Published in Public Health Research & Practice and co-authored by Carmel Williams, Samantha Thomas, Luke Wolfenden and PHRP Editor-in-Chief Don Nutbeam, the paper reflects on the Ottawa Charter’s enduring message 40 years on.
A landmark idea for healthier societies
In November 2026, the world will mark 40 years since the World Health Organization’s first International Conference on Health Promotion produced the Ottawa Charter, a framework that has shaped public health thinking and action ever since.
The Charter recognised that health is shaped not only by healthcare, but by income, housing, education, employment, food systems and living and working environments. Its call for “healthy public policy” placed responsibility for health and equity across government.
Australia helped translate that vision into practice. At the 1988 Adelaide conference, governments were urged to consider the health and equity effects of decisions across every portfolio. The Adelaide Statement helped establish approaches still used today, including health impact assessments and Health in All Policies.
Australia’s public health achievements
Australia is internationally recognised for using legislation and regulation to protect health. Tobacco control reforms restricted advertising, sales and smoking in public places, increased taxation, established VicHealth and introduced world-first plain packaging. More recently, governments have tightened controls on vaping and other nicotine products.
Public policy has also supported HIV/AIDS prevention, comprehensive immunisation, skin cancer prevention, gun control and mandatory folic acid fortification. These gains relied on evidence, political leadership, capable institutions and a strong public health workforce.
Progress has been uneven
Progress has been less consistent on sustained, coordinated action across government. Prevention initiatives have often lost momentum after political transitions or shifting priorities. Long-term reform needs commitment beyond electoral cycles, backed by effective implementation and research.
South Australia’s Health in All Policies initiative showed what is possible by applying a health lens across government and pursuing outcomes that benefited both population health and other sectors. Its lessons have influenced international guidance.
The unfinished work
The benefits of Australia’s public health leadership have not been shared equally. At the opening of the 1988 Adelaide conference, First Nations advocates protested the profound inequalities experienced by Aboriginal and Torres Strait Islander peoples. Decades later, major health, social and economic inequalities persist. Lasting progress requires structural reform that respects and supports Indigenous ways of knowing, being and doing.
Political resolve also remains limited on alcohol, gambling and climate-related health risks, where industry lobbying and commercial interests can impede stronger political action. Too often, governments acknowledge structural causes of poor health but rely on education campaigns that shift responsibility to individuals.
Digital tools can provide personalised support but cannot replace policies that address the conditions shaping health. Chronic underinvestment in prevention, health promotion and public health research also threatens the independent evidence base needed to inform policy and respond to emerging threats.
What the next 40 years require
The Ottawa Charter’s message remains clear: health is shaped by decisions across society. Progress will require sustained political commitment, strong institutions, properly funded prevention and research, and a health promotion community prepared to advocate for structural change.
Healthy public policy has always been political. The question for the next 40 years is whether governments are willing to make health and equity a priority – and act accordingly.
PUBLICATION DATE
07 October 2026
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lauren.hopper@saxinstitute.org.au
