:-) The very earliest critiques of downstream approaches to health
promotion were focussed on the issue of victim blaming. Over 20 years ago
the following concerns were outlined (Labonte and Penfold, 1981; Labonte,
1994):

The argument was simple.  The health of oppressed people (poor, women,
persons from minority cultures, workers, and others) was determined at
least as much, if not more, by structural conditions (poverty hazards,
powerlessness, pollution, and so on) than by personal lifestyles.  Moreover
personal lifestyles were not freely determined by individual choice, but
existed within social and cultural structures that conditioned and
constrained behaviour.  Behavioural health education, social marketing, or
wellness approaches to health promotion fostered victim blaming by assuming
that individuals were entirely responsible for their choices and behaviour.
They also blamed the victim indirectly by ignoring the structural
determinants of health, those causes that are embedded within economic,
class- and gender-based patterns of social relationships." (Labonte, 1994,
p.79).  :-)

Labonte, R. (1994), Death of a program: Birth of a metaphor, In Health
promotion in Canada: provincial, national and international perspectives
(Ed, Rootman, I.) Saunders, Toronto, Canada.
Labonte, R. and Penfold, S. (1981), "Canadian perspectives in health
promotion: a critique", Health Education, Vol. 19 pp. 4-9.

dr

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