Operationalizing the Ottawa Charter for Health Promotion in Thailand

The Ottawa Charter for Health Promotion (1986) marked a fundamental paradigm shift in global health thinking by redefining health not as the mere absence of disease but as a dynamic resource for everyday life (World Health Organization 1986). The Charter articulated five strategic action areas for advancing population health: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services toward health promotion and prevention. The Charter also established three guiding strategies: enable, mediate, and advocate to reduce disparities and expand participation in health promotion efforts (World Health Organization 1986). Nearly two decades after the Ottawa Charter, the global health landscape had undergone profound transformation, shaped by accelerating globalization, widening health inequities, escalating environmental degradation, and the emergence of a double burden of disease, characterized by the simultaneous persistence of infectious diseases and the rapid rise of non-communicable diseases, particularly in low- and middle-income countries (World Health Organization 2005). In response to these evolving global health challenges, the World Health Organization (WHO), in collaboration with Thailand’s Ministry of Public Health, convened the 6th Global Conference on Health Promotion in Bangkok from 7 August 2005 to 11 August 2005, culminating in the adoption of the Bangkok Charter for Health Promotion in a Globalized World (Rissel 2005). The Bangkok Charter emphasized in closing the persistent ‘implementation gap’ by articulating five strategic action areas: building partnerships and alliances; investing in sustainable health promotion; regulating and legislating to protect health; advocating for health based on human rights and equity; and building institutional and human capacity (World Health Organization 2005). In addition, the Charter further emphasized that effective health promotion in the twenty-first century requires sustained intersectoral cooperation, adequate investment, and robust partnerships among governments, international organizations, civil society, and the private sector to address emerging challenges (United Nations 2005). The Thai Health Promotion Foundation (ThaiHealth), established under the Health Promotion Act 2001 and financed through a 2% surcharge on tobacco and alcohol excise taxes, represents one of the most prominent national models on sustainable financing for health promotion (Pongutta et al. 2019). With approximately USD 120 million in annual revenue, 92% of which is allocated to health promotion projects, ThaiHealth has helped institutionalize policy-driven, community-empowered health promotion in Thailand. In 2021, the WHO awarded ThaiHealth the Nelson Mandela Award for Health Promotion, reflecting two decades of transformative national impact (World Health Organization 2021). ThaiHealth operationalizes both charters through its Tri-Power Strategy: Policy Advocacy, Knowledge Creation, and Social Mobilization, functioning as a strategic coordinating platform that links global frameworks to local implementation. This alignment can be conceptualized as follows: (1) the Ottawa Charter providing the foundational areas for health promotion, (2) the Bangkok Charter articulating the core commitments and strategic entry points in the context of globalization, and (3) ThaiHealth operationalizing these global frameworks through its tri-power strategy and implementation mechanisms (Fig. 1). Framework alignment: Ottawa Charter, Bangkok Charter, and ThaiHealth. This figure illustrates how the Ottawa Charter’s core concepts and action areas connect to the Bangkok Charter’s commitments and operational entry points, and how these are reflected in ThaiHealth’s tri-power implementation mechanism. Adult smoking prevalence in Thailand has shown a sustained decline, decreasing from 21.2% in 2007 to 16.5% in 2024 (National Statistical Office 2025), contributed to long-term reductions in smoking-related morbidity (Tobacco Control Research and Knowledge Management Center 2023). Similarly, the prevalence of hazardous alcohol consumption declined markedly from 4.10% in 2004 to 0.50% in 2020 (Senate Committee on Public Health 2023), alongside a reduction in overall adult alcohol consumption from 32.7% in 2004 to 28.0% in 2021 (Tangcharoensathien et al. 2024). The proportion of the Thai population meeting recommended levels of physical activity increased from 66.3% in 2012 to 74.6% in 2019, followed by a substantial decline to 54.3% during the COVID-19 restriction period. As ThaiHealth’s active movements resumed, physical activity levels partially rebounded to 68.9% in 2024 (Thailand Physical Activity Knowledge Development Centre 2024). ThaiHealth enabled more than 3000 soft drink–free schools nationwide, improving cafeteria environments to reduce sugar, fat, and salt intake, and strengthening youth leadership in nutrition and physical activity promotion (Thai Health Promotion Foundation 2020). In parallel, ThaiHealth contributed to the evidence generation, policy advocacy, and public communication that informed the adoption of the sugar-sweetened beverage (SSB) excise tax in 2017. ThaiHealth supported interagency collaboration, aligned stakeholders around shared objectives, and strengthened data systems, which have enhanced evidence-informed policy and enforcement. During this period, Thailand’s global ranking for road traffic fatalities improved from 3rd to 18th, reflecting measurable progress in road safety outcomes (World Health Organization 2023). Thailand’s experience has been cited internationally as a replicable model for strengthening road safety governance through