Can health promotion in Canada effectively respond to the challenge of reducing health inequities presented by the WHO Commission on Social Determinants of Health? Against a background of failure to take seriously issues of social structure, I focus in particular on treatments of stress and its effects on health, and on the destructive congruence of Canadian health promotion initiatives with the neoliberal "individualization" of responsibility for (ill) health. I suggest that the necessary reinvention of the health promotion enterprise is possible, but implausible.
RésuméLa promotion de la santé au Canada peut-elle vraiment relever le défi d'une réduction des inégalités en matière de santé, tel que présenté par la commission des déterminants sociaux de la santé de l'OMS? Dans le contexte où les enjeux de la structure sociale ne sont pas vraiment pris au sérieux, je me penche sur le traitement du stress et ses effets sur la santé ainsi que sur la congruence destructive entre les initiatives canadiennes de promotion de la santé et l'« individualisation » néolibérale des responsabilités quant à la (mauvaise) santé. J' avance qu'une réinvention nécessaire du projet de promotion de la santé est possible, bien que peu plausible. Marmot et al. 2008). As suggested by the reference to social justice, the Commission' s approach was explicitly and unapologetically normative, organized around the imperative of eliminating health inequities -"systematic differences in health" that "are judged to be avoidable by reasonable action." Perhaps unfortunately, the Commission did not elaborate on the major philosophical arguments in support of this position, or on what might constitute "reasonable action" and who should define it. Unfortunately as well, the Commission did not pay much attention to issues of implementation beyond calling for a global social movement. However, it is clear that the Commission was willing to challenge underlying economic and social inequalities and the processes that generate and sustain them. Its report characterized the "unequal distribution of health-damaging experiences" as "not in any sense a 'natural' phenomenon but … the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics" (Commission 2008: 1).Shortly after the Commission' s report appeared, Australian researcher Frances Baum, who had been a member of the Commission, wrote that implementing its recommendations would require "reinventing health promotion for the twenty-first century" with a focus on macro-level aspects of social organization, as "the core of a social movement which advocates for new healthy, equitable and sustainable economic and social structures globally and within countries" (Baum 2008).In this paper, I explore key challenges in the Canadian context to the reinvention that Baum suggests, focusing on how health promotion continues to emphasize individual-level factors and behavioural rather than structural interventions. I suggest that although the reinven...