HEALTH PROMOTION INTERNATIONAL Vol. 13, No. 2
Oxford University Press 1998 Printed in Great Britain

Shifting discourses on health in Canada: from health
promotion to population health

ANN ROBERTSON
Department of Public Health Sciences, University of Toronto,
Toronto, Canada

SUMMARY
This paper argues that discourses 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
epistemological 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 counter-
vailing discourse on health and its determinants.


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  Long have I looked for the truth about the life of people together.
  That life is crisscrossed, tangled, and difficult to understand.
  I have worked hard to understand it and when I had done so
  I told the truth as I found it.

  - Bertolt Brecht
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Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
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