Ottawa 25 years on: a more radical agenda for health equity is still required.

This article revisits our 1995 assessment of the international health promotion agenda. Then we concluded that a more radical agenda for change was required in which responses were both technically sound and infused with an appreciation of the imperative for a change in politics and power. We conclude that this message is even more relevant in 2011 in an era when the continuing rise of transnational corporations (TNCs) poses a major threat to achieving improved and more equitable health. We support and illustrate this claim through the example of food and agriculture TNCs where the combination of producer subsidies, global trade liberalization and strengthened property rights has given increasing power to the corporate food industry and undermined national food security in many countries. We argue that a Health in All Policies approach should be used to monitor and enforce TNC accountability for health. Part of this process should include the use of a form of health impact assessment and health equity impact assessment on their activities. Civil society groups such as the People's Health Movement have a central role to play in monitoring the impacts of TNCs.