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

This paper argues that discourse on health are products of the particularsocial, economic and political context within which they are produced. Inthe early 1980s, the discourse on health in Canada shifted from apost-Lalonde Report lifestyle behaviour discourse to one shaped by thediscourse on the 'social determinants of health'. In Canada, we arecurrently witnessing the emergence of another discourse onhealth-'population health'-as a guiding framework for health policy andpractice. Grounded in a critical social science perspective on health andhealth promotion, this paper critiques the population health discourse interms of its underlying epistemiological assumptions and the theoreticaland political implications which follow. Does it matter whether we talkabout 'heterogeneities in health' or 'inequities in health'? This paperargues that it does, and concludes that population health is becoming aprevailing discourse on health at this particular historical time in Canadabecause it provides powerful rhetoric for the retreat of the welfare state.This paper argues further that it is health promotion's alignment with themoral economy of the welfare state that makes it a countervailing discourseon health and its determinants.