Search

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. [ABSTRACT FROM AUTHOR]

This paper examines the implications that the conceptualization and measurement of poverty have for policies that aim to improve the health of Canadians. In recent years, poverty has been identified as an issue of policy importance within the health sector in Canada. Policy makers are recognizing that efforts to improve the health of Canadians are related to the development and implementation of policies that decrease the proportion of people who live in poverty. At the same time, the Statistics Canada Low-Income Cut-Offs (LICOs), which are the most commonly used tool for measuring poverty in Canada, are being called into question. One of the most frequently cited criticisms of the LICOs is that they are too high, and as such do not measure poverty. Critics who argue that the LICOs are too high disagree with the relative conceptualization of poverty which underlies the LICOs. In this paper, we discuss the LICOs, their underlying assumption that poverty is relative in nature, and the criticism that the LICOs are too high. In addition, we discuss the Sarlo/Fraser Institute poverty lines, which are based on the assumption that poverty is absolute in nature. The manner in which poverty is conceptualized and measured has implications for the types, characteristics and ultimately the success of policies that are developed to reduce poverty and its effect on health. We argue that the success of efforts to enhance the health of Canadians with a reduction in poverty depends on a commitment by policy makers to a relative conceptualization and measurement of poverty. We further contend that policy makers in the health sector cannot independently reduce poverty and its detrimental effects on health. The complex nature of poverty indicates the need for policy makers in the health sector to work collaboratively with their counterparts from a broad range of government and non-government sectors to develop an innovative network of social assistance, economic and employmen... [ABSTRACT FROM AUTHOR]

This paper argues that discourse on health are products of the particular social, economic and political context within which they are produced. In the early 1980s, the discourse on health in Canada shifted from a post-Lalonde Report lifestyle behaviour discourse to one shaped by the discourse on the 'social determinants of health'. In Canada, we are currently witnessing the emergence of another discourse on health-'population health'-as a guiding framework for health policy and practice. Grounded in a critical social science perspective on health and health promotion, this paper critiques the population health discourse in terms of its underlying epistemiological assumptions and the theoretical and political implications which follow. Does it matter whether we talk about 'heterogeneities in health' or 'inequities in health'? This paper argues that it does, and concludes that population health is becoming a prevailing discourse on health at this particular historical time in Canada because it provides powerful rhetoric for the retreat of the welfare state. This paper argues further that it is health promotion's alignment with the moral economy of the welfare state that makes it a countervailing discourse on health and its determinants. Key words: health discourses; health promotion; population health [ABSTRACT FROM AUTHOR]

This paper introduces the Migrant Populations Equity Extension for Ontario's Health Equity Impact Assessment (HEIA) initiatives. It provides a mechanism to address the needs of migrant populations, within a program and policy framework. Validation of an equity extension framework using community leaders and health practitioners engaged in HEIA workshops across Ontario. Participants assessed migrants' health needs and discussed how to integrate these needs into health policy. The Migrant Populations Equity Extension's framework assists decision makers assess relevant populations, collaborate with immigrant communities, improve policy development and mitigate unintended negative impacts of policy initiatives. The tool framework aims to build stakeholder capacity and improve their ability to conduct HEIAs while including migrant populations. The workshops engaged participants in equity discussions, enhanced their knowledge of migrant policy development and promoted HEIA tools in health decision-making. Prior to these workshops, many participants were unaware of the HEIA tool. The workshops informed the validation of the equity extension and support materials for training staff in government and public health. Ongoing research on policy implementation would be valuable. Public health practitioners and migrant communities can use the equity extension's framework to support decision-making processes and address health inequities. This framework may improve policy development and reduce health inequities for Ontario's diverse migrant populations. Many countries are now using health impact assessment and health equity frameworks. This migration population equity extension is an internationally unique framework that engages migrant communities. [ABSTRACT FROM AUTHOR]

This paper explores why Canadian government policies, particularly those related to obesity, are ‘stuck’ at promoting individual lifestyle change. Key concepts within complexity and critical theories are considered a basis for understanding the continued emphasis on lifestyle factors in spite of strong evidence indicating that a change in the environment and conditions of poverty isare needed to tackle obesity. Opportunities to get ‘unstuck’ from individual-level lifestyle interventions are also suggested by critical concepts found within these two theories, although getting ‘unstuck’ will also require cross-sectoral collective action. Our discussion focuses on the Canadian context but will undoubtedly be relevant to other countries, where health promoters and others engage in similar struggles for fundamental government policy change. [ABSTRACT FROM AUTHOR]

