Introduction
The evolution of the healthcare sector is the central factor impacting the effectiveness of care delivery. The emergence of new problems and challenges requires the use of specific tools and approaches to ensure the population’s needs are met and their well-being is preserved. Furthermore, every period has unique requirements for care providers that arise because of technological and social progress and the emergence of a new vision of how patients should be treated.
The increased importance of the ideas of equity, tolerance, and inclusion characterizes the modern age. This means that increasing access to health services and promoting higher patient involvement and coverage are the top priorities of modern health systems and facilities. The World Health Organization (WHO) and national agencies establish policies to attain success in the area and reduce barriers to care. In this way, WHO’s efforts and the Ottawa Charter contribute to expanding access to health services; however, equity issues remain and should be addressed.
Background
Access to health services has always been a critical issue. Historically, qualified and appropriate care was available to minority representatives. In the 20th century, changing views on inclusion and diversity contributed to the establishment of a new model that offered equal opportunities to various population groups. However, regardless of numerous attempts, the problem remains topical. WHO reports that around 3.5 billion people, or about half of the world’s population, cannot acquire the care they need (WHO, 2023).
Furthermore, statistics show that around 5.7 and 8.4 million deaths are linked to the poor quality of care in low-and middle-income regions (National Academies of Sciences, Engineering, and Medicine et al., 2018). Globally, 107 people live with mental illness or untreated chronic conditions, such as diabetes (National Academies of Sciences, Engineering, and Medicine et al., 2018). Under these conditions, widening access to healthcare services is the critical task the modern world should accomplish.
WHO Efforts and Ottawa Charter
WHO correctly realizes the scope of change and the need to promote positive change. It admits that equity of access to health care is critical to universal health coverage (WHO, no date). The idea is essential for vulnerable and marginalized groups who cannot access necessary treatment due to economic, geographic, and cultural barriers (WHO, no date). For this reason, WHO aims to identify the obstacles preventing individuals from receiving treatment and to offer evidence-based solutions to expand access to and improve the quality of care (WHO, no date). The efforts outlined here are central to advancing global progress in expanding health coverage, promoting equity, and ensuring that all patients can benefit from timely, high-quality care.
Thus, the Ottawa Charter is the result of the activities mentioned above. The first International Conference on Health Promotion established the document outlining the main assumptions, terms, definitions, and actions for attaining significant improvement. The Charter defined health promotion as the process of helping people increase their control over their health and improve it (WHO, 1986).
The primary actions within the concept include building healthy public policies, creating supportive environments, strengthening community action, reorienting health services, and laying the groundwork for the future (WHO, 1986). As a result, commitment to the incentive implies considering these factors and ensuring access to all necessary resources for vulnerable population groups (WHO, 1986). The established paradigm became critical to the further development of global health policies.
Developments in Healthcare Systems and Policies
The agreement on the necessity of health promotion and the need for reshaping health policies had a positive impact on the sphere. The Charter established a template that reshaped public health practice over the past years (Nutbeam, Corbin, and Lin, 2021). Nowadays, the key strategies mentioned in the document (building healthy public policies, strengthening community actions, creating supportive environments, reorienting health services, and establishing the basis for the future) form an inclusive framework for effectively addressing the public health challenge (Nutbeam, Corbin, and Lin, 2021). Furthermore, a series of global conferences led by WHO helped to refine and develop the concepts of health promotion applicable to the changing environments (Nutbeam, Corbin, and Lin, 2021). As a result, the acceptance of the new paradigm became a central factor shaping the evolution of the healthcare sector and the shift towards inclusive patterns.
In the United Kingdom (UK), the course selected by WHO contributed to significant changes in the policies. The National Health Service (NHS) focuses on creating supportive environments to reduce the incidence and increase coverage (Thompson, Watson, and Tilford, 2018). Moreover, in 2010, the responsibility for public health and its promotion was transferred from the health service to local governments (Thompson, Watson, and Tilford, 2018).
In 2013, around 4% of the NHS’s budget was spent on prevention programs and the nation’s health improvement (Thompson, Watson, and Tilford, 2018). The country established its flagship health promotion policy, Making Every Contact Count (MECC), with the central aim of improving every person’s mental and physical health by promoting lifestyle change (Thompson, Watson, and Tilford, 2018). The incentive might be considered a narrow interpretation of the Ottawa Charter, as it contributed to establishing a specific framework for inclusion and better health services (Thompson, Watson, and Tilford, 2018). Nevertheless, the UK accepts the need for further improvements.
