32 Health promotion Almost ten years after the Declaration of Primary Heah11 Care was sil!,ned, the Ottawa Charter of I-leallh Promotion came out of the First lnternationa J Conference <JII He::dth Promntion in November J986. The Charter defines health promotion as ~Lht. : pr()(;c:-:s of enabling people to increase conl Tol over, and to improve. their health". l t identified live priority action areas: builtli11g healthy public policy, crcu ting :rnppoi-L ive environments, su·eng Lhening community action. develop ing personal skills and rcoriei Jling health services 111c Second Iuternntionril Conference on Health Promotion that was hclr1 in Adelaide, south Australia in 1988 focused on healthy public policy. I-'our priority nrew-; wc:rc identified: supporting the lwallh of women, improving food security, safc. :l. v nncl nutrition, reduci11g tobat:co and alcohol use and creating suppo1·tive environments for health. 'fhe Third Jnternational Conference on Health Promot ion tl H1t w·. is helcl in Suntls,·all, Sweden centered on sustainable development and equity in creatinli\ supporti ve euviro. nmc. nrs for health. The. Jakarta Declarnlion on Leading Health Promotion in Lo lhe 21"' Ceutury whjcl, is t J,e output of the Fourth International Confere nce Oil Health Prr Jm11Li ou held in 1997 identified five priorities for action: promoti ng social responsibility for health, i11<. :re. 1::;i11g community capacity and empowe ring tbe individual, expanding anti cnn"olidating partnerships for health, increasing _investments for health developmen t a11d securing an infrastmcturc for health promot10n. The Fifth Global Conference on Health Promotion (2000) examined theconl1·ibu Lions maclehy h Mlth promotion in improving the health and quality of life of people living in difficult circumstances. It called for the strengthening of the science anc. l ar L of health prulllotion and strengthening politica J skills and actions for health promotion. Recognizing the changed glol~al context for health promotion, the Bangkok Chai·ter of Health Promotion io 11 Globalized 1-Vorld which was adopted during Lhe 6'11 Global Conference on Health f>romotton in 2005 focuses on the nee<l Lo adclress Lhe determinants of health in a globali7. ed world through health promolio n. Com;eqoent ly, it exp. inds the definition of health promotion to include the determinants of health: Health promotion is the procc-;s of enuhling people to increase control over their health and its determinants. This is done by strengthening individual skills and capabilities and the capacity of gr◊ups to change the social and economic conditions that affect J1ealth (Tang, Beaglehole and O'Byrne, 2005:884). 'J11e Charter recognjzesthatorganizedand empoweredconi nnmities nre higl1 ly effective in detem1ining their own health, and are making go"ernmenti; c'lnd the priv;. 1te sector accountable for the health consequenc es of t11eir policies and practice. <;. About U1irty years after Ll,e Alma-Ala Declaration and twenty-two years after the Ot-tawa Charter. there arc many questions that still need to be asked. 1s there enough political will to inslitule meaningful and lasting structura l changes tl,at de> not only aim to improve J1ea. Jth b11t to effectively address the socioeconomic and othe1· determinants of liea Jtb·? Are the communities compct. cnt, confident and committed enough to actively participate in matters that affect them? And the questions to be answered by community health nurses are: Do nurses engaged in practice do so Jn acc. ordance 