The Ottawa Charter and The Mandala Model

The Mandala model of health is an ecological model which depicts the various determinants of health of an individual. Its comprehensive and holistic representation of these determinants makes it ideal to use as a basis for health promotion initiatives.

The Mandala model of health is an ecological model which depicts the various determinants of health of an individual. Its comprehensive and holistic representation of these determinants makes it ideal to use as a basis for health promotion initiatives.

In the model, we see that the individual is at the center and they are comprised of the mind, body and spirit. The rings around the individual represent their family, community, and culture that interact with each other and the individual. It also shows that the individual is affected by both their built/human made environment and the natural environment (biosphere) in which they live. The four circles around the individual are the four factors that shape the individual: personal behavior practices, the psycho-socio-economic environment (which may include sociological, economical, anthropological and political factors), human biology (which could include genetics, disease, and physical well-being), and the physical environment. According to the diagram, one’s health is also affected by their work (a product of the interaction between the physical environment and one’s psycho-socio-economic environment), lifestyle choices (a product of the interaction between one’s personal behavior and psycho-socio-economic environment), and the sick care system or healthcare system (which would affect their body). This model is supposed to be analyzed as multidisciplinary and 3D, with certain areas emphasized more depending on need.

The Ottawa Charter for Health Promotion defines health promotion as “the process of enabling people to increase control over, and to improve, their health”. They set out five key areas for health promotion to address: Building healthy public policy, Creation of supportive environments, strengthening community action, developing personal skills and reorienting health services. The Mandala model does a good job of identifying the determinants of health and thus areas where these five key health promotion strategies should tackle in order to improve the health of the individual.

Firstly, the Ottawa Charter addresses the building of healthy public policy. This method of health promotion has the ability to affect a large group of people and needs to be targeted towards all sectors (not only the healthcare sector). If one were to consider the Mandala model, health policy would affect the psycho-socio-economic environment, the physical environment and the healthcare system (which would intern affect the individual’s personal behavior and biology). Health policy also has the ability to determine the lifestyle choices one makes and the conditions in which they work. We can see that health policy has the ability to affect almost all aspects that determine an individual’s health. Therefore, it is vital to critically appraise new and existing policy on all sectors, to determine where policy is lacking and where it needs to be altered to enhance the health of the individual. Often, different sectors affect a person’s health and therefore, policy in one area will likely be a part of health policy.

The next area the Ottawa charter highlights as being pivotal for health promotion efforts is the creation of supportive environments. As seen on the model, the individual’s health is affected by their human made environment and their natural environment. They are affected by their family, community, and culture. It is essential that these relationships are supportive and that the individual feels included and valued within their community, psycho-socio-economic environment, and their work environment. Health promotion efforts are vital in ensuring that this happens. Additionally, it is important to ensure that one’s physical environment too is supportive. It is essential that the physical environment in which a person works and lives in is conducive. For example, the emission of large amounts of radiation next to a production plant is likely to cause increased incidence of cancers with those that reside or work near the area. The physical environment one lives in also has the ability to affect their lifestyle choices, which in turn has the ability to affect their health. A supportive environment is essential to the maintenance of factors that affect ones health. It is crucial that health promotion efforts are targeted towards the creation of a supportive environment – whether it be supportive relationships or a physical environment. Since the determinants of health are interrelated, when addressing health promotions initiatives towards creating supportive environments, it is imperative to consider reciprocal maintenance. Looking after one area likely will lead to benefits in numerous other areas as well.

The next area which the Ottawa Charter highlights is that of strengthening community action during health promotions strategies. In the Mandala model, we see that one’s community (circle around the individual) is a determinant of their health. The notion that the Ottawa Charter talks about is that of empowerment and enabling communities to mobilize their resources in order to create positive change for themselves. Health promotions activities need to be targeted towards empowerment; they need to ensure that they utilize community resources and encourage ‘power from within’ rather than ‘power-over’. The Mandala model of health is beneficial in understanding the resources and relationships that affect an individual and community’s health. Therefore, it is a valuable tool that can be used to identify areas where community action can be strengthened and utilized to affect ones health.

The fourth area that the Ottawa Charter highlights is that of developing personal skills. This involves allowing individuals to increase control over their own health via health education and enhancement of their personal and social skills. The Mandala model doesn’t specifically identify health education as a determinant of ones health; this perhaps is a weakness of the model. However, it does identify areas in which a person can learn such skills – such as through work, their community, and their physical environment. It identifies that personal behavior and lifestyle are directly linked to health, both of which can be influenced by one’s level of health education. The Mandala model is therefore a good tool to identify where health promotions activities need to be addressed in order to develop personal health skills.

The final area that the Ottawa charter highlights is the reorientation of health services to areas in which they are necessary. The Mandala model does a good job of highlighting that the ‘sick-care system’ or healthcare system affects ones personal behavior practices and their physical health (biology). The reorientation of health services includes increasing health promotion and educational activities within the healthcare sector, to incorporate a more holistic view on health rather than the previous biomedical perspective. This is where the Mandala model lacks to a certain degree as it associates the healthcare system with the biology and personal behavior of the individual only; it fails to incorporate that the healthcare system should affect any form of health promotion activity on a population scale (ie/ the physical environment or psycho-socio-economic environment). In that respect, the Mandala model takes a rather biomedical and lifestyle approach to the healthcare system, rather than an ecological perspective.

When looking at global health promotion, we often think of an umbrella concept whereby everything one does can be seen to be a health promotion strategy thus affecting the individual’s health. The Mandala models attempt to incorporate as many determinants of health makes it ideal to identify areas that fall under this “umbrella”.  It also does a good job of identifying that lifestyle and the psycho-socio-economic factors affect health and thus should be used in health promotions initiatives. Its holistic nature depicts the reciprocal relationships between individuals, communities, and their environment. It also manages to incorporate all three Health Promotion Paradigms. This makes it ideal to use when identifying facilitators and barriers to getting health and therefore brings out the notion that it isn’t always one’s choice when obtaining health services. The Mandala model does a good job of identifying relationships that determine an individual’s health. However, it doesn’t depict factors such as equity, social justice and empowerment. If one were to use it, the nature of these relationships (consideration of equity, social justice and empowerment) would need to be studied, as they too affect health and are vital for health promotion initiatives. The Mandala model incorporates several determinants of health and thus is a good tool to use in identifying areas where the Ottawa Charter’s health promotion activities should be implemented.

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