The 2030 UN Agenda for Sustainable Development is another vital paradigm that emerged from the recognition of the need to improve health. It builds on the Ottawa Charter’s heritage by focusing on transforming care approaches and ensuring their accessibility at international, national, and local levels (Thompson, Watson, and Tilford, 2018). The Agenda is critical to improving the nation’s health and ensuring that the most vulnerable groups have access to necessary care, as part of WHO’s efforts to enhance care and involve patients in decision-making. In this way, the UK’s health policy adapts to challenges and accepts the need for reorientation established by the WHO and the Ottawa Charter.
Health Literacy
The effectiveness of the policies established by the WHO and the Ottawa Charter can be evidenced by positive changes across several vital spheres that impact the work of the healthcare sector. For instance, the concepts of informed patient choice and self-care are closely associated with health literacy, one of the areas the WHO focuses on. The Shanghai Declaration, which emphasizes the need for large-scale improvement in health literacy through a systematic approach, emerged in response to efforts to expand access to care (WHO, 2016). The process requires societal improvement at different levels and significant government involvement (Sørensen et al., 2021). Nowadays, there is significant progress in raising awareness of the most critical health conditions and their treatments among various population groups (Sørensen et al., 2021).
Furthermore, health literacy continues to grow, leading to informed choices, better decision-making, and better outcomes (Sørensen et al., 2021). Nevertheless, numerous barriers remain, such as the need to distribute economic benefits and establish new educational activities (Sørensen et al., 2021). Despite these issues, the progress demonstrates the effectiveness of the established policies.
In the UK, health literacy is considered an essential aspect for enhancing the nation’s health. Currently, the government is developing a long-term strategic approach to promote health and build supportive environments (Thompson, Watson, and Tilford, 2018). It implies involving key community stakeholders, such as schools and local authorities, to transform and become health-promoting institutions (Thompson, Watson, and Tilford, 2018). It aligns with the ideas of the Ottawa Charter and contributes to reducing the existing burden and complexity (Thompson, Watson, and Tilford, 2018). Furthermore, Scotland and England collaborated as part of the states’ policies to create a healthy nation (Carlyle, Thain, and James, 2022). They use a tool to promote health across various groups (Carlyle, Thain, and James, 2022). Training NHS librarians and specialists helps achieve better results when interacting with patients from diverse backgrounds.
Emergency Management
Emergency management is another crucial aspect of healthcare that requires attention to promote equity. Outbreaks of infectious diseases may lead to public health emergencies that critically affect population health (Corbin et al., 2021a). For low-income communities, the problem is especially critical due to limited access to necessary care and prevention strategies. WHO (2023) admits the importance of addressing this sort of challenge.
Thus, the development of education and communication strategies is one of the results of the existing agenda (Corbin et al., 2021a). Examples from the USA, Singapore, Sierra Leone, Kenya, and South Africa show that it is possible to build resilience in local communities and mitigate the negative impacts of disasters and emergencies (Corbin et al., 2021a). It also includes wider access to care for vulnerable population groups. In this way, the positive changes in emergency management can also be associated with the major provisions of the Ottawa Charter and with evidence of the effectiveness of new policies.
In the UK, this area is a critical aspect of its national health policy, which was shaped to respond to new challenges and ensure greater inclusion. The four UK health systems, England, Wales, Northern Ireland, and Scotland, are designed to promote involvement, promote change, and ensure there is a positive change in the inclusion of broader population groups and coverage (Stewart et al., 2020). In this way, emergency management is part of the political context that emerged from the WHO’s focus on expanding access to care globally (Stewart et al., 2020). Thus, public involvement is a central aspect of emergency responses, making it critical to ensure that more individuals can access the necessary information (Stewart et al., 2020). As a result, the existing paradigm for providing care is evolving in a positive direction.