In low- and middle-income countries (LMICs)--when there are available data--a 'health divide' exists between indigenous and non-indigenous populations living in the same society. Despite the limited available evidence suggesting that indigenous populations have high levels of health needs, there is scant research on indigenous health, especially in Africa, China and South Asia. Pursuing research, however, is clouded by the prior negative experiences that indigenous populations have had with researchers. In this paper, we describe the current evidence base on indigenous health in LMICs, propose practical strategies for undertaking future research, and conclude by describing how global health researchers can contribute to improving the health of indigenous populations. [ABSTRACT FROM AUTHOR]

This paper provides an overview of five key internationally recognized health promotion frameworks and assesses their consideration of gender. This analysis was conducted as part of the Promoting Health in Women project, a Canadian initiative focused on generating a framework for effective health promotion for women. To date, no review of health promotion frameworks has specifically focused on assessing the treatment of gender. This analysis draws on a comprehensive literature review that covered available literature on gender and health promotion frameworks published internationally between 1974 and 2010. Analysis of five key health promotion frameworks revealed that although gender was at times mentioned as a determinant of health, gender was never identified and integrated as a factor critical to successful health promotion. This superficial attention to the role of gender in health promotion is problematic as it limits our capacity to understand how gender influences health, health contexts and health promotion, as well as our ability to integrate gender into future comprehensive health promotion strategies. [ABSTRACT FROM AUTHOR]

This study seeks to identify the impact of social determinants and lifestyle factors on life expectancy and self-perceived health as two measures of objective and subjective health, respectively, using data from Canadian provinces during 2007–21. Through a simple conceptual model, it lays out the direct and indirect pathways through which social and lifestyle determinants affect health. The conceptual model guides the formulation of empirical models, which are used to estimate the effects of social and lifestyle factors on health. The study uses 'panel-corrected standard errors' estimation method to obtain reliable results. The findings confirm that social determinants contribute directly and indirectly (through lifestyle) to life expectancy. For self-perceived health, however, the contributions of both social and lifestyle determinants are only direct. The latter result may be explained by the immediacy of lifestyle and its impact on health in individuals' minds, a notion that is constantly reinforced by the mainstream discourse on health promotion. Our study indicates that lifestyle factors should be addressed within the context of broader social determinants. In other words, an individual agency should be understood within the larger enveloping social structure. The study recognizes redistributive measures aimed at reducing social gradients in health as effective health promotion policies. [ABSTRACT FROM AUTHOR]

Information about the conference of more than 400 Canadian social and health policy experts, community representatives and health researchers, is presented. The conference, which was held on November 29-December 1, 2002, was funded by the Policy Research Program of Health of Canada. The measure aims to explore the implications Canadians health conditions, and to outline policy directions to improve the health of Canadians by influencing the quality of these determinants of health.

As providers of community-based physical activity programs, recreation and sports facilities serve as an important resource for health promotion. Unfortunately, the food environments within these settings often do not reflect healthy eating guidelines. This study sought to describe facilitators and barriers to implementing provincial nutrition guidelines in recreation and sports facilities in three Canadian provinces with nutrition guidelines. Semi-structured interviews were analysed thematically to identify facilitators and barriers to implementing provincial nutrition guidelines. Facilitators and barriers were then categorised using a modified "inside out" socio-ecological model that places health-related and other social environments at the centre. A total of 32 semi-structured interviews were conducted at two time-points across the three guideline provinces. Interview participants included recreation staff managers, facility committee or board members and recreation volunteers. Eight facilitators and barriers were identified across five levels of the inside out socio-ecological model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Findings reinforce the importance of top down (clear expectations regarding guideline implementation at the time of approval) and bottom up (need for buy-in from multiple stakeholders) approaches to ensure successful implementation of nutrition guidelines. The application of a modified socio-ecological model allowed for a more nuanced understanding of leverage points to support successful guideline implementation. Lay summary Healthy eating is an important behaviour for preventing chronic diseases. Supporting people to access healthy foods in places where they live, learn, work or play is a public health priority. Recreation and sports facilities are a setting where people can be physically active. Unfortunately, the food environment in these settings may not reflect nutrition guidelines. In this study, we interviewed key stakeholders from recreation and sports facilities in three Canadian provinces who had put guidelines for healthy eating in place. We used a specific framework to do this called the inside out socio-ecological model. Eight facilitators and barriers were identified using this model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Our findings can help people working in recreation and sports facilities to identify issues that may help or hinder healthy food provision in these settings. [ABSTRACT FROM AUTHOR]

