Health promotion policy in Canada: lessons forgotten, lessons still to learn

Abstract

In this paper, we analyse Canadian health promotion discourse past and present, in the context of selected federal and provincial government policy initiatives. Principally, we examine the health promotion discourse articulated in A New Perspective on the Health of Canadians, Achieving Health for All: A Framework for Health Promotion, the Ottawa Charter for Health Promotion, Improving the Health of Canadians, and Canada Health Action: Building on the Legacy-Volume II-Synthesis reports and Issue papers. We argue that the health promotion lessons of the past 30 years contained within these reports have largely been forgotten, overlooked or disregarded in policy implementation. We conclude, as have many before us, that successful health promotion policy needs to reflect a collectivist rather than individualist ethos where responsibility for the health of Canadians is concerned. Moreover, it needs to be one that addresses the social determinants of health, including inequity, via the coordination of healthy public policy.

Perceptions of the social determinants of health by two groups more and less affiliated with public health in Canada

“…The themes arising from Group 2 conveyed many features of the 1986 Ottawa Charter for Health Promotion [41] and several key health promotion attributes, in particular public education, engaging health services, and calling for government involvement [18,41]. This might partly be explained by the fact that the establishment of their organization and its policy stances preceded the clear development of the SDOH framework.…”

“…A basis in health promotion should not have precluded this: the Ottawa Charter and contemporary Canadian health promotion discourses, including Epp’s Achieving health for all: A framework for health promotion [43] and Hamilton and Bhatti’s population health promotion framework [44], clearly identify inequity as a key structural determinant of health. Targeting inequity is asserted to be fundamental to population health promotion [44], as inequity is interwoven with larger social structures and thus affects health at the population level [18]. Group 2 diverged from the health promotion framework in that discussion focused on strategies aligning with other aspects of health promotion such as health professional education, youth engagement via social media, and primary health care integration.…”

“…Despite this apparent policy interest, tangible action on the SDOH within health policy in Canada has been limited [14-18]. Most notably, the SDOH were absent from the Canadian federal election campaign which occurred concurrently with the CSDH Report’s 2008 release, and from all party health care platforms.…”

Beyond ‘Run, Knit and Relax’: Can Health Promotion in Canada Advance the Social Determinants of Health Agenda?

“…In one of the overview chapters, O'Neill and Stirling (2007: 35) note that a terminological shift from the earlier vocabulary of health education to health promotion recognizes the limits of "just working to change individual lifestyles," but little evidence suggests that the terminological shift has meant anything in practice. Indeed, the book' s editors concede that "the practice of health promotion in all jurisdictions has still largely been based on individual lifestyle change" (Dupéré et al 2007: 373), and the authors of one of the few chapters that is cautiously critical of health promoters' emphasis on "personal skills" and individual-level risk factors concede that a "larger focus on increasing the options available to people to exercise more control over their own health and their environments … has been, for the most part, more evident in rhetoric than in practice" (Frohlich and Poland 2007: 47; see also Low and Thériault 2008). Beyond 'Run, Knit and Relax': Can Health Promotion in Canada Advance the Social Determinants of Health Agenda?…”

Recommendations for action on the social determinants of health: a Canadian perspective

“…1,2 Although historic eff orts to address such disparities have not been successful and Canada's provincial and territorial health goals have been only partly achieved, 3 we are now well positioned to understand and address health disparities at the global, national, and local levels. The global resurgence of interest in addressing health disparities in the 1990s and 2000s through various movements, such as the WHO Commission on the Social Determinants of Health and their fi nal report with evidence-based recommendations, 4,5 have provided momentum to countries around the world to re-engage in dialogue at the national and international levels for this vitally important issue. As part of this global resurgence, a Canadian commission on health equity has been established with a mandate to support policy change for the determinants of health nationally and locally.…”