data integration and multisectoral coordination. ThaiHealth functions as an enabling platform for community-based health promotion by supporting policy participation, capacity development, and knowledge exchange. Currently, over 20 000 communities and partner organizations engage with ThaiHealth nationwide, reflecting the principle that communities play a central role in identifying health challenges and develop appropriate solutions. ThaiHealth’s mechanisms have strengthened the capacity of community leaders, local administrative organizations, and village health volunteers (Phourai and Samukkethum 2023). Using a coordinated mix of mass media, digital platforms, and community-based communication, ThaiHealth communication initiatives have addressed priority health issues, including tobacco and alcohol use, road safety, physical activity, and nutrition, by framing them as shared social concerns rather than individual behaviors (Thai Health Promotion Foundation 2011). National media campaigns such as ‘Alcohol Abstinence during Buddhist Lent’ (Figs 2 and 3), ‘Alcohol-free Social Events’, and ‘Move More, Sit Less’, (Figs 4 and 5) have demonstrated sustained public visibility and resonance, drawing on sociocultural insights and combining broadcast media, online engagement, and on-ground activities. The International Network of Health Promotion Foundations identified ThaiHealth as a global reference in strategic communication ecosystems, moving beyond messaging toward structural and cultural norm shifts (INHPF 2020). Alcohol-free Buddhist Lent campaign: sustaining abstinence beyond Lent. This campaign image encourages continued alcohol abstinence after Buddhist Lent and highlights potential recovery of brain structure and liver condition with sustained alcohol-free behavior. Liver rest challenge campaign during Buddhist Lent. This campaign visual promotes alcohol abstinence throughout Buddhist Lent and presents a 3-month progression framed as a ‘Liver Rest Challenge’ to support healthier liver outcomes. Healthy active meeting campaign: reducing prolonged sitting. This image encourages participants to stand up and stretch after prolonged sitting, emphasizing reduced muscle tension and improved blood circulation as part of a healthy active meeting approach. Sitting too long is dangerous campaign visual. This campaign image warns about the health risks of prolonged sitting and encourages movement, stretching, and relaxation to help prevent office syndrome and chronic non-communicable diseases. ThaiHealth has prioritized the study of the commercial determinants of health (CDoH) as a set of ecosystem-level factors shaping health outcomes among the Thai population. It has supported the development of CDoH intelligence through research on key domains, including tobacco, alcohol, ultra-processed foods, and gambling, while also advancing partnership frameworks and due-diligence criteria grounded in a CDoH approach. ThaiHealth transitions to Data-driven, Outcome-driven, People-centered, AI-driven operations for measurable impacts (Hfocus 2025). This emphasizes targeted projects using big data to identify at-risk populations, shifting from ‘broad approaches’ to ‘proactive area-based and group-specific management’. The AI-driven approach is being developed through pilot initiatives that use AI to identify at-risk groups, support local decision-making, and provide timely guidance for health workers and communities. Early efforts, including an AI-based health promotion assistant and generative AI training, are helping ThaiHealth and its partners turn complex data into actionable insights and more targeted interventions. Transparent data systems link national health surveys with area-level data for community-driven problem-solving (Thai Post 2025). ThaiHealth implements ‘Co-Funding’ with Local Administrative Organizations (LAOs), with over 20 LAOs nationwide jointly using data for provincial health planning (Hfocus 2025). In line with ‘Health in All Policies’, ThaiHealth partners with education, technology, media, business, and LAOs to address structural health factors (Secretariat of the House of Representatives 2016). This responds to the Bangkok Charter's ‘Partner and build alliances’ principle. Examples include the ‘Healthy City’ project in Rayong Province, which combines data-driven approaches with multisectoral cooperation for measurable outcomes (Naewna 2025). The progression from the Ottawa Charter to the Bangkok Charter and the operational experience of ThaiHealth illustrates how global health promotion frameworks can be translated into sustained national action. The ThaiHealth model underscores the importance of aligning policy instruments, data systems, community capacity, and innovation to address complex and evolving health challenges. Strengthening evidence-informed and partnership-based approaches to health promotion may further enhance Thailand’s capacity to respond to emerging risks while contributing lessons of relevance to other national contexts. No specific funding was received for the preparation of this manuscript. This manuscript was prepared on behalf of the Thai Health Promotion Foundation (ThaiHealth), with institutional support from ThaiHealth. The authors declare that they are affiliated with ThaiHealth and contributed to this manuscript in their official capacities. No other conflicts of interest are declared. The data underlying this manuscript will be shared on reasonable request to the corresponding author.

Charter · Government (linguistics) · Health promotion · Operationalization · Promotion (chess) · Public health · Global Healthcare and Medical Tourism · Healthcare Systems and Reforms · School Health and Nursing Education