The Ottawa Charter, a well-recognized framework, is one which can be applied to a variety of heath care programs. Its versatility is influenced by five actions: building healthy public policies, strengthening community action, creating supportive environments, developing personal skills and re-orienting health services (WHO, n.d.). These actions are prioritized based on three strategies including: advocating, enabling and mediating (WHO, n.d.). Given the characteristics of the Ottawa Charter, it is clear that the framework is generalized to better fit a variety of populations and achieve “Health for All” through a health promotion approach (WHO, n.d.). This paper will address the influence sexual risk has on poor health, while using the Ottawa Charter as a backbone to explain how the various elements of the framework can influence the behaviour in Ireland.
Background on Sexual Risk
Sexual risk is a behaviour that can lead to two unwanted pathways: unplanned pregnancies and/or the contraction of a transmitted disease from one partner to another (IAFF, 2017). These behaviours are induced in multiple ways such as changing partners frequently, having oral, anal and vaginal intercourse without protection, or using unreliable or incorrect methods of birth control (IAFF, 2017). The outcomes of these risks have continuously led to a significant increase in the prevalence of sexually transmitted diseases such as gonorrhoea, chlamydia and herpes since the 1990’s (HPSC, 2017). According to the HPSC, rates of sexually transmitted diseases have increased as well between the years 2016 and 2017 alone (HPSC, 2017). However, since the rates of mortality have decreased, the morbidity rates of sexually transmitted diseases (STD’s) have nevertheless increased over the years, especially in those who are between 20 to 29 years old (HPSC, 2017). Therefore, considering the consistent rise in STD’s and morbidity rates (see figure 1 and 2), there is no doubt that a proportional correlation exists with sexual risk behaviours as well.
When addressing sexual risk and the measures needed to improve it, governmental/ legislative health policies play an important role. On October 29th, 2015, Ireland released the National Sexual Health Strategy 2015-2020 which aimed to better sexual health and the wellbeing of individuals while reducing negative sexual health outcomes (Heathy Ireland, n.d.). By building this health care policy, strategic goals were put into place in order to ensure everyone in Ireland will receive comprehensive and age appropriate sexual health education while having access to appropriate prevention and promotion services; equitable and accessible sexual health services, targeted to various needs are available to everyone and high-quality health information regarding sexual health will be provided to support policies, practices and service planning(Heathy Ireland, n.d.). Given these measures, it is clear that the recent Irish sexual health policy is not only conducive to the Ottawa Charter but also marks an initial stepping stone to better aid the situation of poor sexual risk behaviours.
Support in Surrounding Environments
As the 20 to 29-year-old age group (see figure 3) is known to have one of the higher sexual risk morbidity rates, it is pivotal to realize the environments these individuals are in (HPSC, 2017). Majority of the individuals in this age group are in university/college settings, living away from home and/or are experimenting their sexuality. However, despite the significance of these experiences, it is highly important to have healthy, supportive environments around them. Many institutions have attempted to accommodate the sexual risk situation by providing free protection (i.e. condoms) around campus to encourage healthy sexual interactions (HIV Ireland, n.d.). Additionally, information is given out on campus or in the health clinics, usually in the form of brochures, in case students or individuals may need any guidance (HIV Ireland, n.d.). As much of a positive movement this is towards creating supportive environments, it is only a small step. Many other individuals of various ages require support as well and at times, receiving information or protective measures may incur costs that may not be as affordable as hoped for. It is for that reason; supportive environments should start to expand to multiple settings in order to cater towards various populations and determinants of health while hopefully providing affordable options for those in need.
Flaws and Further Suggestions to Address the Ottawa Charter
Despite creating supportive environments and building health policies, there are still flaws in combatting sexual risk. Much of an individual’s decisions lead to their behaviours and ultimately, consequences. Therefore, no matter how much education or information is given, it is important to start at the individual level first. As sexual risk behaviours are on the rise, developing personal skills is a step that should be taken during years in which a person is fulfilling their education or growing through adolescence/youth. This, along with regular doctor check-ups should be used to explain consequences of poor sexual behaviours as it would be more effective in telling the individual about negative consequences or issues they may experience if not cautious enough to take healthy decisions. With enough information given and comfort levels achieved between the individual at risk and the receiver, the higher the awareness of sexual risk will grow.
Multiple health care services around Ireland cater towards testing and treating sexual risk related diseases/infections. As good of an initiative this is, more emphasis should be placed in the preventative measures, to avoid leading to treatment in some individuals. Additionally, by working with individuals and creating a positive atmosphere with them and their family members, would go hand in hand with developing personal skills of the individual when faced in a sexual risk situation and strengthening community actions. Additionally, by collaborating with schools, health boards and the community, awareness about sexual risk can be implemented and information regarding the topic can be easily spread to community members. This will result in the collaboration of multiple people over the years to take action and provide self-help and social support to those in need.
Sexual risk is a health behaviour that has been recently addressed in Ireland and because of this, there is a slow but progressive growth in addressing the issue. Promising steps have been taken at the legislative and environmental level. However, it is important to note that time will be needed to see changes on an individual level and a community level. Therefore, considering measures are implemented correctly and effectively and regard the Ottawa Charter as well as the social determinants of health, consequences of sexual risk can be gradually overcome and “Health for All” can be achieved.