What is needed for health promotion in Africa: band-aid, live aid or real change?

Abstract

Health Promotion in sub-Saharan Africa (SSA) is currently facing many difficult challenges. Health status is worse than in any other region, with the midpoint data indicating that that SSA is not on track to achieve any of the Millenium Development Goals. This paper explores the history of health promotion in Africa, from before Alma Ata, through the 1970s, 1980s and 1990s, and up to the present. Using examples from Mozambique, Zimbabwe and South Africa during their transitional periods, and health promotion approaches adopted to tackle HIV/AIDS, diarrhoea and non-communicable diseases, the paper shows how the focus has shifted away from the ideals of the Ottawa Charter to an individualistic behaviour change approach. The reasons for the shift reflect political choices of governments that have favoured technocratic approaches over harnessing the popular mobilisations that have accompanied national struggles. The experiences of global movements, such as the Global Equity Gauge Alliance are considered as a way of enhancing local health promotion initiatives which, as presently conceived, are limited in their ability to address equity and the broader determinants of ill health.