Population Health in Canada: A Brief Critique

Abstract

An internationally influential model of population health was developed in Canada in the 1990s, shifting the research agenda beyond health care to the social and economic determinants of health. While agreeing that health has important social determinants, the authors believe that this model has serious shortcomings; they critique the model by focusing on its hidden assumptions. Assumptions about how knowledge is produced and an implicit interest group perspective exclude the sociopolitical and class contexts that shape interest group power and citizen health. Overly rationalist assumptions about change understate the role of agency. The authors review the policy and practice implications of the Canadian population health model and point to alternative ways of viewing the determinants of health.

The determinants of First Nation and Inuit health: A critical population health approach

“…A significant critique relates to the framework's inability to consider the theoretical contexts within which the determinants of health and social inequalities are produced and structured (Labonte et al, 2005;Coburn et al, 1996). Some suggest the framework over-emphasizes the identification of socio-economic determinants, and discounts the social-structural influences that initially produce those particular determinants (Coburn et al, 2003;Hayes, 1999), for example by focusing on income inequality as a determinant of health rather than seeking to understand the drivers of income inequality (e.g., changes to the tax and transfer system or returns on post-secondary education in the labour market). Critics relate these shortcomings to a fixation with positivist methods, including large-scale survey analysis and categorical approaches (Labonte and Robertson, 1996).…”

MEASURING POPULATION HEALTH: A Review of Indicators

“…The conceptual framework developed by the Canadian Institute for Advanced Research's (CIAR) Population Health Program also received wide acceptance as an approach to research and reporting on population health (35). Critics pointed to a lack of theoretical understanding of the impacts of global political regimes and social structures on health (24), as well as a lack of recognition of the agency of individuals and populations (85). A forthcoming and final book by the CIAR Population Health Program addresses some of these critics' claims (49).…”

Epidemiology and the Macrosocial Determinants of Health

“…He (33) and others (32,(35)(36)(37)(38)(39)(40)(41)(42) have long noted that social, political, environmental, and economic structures or processes influence and interact with downstream social factors and conditions to affect health. Others, too, have encouraged study of ''sociopolitical,'' ''socioeconomic,'' ''societal,'' ''global,'' ''upstream,'' ''ultimate,'' ''structural,'' or ''macro'' factors and their effect on health (31,32,34,35,39,40,(42)(43)(44). Established multilevel epidemiologic perspectives such as eco-epidemiology (45) and eco-social theory (9) also would seem to necessitate their integration into any understanding of health.…”