Health Promotion International, Vol. 18, No. 4, 397-405, December 2003
© Oxford University Press 2003 All rights reserved
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Barriers to addressing the societal determinants of health: public health units and poverty in Ontario, Canada*
School of Health Policy and Management, York University, Toronto, Canada
Address for correspondence: Dr Dennis Raphael, School of Health Policy and Management, Atkinson Faculty of Liberal and Professional Studies, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada, E-mail: draphael{at}yorku.ca
Despite Canada's reputation as a leader in health promotion and population health concepts, actual public health practice for the most part remains wedded to downstream strategies focussed on behaviour change. In Canada's largest province this has led to the implementation of a heart health promotion approach focussed on diet, activity and tobacco use. This is so despite increasing evidence that these approaches are generally ineffective, particularly for those at greatest risk. In addition, these strategies appear to divert public and governmental attention away from addressing the broader societal determinants of health. Examples of Ontario public health units that have begun to address societal determinants of health provide a counterbalance to the dominant paradigm that frames health as an individual responsibility. These new approaches focus attention upon the health-threatening effects of governments' regressive social and economic policies in a manner consistent with the best principles of health promotion.
Key words: critical perspectives; population health; public health
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