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The Ottawa Charter is a significant document in relation to health promotion and the priorities for action needed to facilitate health for all people. The relevance of this document to an intensive care setting and the extent to which it may be translated into meaningful practice is examined in this paper. Acute care is an area lying at the extreme end of tertiary health, and at first glance it may be difficult to reconcile the significance of health promotion and the Ottawa Charter with this particular area of health care practice. On closer inspection, however, the relevance of the Charter lies in its impact on the number and type of patients seen in the Intensive Care Unit, and on the effect that the implementation of the health promotion action areas has on the client base. Even at the extreme end of tertiary care it is equally important to be aware of public health issues and to advocate, enable and mediate, where necessary, on behalf of and alongside patients, particularly as we care for them when they are most vulnerable. A commitment to both action and meaningful practice must continue to be pursued while equity in health remains a goal to be achieved.