In this article, we explore challenges and opportunities in research oriented to understanding the relations among elements of socio-economic life and mental health (MH) and the development and evaluation of mental health promotion (HP) initiatives. We review the population health intervention research (PHIR) literature and respond to recommendations regarding social determinants of health and health inequities-focused research. We discuss three inter-related issue areas: first, the continued dominance of linear and individually oriented theories within predominantly quantitative research approaches and the underdevelopment of ontological and theoretical perspectives that capture complexity; second, the inconsistent use of measures of socio-economic status and health with a lack of attention to taken for granted assumptions; and third, the continued focus on measuring MH challenges to the neglect of exploring the meaning of MH in a positive sense. We extend recommendations within the PHIR literature by sharing our application of a historical–dialectical ontological perspective within a process of social praxis with diverse Canadian young people with varying degrees of access to socio-economic resources. Young people were engaged to explore the relations among socio-economic processes, young people's MH and implications for mental HP. We argue that this ontological perspective can support the development of structurally oriented critical qualitative research approaches in PHIR. [ABSTRACT FROM AUTHOR]

Food insecurity impacts millions of people globally. It has been recognized as a priority and a human right by the United Nations where empowerment of women is identified as a significant goal in addressing food insecurity. In the Maritime Province of Nova Scotia (NS), Canada, more than one in five children live in food insecure households. Since 2002, participatory action research (PAR) has been an integral component of food costing in NS with an aim to support capacity building for food security. Building on earlier research that examined short-term outcomes, and recognizing a lack of research examining outcomes of PAR processes, this study aimed to explore the medium-term individual capacity building processes and outcomes of women involved in Participatory Food Costing (PFC). Findings revealed that capacities were built with respect to interrelated themes of 'awareness, participation, personal development, readiness to change, political impact, influence on others, self-esteem, project growth and project continuity'. In addition, the involvement of these women in PFC resulted in both personal empowerment and food security-related policy change. Involving vulnerable populations through PAR is valuable in influencing health-related policy. [ABSTRACT FROM AUTHOR]

The Ottawa Charter for Health Promotion represents a turning point in public health thinking. The key messages and approaches, such as ‘enabling, mediating and advocating’, of this historical paper have not lost their timeliness and they are still considered to be the lessons for those health policy-makers who are willing to move beyond the health sector and to push health higher on the political agenda. [ABSTRACT FROM PUBLISHER]

Despite evidence that public policy that equitably distributes the prerequisites/social determinants of health (PrH/SDH) is a worthy goal, progress in achieving such healthy public policy (HPP) has been uneven. This has especially been the case in nations where the business sector dominates the making of public policy. In response, various models of the policy process have been developed to create what Kickbusch calls a health political science to correct this situation. In this article I examine an aspect of health political science that is frequently neglected: the raw politics of power and influence. Using Canada as an example, I argue that aspects of HPP related to the distribution of key PrH/SDH are embedded within issues of power, influence, and competing interests such that key sectors of society oppose and are successful in blocking such HPP. By identifying these opponents and understanding why and how they block HPP, these barriers can be surmounted. These efforts to identify opponents of HPP that provide an equitable distribution of the PrH/SDH will be especially necessary where a nation's political economy is dominated by the business and corporate sector. [ABSTRACT FROM AUTHOR]

The article discusses the aspects and development of health promotion in Ottawa, Ontario. It mentions that health promotion persists to call upon public health advocates and practitioners to keep focused on the elements of health, to work and decrease biases. Moreover, it notes that the principles of inseparable connection between people and their environment and the consideration of a socio-ecological approach to health have driven the development of Health 2020.

