SHIFTING DISCOURSES ON HEALTH IN CANADA - FROM HEALTH PROMOTION TO POPULATION HEALTH

This paper argues that discourses on health are products of the partic ular social, economic and political context within which they are prod uced. In the early 1980s, the discourse on health in Canada shifted fr om a post-Lalonde Report lifestyle behaviour discourse to one shaped b y the discourse on the 'social determinants of health'. In Canada, we are currently witnessing the emergence of another discourse on health- 'population henlth'-as a guiding framework for health policy and pract ice. Grounded in a critical social science perspective on health and h ealth promotion, this paper critiques the population health discourse in terms of its underlying epistemological assumptions and the theoret ical and political implications which follow. Does it matter whether w e talk about 'heterogeneities in health' or 'inequities in health'? Th is paper argues that it does, and concludes that population health is becoming a prevailing discourse on health at this particular historica l time in Canada because it provides powerful rhetoric for the retreat of the welfare state. This paper argues further that it is health pro motion's alignment with the moral economy of the welfare state that ma kes it a counter-vailing discourse on health and its determinants.