Thanks, Dennis for this and all the other gems you identify. This article
for me is a "must-read" as I wondered about some of the same ulterior
motives when doing the lit review for my dissertation in 96. I was
particularly struck with the timing of this movement in Canada and its
medical roots. I wondered whether this was a backlash to the health
promotion movement gaining momentum after Alma Ata and considered a threat
to the continuing medical dominance of public health. It seems to me
despite its population health's focus on the social determinants of health
it still is a very medicocentric approach. That is, the rhetoric to cutdown
health care systems in the name of improving the health of populations by
improving the economy is at once appealing to politicians for obvious
reasons but also is based on the understanding of "health care" as medical
treatment, prevention, and intervention services. Health care workers in
the system whose primary focus is health rather than disease, such as
nurses, are invisible in the discourse and have been the first to suffer in
the cutbacks. Some of the very things that Thomas McKeown identified as
contributing to better health, such as nutrition and spacing/limiting of
pregnancies are related to the historic work of early public health nurses.
When I read his work, I wondered whether there were public health nurses as
part of the health system he damned that were as invisible to him as the
contemporary work of public health nurses is to the current proponents of
population health in Canada.
I'd be interested in other's perspectives on this. Adeline


At 12:35 PM 10/21/99 -0400, you wrote:

>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.
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>  I told the truth as I found it.
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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
>McMurrich Building, Room 101
>Toronto, Ontario, CANADA M5S 1A8
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