Medicine for the twenty-first century: challenges in personal and public health promotion

Over the last two decades, definitions of health and what creates health have changed dramatically. Health promotion concepts and practices have been in the forefront of that change and have had considerable impact on how health is viewed and what contributes to it. The fact remains, however, that, at this point, its true potential is largely unrealized. Canada has played a significant role in the development of health promotion internationally through cosponsorship of the First International Conference on Health Promotion in 1986, which produced the Ottawa Charter, and nationally through the release of Achieving Health for All: A Framework for Health Promotion in the same year. I review the background of health promotion from an international perspective, but I focus on the Canadian experience. Drawing on experience gained over many years of attempting to implement health promotion and analyze its impact, I present current issues and emphasize the need for strategic direction.