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This chapter represents a preliminary effort to understand the health implications of transnsational economic integration (globalization) for population health in Canadian metropolitan areas, and to inform the development of policy responses and strategies of resistance. Special emphasis is placed on health equity as it is affected by social determinants of health. I first provide a stylized description of the rationale for concentrating on major metropolitan areas, rather than on Canadian society as a whole, with reference to the evidence base on place-related effects on health. I then summarize the major channels of influence leading from globalization to social determinants of health in metropolitan areas. These involve labour markets; the attractiveness of urban ‘revitalization’ schemes in a context of changing opportunities for capital accumulation and growth promotion; and migration. The chapter concludes with some rather pessimistic observations about the prospects for increased health equity, given today’s neoliberal drift in public policy and pressures for policy convergence around economic competitiveness.

In 2008, the collapse of the market for securitized subprime mortgages in the United States triggered a financial crisis that spread rapidly around the world. Although Canada’s financial institutions were not directly threatened as in other countries, the extent of continental economic integration meant that the crisis weakened the Canadian economy and profoundly affected the lives of many working Canadians. At the time of this writing, it is unclear when recovery will begin or how robust it will be. It is also unclear what longerterm effects the crisis will have on employment, the distribution of income, and the extent of poverty in Canada. We do know that every recent recession has brought with it a widening of income disparities and that the long term consequences of a growth in poverty and economic insecurity are felt for decades: in individual lives, on social development, and on economic performance.