"Insidious habits": The moral vision of the Lalonde Report in historical perspective

The Lalonde Report, A New Perspective on the Health of Canadians, is rightly celebrated as an important Canadian contribution to the development of health promotion. It introduced the "Health Field Concept"-the idea that health was the result of human biology, health care systems, the environment, and lifestyle. Although the health field concept was new, the report drew on a long tradition within public health of blaming individuals for their own health problems. With less evidence, some scholars have also made the case for the Lalonde Report contributing to the social determinants of health. But A New Perspective paid little attention to the systemic barriers that prevented people from eating well, exercising, drinking less, or quitting smoking. While it occasionally acknowledged the constraints of poverty, the focus was much more on people's individual responsibility to improve their health. This paper contextualizes the Lalonde Report in the longer history of public health campaigns in Canada and shows the extent to which the Lalonde Report was a product of its time, age, and authors. At the end, the paper will address the intellectual origins of the social determinants of health and argue that the Lalonde Report made only a marginal contribution to the social determinants of health.