The past 25 years have seen enormous shifts in the environmental, political, economic and social landscapes that condition people's abilities to be healthy. Climate change is now a reality. China, India, Brazil and other ‘developing’ countries are emerging as new axes of political and economic power. Global capitalism has become increasingly predatory and crisis ridden, a result of unregulated and irresponsible greed of unimaginable scale. The elite response has been the increased erosion of the health and other social protection policies of redistribution that characterized the first-world run-up to the Ottawa Charter. These new realities challenge health promoters in ways unforeseen a quarter century ago. It is imperative that local determinants of health, to which health promoters give their attention, be traced to broader, even global levels of determinants. Support for groups acting at these levels should become a fundamental practice tenet. So, too, should advocacy for the social state, in which progressive taxation and hefty social investment blunt the health inequalities created by unfettered markets. As environmental and economic insecurities and inequalities increase in many of the world's countries, so does the risk of xenophobia and conflict. The roots of racism are complex; but weeding them out becomes another health promotion practice of the new millennium. There are some hopeful signs of health promoting political change, much of it emanating now from countries in the global South; but the threat of a return to health behaviourism in the face of the new global pandemic of chronic disease is real and must be confronted. [ABSTRACT FROM PUBLISHER]

The challenge of understanding what has happened in the 25 years since the Ottawa Charter would be difficult enough if there had been no Charter. However, our task is to interpret to what extent the Charter has influenced the world of health promotion as it is today. The task here is to consider what has happened regarding one action component of the Charter, notably developing personal skills. In taking only one of the five components, we are deconstructing the holistic approach that was implied in the Ottawa Charter and it is somewhat strange to isolate this action area from the others, and perhaps outside the ‘spirit’ of the Charter. Nonetheless, the approach will be to interpret this area broadly while still being restrictive and not venturing into discussions of the other action areas except where the connection is so strong that to isolate personal skills from the other area would be unproductive. The Ottawa Charter brought to the table, for health promotion and education, a growing recognition that health was a broad concept in its own right. It made explicit that ties to disease approaches were highly related to health education and promotion, but that health promotion had to go well beyond a narrow interpretation of the field. It recognized that active participation by people, to directly affect their health and the broader determinants of it, was paramount. [ABSTRACT FROM PUBLISHER]

November 2006 marked the 20-year anniversary of the Ottawa Charter for Health Promotion and Canada's Epp Report. Encapsulating the tenets of health promotion (HP), these publications articulated a vision for reducing health inequities, and described a policy framework for achieving this vision, respectively. These documents also triggered the launch of the population health (PH) field, focused on elucidating the empirical relationships between socioeconomic gradients and population health inequities. Over two decades, a rich HP/PH theoretical and evidentiary base on socioeconomic gradients in health has established. Yet, despite valuable contributions from Canadian researchers, insufficient headway has been made in this country to achieve the Charter's vision. There are numerous challenges to reducing population health inequities in Canada. Informational challenges include complexity of HP/PH evidence, and inadequate knowledge translation beyond traditional targets. Institutional challenges include the relative immunity of the healthcare sector to funding reductions, and the organization of policy responsibilities into silos. Concerns from non-healthcare sectors of 'health imperialism', and intergovernmental tensions are interest-related challenges, while ideological challenges include lack of media discourse on health inequities and a strong neo-liberal political climate. Gains have been made in Canada towards reducing health inequities. The HP/PH discourses are firmly entrenched in academic and policy spheres across the country, while several inter-sectoral policy initiatives are currently underway. HP/PH researchers could be more proactive in the knowledge-translation sphere by engaging other researchers outside of medicine and health, non-healthcare policy-makers, and the general public, vis-à-vis the media, on the health inequities knowledge base. Ultimately, significant and sustained progress will only be made if researchers and other champions recognize the inherently political aspect of their work and understand how to overcome ideologically driven resistance. [ABSTRACT FROM AUTHOR]

The article focuses on the history of health promotion in Ottawa, Ontario. It mentions that in 1986, the Human Genome Project was introduced laying down the frameworks for a new age in health and medical research. Moreover, it notes that the World Health Organization (WHO) led the preparation of a global strategy "Health for All by the Year 2000," which became the catalyst for comprehensive health development.