bioethics. 2013;23(2):97-111. doi:10.1111/j.1467-8519.2008.00716.x
  18. The effect of girls’ education on health outcomes: Fact sheet. Population Reference Bureau. Accessed June 29, 2011. Published August 2011.
  19. Kishimoto S, Lobina E, Petitjean O, eds. Our public water future: The global experience with remunicipalisation. Amsterdam, London, Paris, Cape Town, Brussels: Transnational Institute (TNI), Public Services International Research Unit (PSIRU), Multinationals Observatory, Municipal Services Project (MSP), European Federation of Public Service Unions (EPSU); 2015. Accessed June 29, 2016.
  20. Meadows DH, Meadows DL, Randers J, Behrens WW. The Limits to growth: A report for the Club of Rome’s project on the predicament of mankind. Washington, DC: Potomac Associates; 1972. Accessed on June 29, 2016.
  21. Labonté R, Baum F, Sanders D. Poverty, justice and health. In: Detels R, Tan CC, Karim QA, Guilliford M, eds. Oxford Textbook of Public Health. Oxford: Oxford University Press; 2015.
  22. World Commission on Environment and Development. Our Common Future. Oxford: Oxford University Press; 1987.
  23. Labonté R. Econology: integrating health and environment. Health Promot Int. 1991;6(1): 49-65.
  24. My priority list differs somewhat from a list of health-related SDGs developed by the WHO, which are more narrowly focused and less politically critical. See: Accessed June 30, 2016.
  25. Reich R. Why we must end upward pre-distributions to the rich. Robert Reich website. Accessed June 30, 2016. Published September 27, 2015.
  26. Kumhof M, Rancière R. Inequality, leverage and crises; International Monetary Fund working paper. Accessed June 30, 2016. Published November 2010.
  27. Standing G. The Precariat: From denizens to citizens? Polity. 2012;44(4):588-608.
  28. Caldbick S, Labonté R, Mohindra KS, Ruckert  A. Globalization and the rise of precarious employment: the new frontier for workplace health promotion. Glob Health Promot. 2014;21(2):23-32.
  29. ILO adopts historic labour standard to tackle the informal economy [news release]. International Labour Organization: 104th International Labour Conference; June 12, 2015. Accessed June 30, 2016.
  30. Dagdeviren H, van der Hoeven R, Weeks J. Redistribution matters: growth for poverty reduction; International Labour Organization employment paper. Accessed June 30, 2016. Published October 2001.
  31. UNCTAD Secretary-General proposes four ‘action lines’ to help end poverty and meet new development goals [news release].  United Nations Conference on Trade and Development; September 14, 2015. Accessed June 30, 2016.
  32. Ruckert A, Labonté R. Public-private partnerships (PPPs) in global health: the good, the bad and the ugly. Third World Q. 2014;35(9):1598-1614.
  33. Innovative finance: Overview. Rockerfeller Foundation website. Accessed June 30, 2016.
  34. Koelen MA, Lindström B. Making healthy choices easy choices: the role of empowerment. Eur J Clin Nutr. 2005;59(1):S10-S15. doi:10.1038/sj.ejcn.1602168
  35. Lovell E, Bahadur A, Tanner T, Morsi H, Overseas Development Institute. Resilience: the big picture. Accessed June 30, 2016. Published June 2016.
  36. Resilience. Rockefeller Foundation website. Accessed June 30, 2016.
  37. McKnight JL, Kretzmann JP; Institute for Policy Research Northwestern University. Mapping community capacity. Accessed June 30, 2016. Published 1990. Revised 1996.
  38. World Health Organization (WHO). Draft Shanghai declaration on health promotion in the 2030 agenda for sustainable development: ensuring sustainable health and well-being for all. Accessed June 30, 2016. Published May 20, 2016.
  39. Ruckert A, Schram A, Labonté R, et al. Policy coherence, health, and the sustainable development goals: What's trade got to do with it? Crit Public Health. 2016; forthcoming. doi:10.1080/09581596.2016.1178379
  40. International Network of Civil Liberties Organizations. “Take back the streets”: Repression and criminalization of protest around the world. Accessed June 30, 2016. Published October 2013.
  41. Statista: The statistics portal. Gini index: inequality of income distribution in China from 2005-2015. Accessed June 30, 2016.
  42. Wildau G, Mitchell T. China income inequality among world’s worst. Financial Times. January 14, 2016. Accessed June 30, 2016.
  43. China pursues journalists and dissidents overseas. Reporters without Borders for Freedom of Information. November 20, 2015. Accessed June 30, 2016.
  44. Labonté R. Toward a post-Charter health promotion. Health Promot Inte. 2011;26(S2): ii183-186.
  45.  ‘Unprecedented’ 65 million people displaced by war and persecution in 2015 – UN. UN News Centre. June 20, 2016. Accessed June 30, 2016.
  46. Ostry JD, Loungani P, Furceri D. Neoliberalism: Oversold? IMF Finance & Development. 2016;53(1):38-41.