Well-Being as the Measure of Equity
Another critical change cultivated by the WHO policy is the emergence of a new perspective on well-being. The Ottawa Charter outlines peace, education, food, shelter, income, a stable ecosystem, sustainable resources, social justice, and equity as the significant health prerequisites (WHO, 1986). At the same time, these social determinants of health are critical for the nation’s well-being (Corbin et al., 2021b). Furthermore, individuals’ ability to understand and alter these social determinants is fundamental for widening access to care and necessary services (Corbin et al., 2021b).
Under these conditions, new measures and policies for well-being are proposed to address a broader range of challenges and their evolving character. Nowadays, health promotion is linked to well-being policy frameworks and sustainable development (Corbin et al., 2021b). The broadening of the concept results in the establishment of inclusive patterns and better cooperation at different levels, which is fundamental for care accessibility (Corbin et al., 2021b). Under these conditions, the shift towards equity and inclusive patterns lays the foundation for enhanced well-being, which, in turn, leads to greater inclusivity and health coverage.
In the UK, the focus on well-being is a critical part of existing approaches to restructuring care and ensuring the sector works more effectively. The example of a policy aimed at improving well-being is the Community Wealth Building program. It is designed to address the economic difficulties faced by disadvantaged places through economic inclusion, changes to existing local policies, and investment in local health (Rose et al., 2023).
The project emerged from significant health disparities in the state, including a high percentage of people living in socioeconomically disadvantaged areas for prolonged periods (Rose et al., 2023). Thus, the introduction of the program led to a reduction in mental health problems and increased well-being (Rose et al., 2023). It means that promoting well-being, as one of the significant aspects of the Ottawa Charter, helps achieve better outcomes and create more effective health policies.
Multidisciplinary Teamworking as Part of Equity and Health Promotion
The improvement in global health can also be achieved by building teams that can alter the existing approaches to delivering care. Thus, multidisciplinary teamwork is one of the tools that lay the foundation for inclusion and equity (WHO, 1986). Thus, the recent COVID-19 pandemic highlighted the critical vulnerability of disjoined systems and their inability to address systemic challenges (Douglas et al., 2022). As a result, multidisciplinary teams (MDTs) became a systemic intervention to ensure care and social integration in the UK (Douglas et al., 2022).
The Integrated Care and Support Pioneers Programme is an incentive to integrate health and social care, ensuring that vulnerable groups with multiple chronic conditions are included (Douglas et al., 2022). The project aligns with the WHO’s goals for transforming how current health systems operate (Douglas et al., 2022). The UK aims to lay the foundations for social and care integration to deliver patient-oriented care that benefits the country (Douglas et al., 2022). The emphasis on building such teams is critical for cultivating equity and expanding health coverage.
Additionally, changes in working practices are among the current trends across various health systems. In the UK, healthcare professionals are encouraged to collaborate to enhance care delivery for diverse patients (Schot, Tummersand Noordegraaf, 2020). The central idea is that this collaboration occurs across settings, including emergency department teams, grassroots networks in neighborhood care, and within existing care chains (Schot, Tummers, and Noordegraaf, 2020).
The current government policy priorities support the development of public health teams to cultivate equity and inclusion (Public Health England, 2014). The reorganization of public health in 2013 concentrated on modernizing the sector’s work and improving access to care (Public Health England, 2014). Thus, governmental support facilitated the provision of seamless service, which also contributed to the fast responses to specific situations and their resolution (Schot, Tummers, and Noordegraaf, 2020). It means that the focus on multidisciplinary work became one of the results of the WHO’s recommendations.
Inequality and Patient Engagement
Finally, the Ottawa Charter and the aim of promoting public health contributed to significant changes in addressing equity problems. The UK health system was designed to provide care based on current needs, not on a patient’s ability to pay (Anderson et al., 2022). As a result, efforts are underway to address equity issues and increase access to care for the most vulnerable groups.
First, the governmental approach ensures treatment for individuals who require it and are citizens of the state (Anderson et al., 2022). The Health and Social Care Act contributed to the decentralization of decision-making about the provision of care (Ford et al., 2021). It helped inform more informed choices regarding the needs of local communities and the most vulnerable individuals within them (Ford et al., 2021).
Additionally, the NHS has developed a Core20PLUS5 framework to reduce healthcare inequalities at the national and system levels (NHS England, no date). The program helps maximize opportunities to access care for all groups and ensure they do not suffer from discrimination in accessing various types of care (Briggs, Arora, and Falconer, 2022). In this way, engaging patients in decision-making and attracting new stakeholders can be viewed as a significant achievement.
Current Progress
In this way, it is possible to state that introducing new priorities for promoting public health and addressing health equity has become a central aspect of transforming global healthcare systems. It triggered the rise of new policies aimed at fostering inclusion and helping vulnerable groups access care. For instance, in the UK, the National Health Service and governmental regulations focused on reducing barriers to accessing care (Anderson et al., 2022).
In line with the Ottawa Charter, the state cultivated cross-functional, multidisciplinary teams, adopted policies to improve inclusion, and expanded care coverage. Thus, it is possible to acknowledge significant progress in creating a more effective system; at the same time, the national reports show that the problems persist, as many people lack access to the required care (Anderson et al., 2022). It means there is a critical need to continue redirecting the sector to create a more inclusive environment.
Conclusion
Altogether, the Ottawa Charter and the WHO’s focus on improving access to care became a critical step towards building a new paradigm of care provision. Over the last 30 years, most health systems globally have undergone a radical transformation, with the primary goal of achieving the milestones outlined in the document and laying the foundation for future evolution. The UK concentrates on cultivating health literacy, inclusion, emergency management, community engagement, and teamwork to attain better results. At the same time, there are still numerous challenges related to individuals’ socioeconomic status and their ability to access necessary care. In this way, the Ottawa Charter and the WHO’s ideas should serve as the basis for future policy development and the creation of new policies.
Reference List
Anderson, M. et al. (2022) The United Kingdom: health system summary.
Briggs, A., Arora, S. and Falconer, C. (2022) Health equity and the UK Health Security Agency.
Carlyle, R., Thain, A. and James, S. (2022) ‘Development and spread of health literacy eLearning: a partnership across Scotland and England.’ Health Information and Libraries Journal, 39(3), pp. 299–303.
Corbin, H. et al. (2021a) ‘A health promotion approach to emergency management: effective community engagement strategies from five cases,’ Health Promotion International,13(36), pp. 24-38.
Corbin, J. H. et al. (2021b) ‘Wellbeing as a policy framework for health promotion and sustainable development,’ Health Promotion International, 36(1), pp. 64–i69.
Douglas, N. et al. (2022) ‘Observations of community-based multidisciplinary team meetings in health and social care for older people with long term conditions in England,’ BMC Health Services Research, 22(758).
Ford, J. et al. (2021) ‘Transforming health systems to reduce health inequalities,’ Future Healthcare Journal,’ 8(2), pp. 204–209.
National Academies of Sciences, Engineering, and Medicine et al. (2018) Crossing the global quality chasm: improving health care worldwide. New York, NY: National Academies Press.
NHS England (no date) Core20PLUS5 (adults) – an approach to reducing healthcare inequalities.
Nutbeam, D., Corbin, J. H. and Lin, V. (2021) ‘The continuing evolution of health promotion,’ Health Promotion International, 36(1), pp. 1–3.
Public Health England. (2014) Public health in the 21st century: organising and managing multidisciplinary teams in a local government context.
Rose, T., et al. (2023) ‘The mental health and wellbeing impact of a Community Wealth Building programme in England: a difference-in-differences study,’ The Lancet, 8(6), pp. 403-410.
Schot, E., Tummers, L. and Noordegraaf, M. (2020) ‘Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration,’ Journal of Interprofessional Care, 34(3), pp. 332-342.
Sørensen, K. et al. (2021) ‘Building health literacy system capacity: a framework for health literate systems,’ Health Promotion International, 36(1), pp. 13–i23.
Stewart, E. et al. (2020) ‘Transforming health care: the policy and politics of service reconfiguration in the UK’s four health systems.’ Health Economics, Policy, and Law, 15(3), pp. 289–307.
Thompson, S. R., Watson, M. C. and Tilford, S. (2018). The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education, 56(2), pp. 73-84.
World Health Organization (WHO) (no date) Improving access and quality.
World Health Organization (WHO) (1986) Ottawa Charter for health promotion.
World Health Organization (WHO) (2016) Promoting health in the SDGs.
World Health Organization (WHO) (2023) 1.1 improved access to quality essential health services.